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Kavian JA. The Continuum of Medicine: Treating Patients Beyond Their Disease. Clin Pediatr (Phila) 2024; 63:1154-1155. [PMID: 38135928 DOI: 10.1177/00099228231220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
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2
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Guttmann KF, Raviv GN, Fortney CA, Ramirez M, Smith CB. Parent Perspectives on Communication Quality in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:382-388. [PMID: 38975667 PMCID: PMC11334642 DOI: 10.1097/anc.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking. PURPOSE We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences. METHODS We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke. RESULTS Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course. IMPLICATIONS FOR PRACTICE AND RESEARCH We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Guttmann and Ms Raviv); The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio (Dr Fortney); Research Division, Hebrew Home at Riverdale, Riverdale, New York, USA (Dr Ramirez); Division of Hematology and Medical Oncology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith); Brookdale Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith and Dr Guttmann)
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3
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Corn BW, Feldman DB, Schenker Y, Rosa WE, Margalit M. Hope-enhancement interventions: A third wave coalesces. Psychooncology 2024; 33:e9300. [PMID: 39010250 DOI: 10.1002/pon.9300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Affiliation(s)
| | | | - Yael Schenker
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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4
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Angelos P, Taylor LJ, Roggin K, Schwarze ML, Vaughan LM, Wightman SC, Sade RM. Decision-Making in Surgery. Ann Thorac Surg 2024; 117:1087-1094. [PMID: 38242340 DOI: 10.1016/j.athoracsur.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
Surgeons face unique challenges in perioperative decision-making and communication with patients and families. In cardiothoracic surgery, the stakes are high, life and death decisions must be made quickly, and surgeons often lack a longstanding relationship with patients and families prior to intervention. This review considers specific challenges in the preoperative period followed by those faced postoperatively. While preoperative deliberation and informed consent focus on reaching a decision between 2 or more alternative approaches, the most vexing postoperative decisions often involve the patient's discontent with the best-case outcome or how to ensure goal-concordant care when complications arise. This review explores the preoperative ethical and legal requirement for informed consent by describing the contemporary preferred method, shared decision-making. We also present a framework to optimize surgeon communication and promote patient and family engagement in the setting of high-risk surgery for older patients with serious illness. In the postoperative period the family is often tasked with deciding what to do about major complications when the patient has lost decision-making capacity. We discuss several examples and offer strategies for surgeons to navigate these challenging situations. We also explore the concepts of clinical heroism and futility in relation to communicating with patients and families about the outcomes of surgery. Persistent ethical challenges in decision-making suggest that surgeons should improve their skills in communicating with patients to better engage with them, both before and after surgery.
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Affiliation(s)
- Peter Angelos
- Department of Surgery, The University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois
| | - Lauren J Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia; Department of Surgery, Central Virginia VA Healthcare System, Richmond, Virginia
| | - Kevin Roggin
- Division of Surgical Oncology, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Margaret L Schwarze
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Leigh M Vaughan
- Division of General Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
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5
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Ashana DC, Welsh W, Preiss D, Sperling J, You H, Tu K, Carson SS, Hough C, White DB, Kerlin M, Docherty S, Johnson KS, Cox CE. Racial Differences in Shared Decision-Making About Critical Illness. JAMA Intern Med 2024; 184:424-432. [PMID: 38407845 PMCID: PMC10897823 DOI: 10.1001/jamainternmed.2023.8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shared decision-making. Objective To compare critical care clinicians' approaches to shared decision-making in recorded conversations with Black and White caregivers of patients with critical illness. Design, Setting, and Participants This thematic analysis consisted of unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial of a decision aid about prolonged mechanical ventilation at 13 intensive care units in the US. Participants in meetings included critical care clinicians and Black or White caregivers of patients who underwent mechanical ventilation. The codebook included components of shared decision-making and known mechanisms of racial disparities in clinical communication. Analysts were blinded to caregiver race during coding. Patterns within and across racial groups were evaluated to identify themes. Data analysis was conducted between August 2021 and April 2023. Main Outcomes and Measures The main outcomes were themes describing clinician behaviors varying by self-reported race of the caregivers. Results The overall sample comprised 20 Black and 19 White caregivers for a total of 39 audio-recorded meetings with clinicians. The duration of meetings was similar for both Black and White caregivers (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both Black and White caregivers were generally middle-aged (mean [SD] age, 47.6 [9.9] years vs 51.9 [8.8] years, respectively), female (15 [75.0%] vs 14 [73.7%], respectively), and possessed a high level of self-assessed health literacy, which was scored from 3 to 15 with lower scores indicating increasing health literacy (mean [SD], 5.8 [2.3] vs 5.3 [2.0], respectively). Clinicians conducting meetings with Black and White caregivers were generally young (mean [SD] age, 38.8 [6.6] years vs 37.9 [8.2] years, respectively), male (13 [72.2%] vs 12 [70.6%], respectively), and White (14 [77.8%] vs 17 [100%], respectively). Four variations in clinicians' shared decision-making behaviors by caregiver race were identified: (1) providing limited emotional support for Black caregivers, (2) failing to acknowledge trust and gratitude expressed by Black caregivers, (3) sharing limited medical information with Black caregivers, and (4) challenging Black caregivers' preferences for restorative care. These themes encompass both relational and informational aspects of shared decision-making. Conclusions and Relevance The results of this thematic analysis showed that critical care clinicians missed opportunities to acknowledge emotions and value the knowledge of Black caregivers compared with White caregivers. These findings may inform future clinician-level interventions aimed at promoting equitable shared decision-making.
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Affiliation(s)
- Deepshikha C. Ashana
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Whitney Welsh
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Doreet Preiss
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - HyunBin You
- School of Nursing, Duke University, Durham, North Carolina
| | - Karissa Tu
- School of Medicine, University of Washington, Seattle
| | | | - Catherine Hough
- Department of Medicine, Oregon Health and Science University, Portland
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meeta Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Kimberly S. Johnson
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
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6
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Corn BW, Feldman DB. The Ethics of Hope-A Moral Imperative for Oncologists. JAMA Oncol 2024:2816785. [PMID: 38512274 DOI: 10.1001/jamaoncol.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This Viewpoint suggests that giving patients with terminal cancer unrealistic hope based only on cure is ethically inferior to redirecting patients toward noncurative goals and noncancer-related hope.
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Affiliation(s)
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California
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Merluzzi TV, Salamanca-Balen N, Philip EJ, Salsman JM, Chirico A. Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care. Cancers (Basel) 2024; 16:342. [PMID: 38254831 PMCID: PMC10813714 DOI: 10.3390/cancers16020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Palliative care improves patients' symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient's needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.
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Affiliation(s)
- Thomas V. Merluzzi
- Department of Psychology, University of Notre Dame, Notre Dame, IN 46556, USA;
| | | | - Errol J. Philip
- School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Atrium Health—Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA;
| | - Andrea Chirico
- Department of Social and Developmental Psychology, Sapienza University of Rome, 00185 Roma, Italy;
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8
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Loučka M, Althouse AD, Arnold RM, Smith TJ, Smith KJ, White DB, Rosenzweig MQ, Schenker Y. Hope and illness expectations: A cross-sectional study in patients with advanced cancer. Palliat Med 2024; 38:131-139. [PMID: 38087831 DOI: 10.1177/02692163231214422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The fear of taking away hope hinders clinicians' willingness to share serious news with patients with advanced disease. Unrealistic illness expectations, on the other hand, can complicate decision making and end-of-life care outcomes. Exploration of the association between hope and illness expectations can support clinicians in better communication with their patients. AIM The aim of this study was to explore whether realistic illness expectations are associated with reduced hope in people with advanced cancer. DESIGN This is a cross-sectional secondary analysis of baseline data from a primary palliative care cluster-randomized trial CONNECT (data collected from July 2016 to October 2020). Hope was measured by Herth Hope Index. Illness expectations were measured by assessing patients' understanding of their treatment goals, life expectancy, and terminal illness acknowledgement. Multivariable regression was performed, adjusting for demographical and clinical confounders. SETTING/PARTICIPANTS Adult patients with advanced solid cancers recruited across 17 oncology clinics. RESULTS Data from 672 patients were included in the study, with mean age of 69.3 years (±10.2), 53.6% were female. Proportion of patients indicating realistic expectations varied based on which question was asked from 10% to 46%. Median level of hope was 39 (IQR = 36-43). Multivariate non-inferiority regression did not find any significant differences in hope between patients with more and less realistic illness expectations. CONCLUSIONS Our results suggest that hope can be sustained while holding both realistic and unrealistic illness expectations. Communication about serious news should focus on clarifying the expectations as well as supporting people's hopes.
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Affiliation(s)
- Martin Loučka
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Center for Palliative Care, Prague, Czech Republic
| | - Andrew D Althouse
- Department of Medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
- Palliative Research Center, University of Pittsburgh and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas J Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth J Smith
- Division of General Internal Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas B White
- Palliative Research Center, University of Pittsburgh and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- Palliative Research Center, University of Pittsburgh and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
- Palliative Research Center, University of Pittsburgh and Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Guttmann KF, Raviv GN, Fortney CA, Weintraub AS. Parent Perspectives on Defining Neonatal Serious Illness. J Palliat Med 2023; 26:1529-1534. [PMID: 37327045 DOI: 10.1089/jpm.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Objectives: We hoped to understand (1) how parents of seriously ill neonatal intensive care unit patients conceptualize neonatal serious illness, and (2) how parent and physician perspectives on neonatal serious illness might differ. Design: This was a prospective survey study. Setting/Subjects: Parent members of the Courageous Parents Network. Measurements: We circulated a modified version of a previously developed survey. Participants were presented with a list of potential definition components and asked to rank components by importance and suggest modifications to the definition as needed. Thematic analysis of free-text responses was conducted to identify key themes in parent responses Results: Eighty-eight percent of parent participants agreed or strongly agreed with our working definition of neonatal serious illness. Parents agreed with the content of the definition but suggested using different language (especially less jargon) when using the definition to inform conversations with parents. Conclusions: The majority of parents surveyed for this study supported our definition of neonatal serious illness, which suggests that it may be useful for clinical and research applications. At the same time, parent responses revealed important differences in perceptions about serious illness between parents and physicians. In addition, parents will likely use any definition of neonatal serious illness differently than clinicians. We therefore propose that our definition be used to identify neonates with serious illness for the purposes of research and clinical care, but should not be used verbatim for communication with parents.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gabriella N Raviv
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine A Fortney
- The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio, USA
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sansom-Daly UM. Specialty Palliative Care for Adolescents and Young Adults With Cancer-Developmental Considerations and an Agenda for Future Research. JAMA Netw Open 2023; 6:e2338681. [PMID: 37862019 DOI: 10.1001/jamanetworkopen.2023.38681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Affiliation(s)
- Ursula M Sansom-Daly
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Abstract
This Viewpoint identifies examples of bad communication from cancer clinicians toward patients as well as better methods for clinicians to use when communicating with patients with cancer.
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Affiliation(s)
- Donald R Sullivan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland
- Knight Cancer Institute, Oregon Health and Science University, Portland
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abby R Rosenberg
- Division of Pediatric Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Kaplan A, Comisar L, Ufere NN, Jannat-Khah D, Rosenblatt R, Fortune B, Prigerson HG, Brown R. Understanding Prognosis: Discrepancy in Prognosis Estimates Between Patients With Cirrhosis and their Hepatologists. Clin Gastroenterol Hepatol 2023; 21:1005-1012.e4. [PMID: 35643416 PMCID: PMC9699897 DOI: 10.1016/j.cgh.2022.04.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients require a clear understanding of their prognosis to make informed decisions about their care. The aim of this study was to compare the perceptions of prognosis and transplant candidacy between patients with cirrhosis and their hepatologists. METHODS Patients with cirrhosis and their hepatologists were prospectively recruited at an urban liver transplant center. Patients and hepatologists were asked about transplant candidacy and about how many years patients would live with and without a liver transplant. Agreement between patients and hepatologists was assessed with the weighted kappa statistic. Associations between patient/hepatologists' prognostic estimates and those predicted by patients' Model for End-Stage Liver Disease-Sodium (MELD-Na) score were estimated using the Pearson correlation coefficient. RESULTS Seventy patients and 6 hepatologists were enrolled in the study. Patients were predominantly male (61.4%) and white (68.6%), with a mean MELD-Na score of 19 ± 9. There was no-slight agreement between patients and hepatologists regarding survival without and with a liver transplant (κ = 0.1 and 0.2, respectively), with patients more optimistic than their hepatologists. There was greater agreement between patients and hepatologists about transplant candidacy (κ = 0.6). There was a negligible association between MELD-Na and patient estimates (r = -0.24, P = .05) but a moderate association between MELD-Na and hepatologist estimates (r = -0.51, P < .001), with higher MELD-Na scores associated with lower predicted survival. CONCLUSIONS Patients with cirrhosis are more optimistic and less accurate in their predictions of survival compared with hepatologists, although they are more realistic about their transplant candidacy. Aligning patient and provider expectations may increase the likelihood that patients receive value-concordant care.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, New York
| | - Lauren Comisar
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Nneka N Ufere
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deanna Jannat-Khah
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, New York
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, New York
| | - Holly G Prigerson
- Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
| | - Robert Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, New York.
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Yang GM, Ong WY, Tan J, Ding J, Ho S, Tan D, Neo P. Motivations and experiences of patients with advanced cancer participating in Phase 1 clinical trials: A qualitative study. Palliat Med 2023; 37:257-264. [PMID: 36476098 DOI: 10.1177/02692163221137105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Persons with advanced cancer may participate in Phase 1 clinical trials - first-in-human trials that are conducted with the main objectives of safety and dosing. The motivations for participation are not well understood and may include hope for cure. AIM To explore the perspectives of persons with advanced cancer in order to understand the motivations for participating in Phase 1 clinical trials, experiences while being on trial and views on palliative care provision. DESIGN Qualitative study with a constructivist stance, using thematic analysis based upon the grounded theory approach. SETTING/PARTICIPANTS 20 persons with advanced cancer who were participating in a Phase 1 clinical trial. RESULTS Many participants described how Phase 1 clinical trial participation was their last hope, as they were cognisant of their advanced disease. Information-seeking needs differed - some needed comprehensive information while others relied on the doctor's recommendation. Participants experienced varied negative and positive physical and psycho-emotional concerns, and needed to draw on multiple sources of support such as family, friends and healthcare professionals. Some could list potential benefits of palliative care but felt they did not require it yet. The overarching theme was hope and positive thinking as a way of coping. CONCLUSIONS The concepts of hope as a way of coping and the supportive presence of healthcare professionals could be weaved into a future model of palliative care to improve the illness journey for patients considering Phase 1 clinical trial participation and other persons with advanced cancer.
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Affiliation(s)
- Grace Meijuan Yang
- Division of Supportive and Palliative care, National Cancer Centre Singapore, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Wah Ying Ong
- Division of Supportive and Palliative care, National Cancer Centre Singapore, Singapore
| | - Jasmine Tan
- Division of Supportive and Palliative care, National Cancer Centre Singapore, Singapore
| | | | - Shirlynn Ho
- Division of Supportive and Palliative care, National Cancer Centre Singapore, Singapore
| | - Daniel Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Patricia Neo
- Division of Supportive and Palliative care, National Cancer Centre Singapore, Singapore
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14
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Choi A, Sanft T. Establishing Goals of Care. Med Clin North Am 2022; 106:653-662. [PMID: 35725231 DOI: 10.1016/j.mcna.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Establishing goals of care (GOC) is a crucial component of a patient's treatment plan. The need for better physician-patient communication in this area has been recognized for decades, yet several gaps remain. Challenges exist for both physician and patient. Physicians should pursue a patient-led approach, exercise cultural competency, and use various communication techniques to guide patients when establishing GOC.
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Affiliation(s)
- Alex Choi
- Yale Palliative Care Program, Yale New Haven Hospital, New Haven, CT, USA.
| | - Tara Sanft
- Survivorship Clinic, Yale New Haven Hospital, New Haven, CT, USA
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15
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Hart JL. Deception, honesty, and professionalism: a persistent challenge in modern medicine. Curr Opin Psychol 2022; 47:101434. [DOI: 10.1016/j.copsyc.2022.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
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16
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Bergsträsser E, Lukose S, Zimmermann K, Oxenius A. Palliative Care in Children With Advanced Heart Disease in a Tertiary Care Environment: A Mini Review. Front Cardiovasc Med 2022; 9:863031. [PMID: 35463792 PMCID: PMC9023876 DOI: 10.3389/fcvm.2022.863031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Palliative care for children continues to evolve. More recently, this has also been true in the field of pediatric cardiology, particularly for children with advanced heart disease. In these children, similarly to children with cancer, treatment successes are offset by the risks of long-term morbidities, including premature death. This mini review aims to provide an overview of current knowledge on children suffering from advanced heart disease, their medical care during various phases of illness (including the palliative and end-of-life phase), symptom burden, experiences of parents, prognostic understanding of parents and physicians, and current status of the involvement of pediatric palliative care. In conclusion, the suffering of these children at the end of their young lives is pronounced and many parents feel prepared neither for medical problems nor for the child’s death. An effective and mutually trusting partnership between pediatric cardiology and pediatric palliative care would appear to be a prerequisite for the timely involvement of palliative care in further supporting these children and their families.
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Affiliation(s)
- Eva Bergsträsser
- Pediatric Palliative Care, Department of Medicine I, University Children’s Hospital Zurich, Zurich, Switzerland
- *Correspondence: Eva Bergsträsser,
| | - Saumya Lukose
- Pediatric Palliative Care, Department of Medicine I, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Karin Zimmermann
- Pediatric Palliative Care, Department of Medicine I, University Children’s Hospital Zurich, Zurich, Switzerland
- Department Public Health, Nursing Science, University of Basel, Basel, Switzerland
| | - Angela Oxenius
- Pediatric Cardiology, Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
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Risco JR, Kelly AG, Holloway RG. Prognostication in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:175-193. [PMID: 36055715 DOI: 10.1016/b978-0-323-85029-2.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Prognosticating is central to primary palliative care in neurology. Many neurologic diseases carry a high burden of troubling symptoms, and many individuals consider health states due to neurologic disease worse than death. Many patients and families report high levels of need for information at all disease stages, including information about prognosis. There are many barriers to communicating prognosis including prognostic uncertainty, lack of training and experience, fear of destroying hope, and not enough time. Developing the right mindset, tools, and skills can improve one's ability to formulate and communicate prognosis. Prognosticating is subject to many biases which can dramatically affect the quality of patient care; it is important for providers to recognize and reduce them. Patients and surrogates often do not hear what they are told, and even when they hear correctly, they form their own opinions. With practice and self-reflection, one can improve their prognostic skills, help patients and families create honest roadmaps of the future, and deliver high-quality person-centered care.
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Affiliation(s)
- Jorge R Risco
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Adam G Kelly
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Robert G Holloway
- Department of Neurology, University of Rochester, Rochester, NY, United States.
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