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Vlckova K, Gonella S, Bavelaar L, Mitchell G, Sussman T. Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence. Int J Nurs Pract 2024; 30:e13224. [PMID: 38113927 DOI: 10.1111/ijn.13224] [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] [Received: 08/22/2022] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
AIM This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations. BACKGROUND Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex. DESIGN A systematic review was conducted. DATA SOURCES Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis. RESULTS Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data. CONCLUSION The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.
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Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care, Prague, The Czech Republic
- Third Faculty of Medicine, Prague, The Czech Republic
| | - Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Torino, Torino, Italy
| | - Laura Bavelaar
- Leiden University Medical Center, Leiden, The Netherlands
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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Dalgarno L, Birt L, Bond C, Blacklock J, Blyth A, Inch J, Notman F, Daffu-O’Reilly A, Spargo M, Watts L, Wright D, Poland F. Why the trial researcher matters: Day-to-day work viewed through the lens of normalization process theory. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100254. [PMID: 37426703 PMCID: PMC10323713 DOI: 10.1016/j.ssmqr.2023.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 07/11/2023]
Abstract
Researchers working in the field, the places where research-relevant activity happens, are essential to recruitment and data collection in randomised controlled trials (RCTs). This study aimed to understand the nature of this often invisible work. Data were generated through an RCT of a pharmacist-led medication management service for older people in care homes. The study was conducted over three years and employed seven Research Associates (RA) working in Scotland, Northern Ireland, and England. Weekly research team meetings and Programme Management Group meetings naturally generated 129 sets of minutes. This documentary data was supplemented with two end-of-study RA debriefing meetings. Data were coded to sort the work being done in the field, then deductively explored through the lens of Normalization Process Theory to enable a greater understanding of the depth, breadth and complexity of work carried out by these trial delivery RAs. Results indicate RAs helped stakeholders and participants make sense of the research, they built relationships with participants to support retention, operationalised complex data collection procedures and reflected on their own work contexts to reach agreement on changes to trial procedures. The debrief discussions enabled RAs to explore and reflect on experiences from the field which had affected their day-to-day work. The learning from the challenges faced in facilitating care home research may be useful to inform future research team preparation for complex interventions. Scrutinising these data sources through the lens of NPT enabled us to identify RAs as linchpins in the successful conduct of a complex RCT study.
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Affiliation(s)
- Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
- General Practice and Primary Care, University of Glasgow, Scotland, UK
| | - Linda Birt
- School Health Sciences, University of East Anglia, UK
- School of Healthcare, University of Leicester, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Jeanette Blacklock
- School of Healthcare, University of Leicester, UK
- School of Pharmacy, University of East Anglia, UK
| | - Annie Blyth
- School of Pharmacy, University of East Anglia, UK
| | - Jacqueline Inch
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Frances Notman
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | | | | | - Laura Watts
- School of Pharmacy, University of East Anglia, UK
| | - David Wright
- School of Healthcare, University of Leicester, UK
| | - Fiona Poland
- School Health Sciences, University of East Anglia, UK
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Bernard M, Poncin E, Bovet E, Tamches E, Cantin B, Pralong J, Borasio GD. Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers. BMC Palliat Care 2023; 22:52. [PMID: 37101149 PMCID: PMC10134658 DOI: 10.1186/s12904-023-01172-x] [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] [Received: 09/16/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. METHODS This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention's effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers' eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. RESULTS Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. CONCLUSIONS Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care.
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Affiliation(s)
- Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland.
| | - Emmanuelle Poncin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
| | - Emilie Bovet
- Haute École de Santé Vaud (HESAV), Haute École Spécialisée de Suisse Occidentale (HES-SO), Lausanne, Switzerland
| | - Emmanuel Tamches
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
| | - Boris Cantin
- Palliative Care Center, Fribourg Hospital, Fribourg, Switzerland
| | | | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
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Koniewski M, Barańska I, Kijowska V, van der Steen JT, Wichmann AB, Payne S, Gambassi G, Van Den Noortgate N, Finne-Soveri H, Smets T, Van den Block L, Szczerbińska K. Measuring relatives' perceptions of end-of-life communication with physicians in five countries: a psychometric analysis. Eur J Ageing 2022; 19:1561-1570. [PMID: 36506660 PMCID: PMC9729495 DOI: 10.1007/s10433-022-00742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
The Family Perceptions of Physician-Family Caregiver Communication scale (FPPFC) was developed to assess quality of physician-family end-of-life communication in nursing homes. However, its validity has been tested only in the USA and the Netherlands. The aim of this paper is to evaluate the FPPFC construct validity and its reliability, as well as the psychometric characteristics of the items comprising the scale. Data were collected in cross-sectional study in Belgium, Finland, Italy, the Netherlands and Poland. The factorial structure was tested in confirmatory factor analysis. Item parameters were obtained using an item response theory model. Participants were 737 relatives of nursing home residents who died up to 3 months prior to the study. In general, the FPPFC scale proved to be a unidimensional and reliable measure of the perceived quality of physician-family communication in nursing home settings in all five countries. Nevertheless, we found unsatisfactory fit to the data with a confirmatory model. An item that referred to advance care planning performed less well in Poland and Italy than in the Northern European countries. In the item analysis, we found that with no loss of reliability and with increased coherency of the item content across countries, the full 7-item version can be shortened to a 4-item version, which may be more appropriate for international studies. Therefore, we recommend use of the brief 4-item FPPFC version by nursing home managers and professionals as an evaluation tool, and by researchers for their studies as these four items confer the same meaning across countries. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00742-x.
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Affiliation(s)
| | - Ilona Barańska
- Laboratory for Research On Aging Society, Department of Sociology of Medicine, The Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Skawińska 8 Street, 31-066 Kraków, Poland
| | - Violetta Kijowska
- Laboratory for Research On Aging Society, Department of Sociology of Medicine, The Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Skawińska 8 Street, 31-066 Kraków, Poland
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-VU University Medical Center (Department During the Study), Amsterdam, The Netherlands
| | - Anne B. Wichmann
- Department of Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sheila Payne
- International Observatory On End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Katarzyna Szczerbińska
- Laboratory for Research On Aging Society, Department of Sociology of Medicine, The Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Skawińska 8 Street, 31-066 Kraków, Poland
| | - PACE project
- Institute of Sociology, Jagiellonian University, Kraków, Poland
- Laboratory for Research On Aging Society, Department of Sociology of Medicine, The Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Skawińska 8 Street, 31-066 Kraków, Poland
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-VU University Medical Center (Department During the Study), Amsterdam, The Netherlands
- Department of Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- International Observatory On End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
- Finnish Institute for Health and Welfare, Helsinki, Finland
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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