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Lee J, Kim SG, Lee SI, Youn H. Psychosocial Factors Associated With Thoughts Regarding Life-Sustaining Treatment for Oneself and Family Members. Psychiatry Investig 2024; 21:646-654. [PMID: 38960442 PMCID: PMC11222083 DOI: 10.30773/pi.2024.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the thoughts of the general population regarding life-sustaining treatment for both oneself and family members and to assess the factors associated with those thoughts. METHODS A total of 1,500 individuals participated in this study by completing a questionnaire consisting of self-reporting items with some instructions, basic demographic information, thoughts on life-sustaining treatment, and psychosocial scales. The disease status was calculated using the Charlson Comorbidity Index. The psychosocial scales included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index, and Multidimensional Scale of Perceived Social Support. RESULTS The majority of participants did not want to receive life-sustaining treatment for both themselves and their families. However, more people wanted life-sustaining treatment for their family members (35.9%) than for themselves (21.6%). Among the basic demographic characteristics, there were significant differences in age, sex, marital status, living arrangements, occupational status, religion, and disease status. Regarding the psychosocial scales, there were significant differences in the PHQ-9 and GAD-7 scores between the group that preferred life-sustaining treatment for family members and the group that did not. CONCLUSION The findings suggest that life-sustaining treatment decisions for oneself and for one's family members can be different. We recommend a more clear expression of one's preferences regarding the last moments of one's life, including advance directives.
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Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Ostan R, Varani S, Pannuti F, Pannuti R, Biasco G, Bruera E. End-of-life care for patients with cancer: Clinical, geographical, and sociocultural differences. Palliat Support Care 2024; 22:155-162. [PMID: 36779268 DOI: 10.1017/s1478951523000032] [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: 02/14/2023]
Abstract
OBJECTIVES Timely, effective and personalized identification of the multidimensional needs in patients with advanced cancer are major goals of appropriate palliative care (PC) delivery. However, there is considerable variation in structures, processes, and patient demographics that might influence the intensity of end-of-life care. This study aims to characterize patterns in clinical and demographic characteristics at the inception point and their association with the intensity of care during the last month of life in advanced cancer patients assisted at home. METHODS Cancer patients entered in home PC during 2020 in Italy were considered. The association between home PC services during the last month of life (primary outcome) and demographic data, performance status (Karnofsky Performance Score [KPS]), symptoms, and therapies at the entry was explored in this retrospective study. RESULTS Among 1,721 consecutive patients (919 in Centre-North and 802 in Centre-South Italy), patients from Centre-South were younger (p < 0.001), had worse KPS (p < 0.001), and shorter survival (p = 0.010). Patient age was inversely associated with the number of total/physician/nurses services during the last month of life (p < 0.001, p = 0.001, and p = 0.008, respectively). Patients with severe symptoms (asthenia, pain, and anxiety) at inception needed more PC services at the end of life (p = 0.026, p = 0.008, and p = 0.038, respectively). The distribution of workload differed according to the geographical area, with higher number of PC services provided by physicians (p < 0.001) in Centre-North and by nurses (p = 0.002) in Centre-South. SIGNIFICANCE OF RESULTS These findings highlight major disparity in access and nature of PC in a country with universal access to health services. Studies aimed at comparing PC models among different countries should pay attention to the local heterogeneity within each health-care system.
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Affiliation(s)
- Rita Ostan
- Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
| | - Silvia Varani
- Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
| | | | - Raffaella Pannuti
- Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
| | - Guido Biasco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
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Bradley N, Dowrick C, Lloyd-Williams M. Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances. Palliat Care Soc Pract 2023; 17:26323524231214549. [PMID: 38044931 PMCID: PMC10693225 DOI: 10.1177/26323524231214549] [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] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life. Objectives This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients. Design Qualitative research using observations of hospice day services and interviews with service providers. Methods Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service. Results Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances. Conclusion Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.
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Affiliation(s)
- Natasha Bradley
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT7 1NN, UK
- Centre for Health & Clinical Research, University of the West of England (UWE), Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Almeida M, Lobão C, Coelho A, Parola V. Emotional Management Strategies in Prehospital Nurses: A Scoping Review. NURSING REPORTS 2023; 13:1524-1538. [PMID: 37987407 PMCID: PMC10661275 DOI: 10.3390/nursrep13040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Prehospital care is intricate and unpredictable. Nurses in this environment encounter psychologically challenging situations and traumatic experiences daily. Nurses respond variably when delivering care in this context. This study aims to map the emotional management strategies used by prehospital nurses. METHODS Research was conducted in MEDLINE, CINAHL Complete, and the Open Access Scientific Repository of Portugal (RCAAP). The inclusion criteria were studies with prehospital nurses in Portuguese, English, and Spanish languages, covering all study types. RESULTS From the initial 511 studies identified, four studies were deemed eligible after rigorous screening. The strategies used are individual (pre- and post-event) and collective, varying from formal to informal, with or without institutional support. Notable experiences included a lack of technical/scientific preparation, personal life association, treating acquaintances, pediatric-age patients, childbirth, cardiopulmonary arrests in young individuals, traffic accidents, and suicides. CONCLUSIONS Nurses need training in basic emotional management tools. This research provides an initial understanding of their emotional well-being's impact on personal and professional performance. This study was prospectively registered with the Open Science Framework (OSF) on 29 June 2023, with the registration number: z638t.
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Affiliation(s)
- Marisa Almeida
- Centro Hospitalar do Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Catarina Lobão
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
| | - Adriana Coelho
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Vítor Parola
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
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Limonero JT, Maté-Méndez J, Gómez-Romero MJ, Mateo-Ortega D, González-Barboteo J, Bernaus M, López-Postigo M, Sirgo A, Viel S, Sánchez-Julve C, Bayés R, Gómez-Batiste X, Tomás-Sábado J. Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties. BMJ Support Palliat Care 2023; 13:e177-e184. [PMID: 33277319 PMCID: PMC10646856 DOI: 10.1136/bmjspcare-2020-002608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.
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Affiliation(s)
- Joaquín T Limonero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Jorge Maté-Méndez
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psycho-oncology Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María José Gómez-Romero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Terrassa, Barcelona, Spain
| | - Dolors Mateo-Ortega
- Palliative Care Unit, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Jesús González-Barboteo
- Palliative Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Bernaus
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Montserrat López-Postigo
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Agustina Sirgo
- Psycho-oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, Barcelona, Spain
| | - Silvia Viel
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Member of the Group of Psychologists of the Catalan-Balearic Society for Palliative Care, Barcelona, Spain
| | - Cruz Sánchez-Julve
- Palliative Care Unit, Sant Camil Hospital-Residence Foundation-Sant Pere de Ribes, Sant Pere de Ribes, Barcelona, Spain
| | - Ramon Bayés
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
| | - Joaquín Tomás-Sábado
- University of Gimbernat and Tomas Cerda School of Nursing, Sant Cugat del Vallés, Barcelona, Spain
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Gaughan S, Williams M. The holistic management of malignant bowel obstruction in women with advanced ovarian cancer at end of life. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:550-555. [PMID: 37344127 DOI: 10.12968/bjon.2023.32.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Bowel obstruction is commonly a pre-terminal event in women with advanced ovarian cancer. Management of symptoms will often be the focus rather than surgical intervention. Determining the patient's end-of-life wishes is paramount - because the prognosis for these patients can be short, advanced care planning is key. This case study will explore the management of nausea and vomiting associated with malignant bowel obstruction and demonstrate how a patient's psychological and social wellbeing is as important as managing the physical symptoms. It will discuss how skilled and effective communication is vital early in the disease trajectory in ensuring the patient's needs are met. Additionally, by undertaking a thorough holistic needs assessment, all aspects of end-of-life care can be discussed with the patient and family, which may enable the achievement of a preferred place of care and a peaceful, dignified death. Multidisciplinary working and co-ordination of care may allow for quick interventions, meeting individual needs and symptoms being managed more effectively.
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Affiliation(s)
- Sarah Gaughan
- Macmillan Lung and Rarer Clinical Nurse Specialist and Team Lead, Buckinghamshire Hospitals NHS Trust: Aylesbury
| | - Mary Williams
- Senior Lecturer in Cancer, Palliative and End of Life Care, Buckinghamshire New University, High Wycombe
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Labouvie H, Dietz T, Schiewer V, Kusch M. Früherkennung seelischer Belastung in der onkologischen Versorgungspraxis. DIAGNOSTICA 2023. [DOI: 10.1026/0012-1924/a000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Zusammenfassung. Die Distress-Skala (DS) bildet ein Single-Item-Instrument in Form einer zehnstufigen Likertskala in 2 Varianten zur Identifikation psychosozialer Belastungen zum Krankheitsbeginn (Screening-Variante) sowie im Krankheitsverlauf (Verlaufsvariante). Die DS wurde an einer Stichprobe onkologisch erkrankter Patientinnen und Patienten mit einer Größe von N = 661 nahe am Diagnosezeitpunkt validiert. Bei N = 92 der Stichprobe lagen insgesamt 3 Erhebungszeitpunkte vor, anhand dessen die Validierung der Verlaufsvariante erfolgte. Unter Verwendung des HADS-Gesamtsummenscore-Schwellenwerts > 14 als externes Kriterium wurde für die Screening-Variante der DS ein Schwellenwert > 7 mit einer Sensitivität von 81 % bzw. 78 % und einer Spezifität von 71 % bzw. 75 % ermittelt. Die Verlaufsvariante der DS erzielte bei einem Schwellenwert von > 5 eine Sensitivität zu T2 von 77 % und zu T3 von 70 % und eine Spezifität zu T2 von 67 % und zu T3 von 78 %. Die Ergebnisse weisen eine gute Diskriminierungsfähigkeit auf und empfehlen den Einsatz der DS zu Beginn der Krebserkrankung bzw. im Krankheitsverlauf.
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Affiliation(s)
- Hildegard Labouvie
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Thilo Dietz
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Vera Schiewer
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Michael Kusch
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
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Yu V, Yilmaz S, Freitag J, Loh KP, Kehoe L, Digiovanni G, Bauer J, Sanapala C, Epstein RM, Yousefi-Nooraie R, Mohile S. The role of social networks in prognostic understanding of older adults with advanced cancer. PATIENT EDUCATION AND COUNSELING 2023; 106:135-141. [PMID: 36270857 PMCID: PMC10069282 DOI: 10.1016/j.pec.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Explore how older patients utilize their social networks to inform prognostic understanding. METHODS In a pilot study of adults (≥65 years old) with advanced cancer, 16 patients completed surveys, social network maps, and semi-structured interviews exploring with whom they preferred to communicate about their illness. Interviews were analyzed using open-coding, and codes were categorized into emergent themes. Social network maps and themes were analyzed via mixed-methods social network analysis (MMSNA). Three case examples with diverse network characteristics and communication patterns were selected for further analysis. RESULTS Three overarching themes (i.e., prognostic understanding, social support, and therapeutic alliance) revealed that patients' prognostic understanding was strongly influenced by the quality of the social support patients perceived from members of their social networks. Patients demonstrated prognostic understanding when they reported close relationships and open communication with their network members. Case examples revealed some ways that patients sought information and had better sense of their prognosis when they had supportive social networks. CONCLUSION Findings illustrate how understanding social networks may provide information on how older adults with cancer seek, share, and process prognostic information.
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Affiliation(s)
- Veronica Yu
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sule Yilmaz
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jorie Freitag
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Lee Kehoe
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA
| | - Grace Digiovanni
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jessica Bauer
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Chandrika Sanapala
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ronald M Epstein
- Department of Family Medicine Research, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
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Ho S, Cook KV, Chen ZJ, Kurniati NMT, Suwartono C, Widyarini N, Wong PTP, Cowden RG. Suffering, psychological distress, and well-being in Indonesia: A prospective cohort study. Stress Health 2022; 38:879-890. [PMID: 35244330 PMCID: PMC10078741 DOI: 10.1002/smi.3139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 12/16/2022]
Abstract
Research on the subjective experience of suffering has typically focussed on older clinical samples living in Western, educated, industrialised, rich, and democratic (WEIRD) countries. To further extend the existing body of empirical research on suffering to less WEIRD contexts, we use three waves of data (Wave 1: December 2020; Wave 2: January 2021; Wave 3: February 2021) from a sample of nonclinical Indonesian adults (n = 594) to examine associations between suffering, two indices of psychological distress, and 10 facets of well-being. In our primary analysis, we estimated a series of multiple regression models that adjusted for a range of sociodemographic characteristics, financial and material stability, religious/spiritual factors, prior values of overall suffering, and prior values of each outcome assessed in Wave 1. Results indicated that overall suffering assessed in Wave 2 was associated with an increase in both indices of psychological distress and a decrease in eight facets of well-being assessed in Wave 3. Using a similar analytic approach, results from a secondary analysis indicated that higher scores on both indices of psychological distress and lower scores on seven of the well-being facets assessed in Wave 2 were associated with worse subsequent overall suffering assessed in Wave 3. These findings contribute to empirical literature on the implications of suffering for well-being.
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Affiliation(s)
- Samuel Ho
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA
| | - Kaye V Cook
- Department of Psychology, Gordon College, Wenham, Massachusetts, USA
| | - Zhuo Job Chen
- School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | | | - Christiany Suwartono
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Nilam Widyarini
- Department of Psychology, Gunadarma University, Depok, Indonesia
| | - Paul T P Wong
- Department of Psychology, Trent University, Peterborough, Ontario, Canada
| | - Richard G Cowden
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA
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Bradley N, Dowrick C, Lloyd-Williams M. Feasibility of Patient Reported Outcome Measures in Psychosocial Palliative Care: Observational Cohort Study of Hospice Day Care and Social Support Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13258. [PMID: 36293835 PMCID: PMC9603547 DOI: 10.3390/ijerph192013258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Palliative care patients can be at risk of social isolation or loneliness. Interventions that can provide effective social support, and particularly emotional support, could facilitate healthy coping that bolsters quality of life and reduces depression in palliative care patients. This is an observational cohort study which recruited thirty patients (n = 30) from the day services of four independent hospices in England. Participants completed patient reported outcome measures in perceived social support, loneliness, and depression, at up to three time points. Age range was 56-91 years, males and females were equally represented, and the sample was 93% white British. In participants that provided two or more timepoints, perceived social support increased, and loneliness and depression decreased. Largest changes with the least variation between participants was in emotional support (p = 0.165) and loneliness (p = 0.104). These results suggest that the psychosocial patient reported outcome measures used (MOS-SS, UCLA, BEDS) could be sensitive to change aligned with the goals of this intervention in palliative care. Participants in this study were observed to derive psychosocial benefit from attending the hospice day service.
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Affiliation(s)
- Natasha Bradley
- Centre for Health & Clinical Research, University of the West of England, Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
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11
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Bradley NM, Dowrick CF, Lloyd-Williams M. A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic? Palliat Care 2022; 21:170. [PMID: 36195870 PMCID: PMC9532229 DOI: 10.1186/s12904-022-01061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes. METHODS An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018. RESULTS Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services. CONCLUSIONS The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.
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Affiliation(s)
- N M Bradley
- Research Fellow in Realist Evaluation, Centre for Health & Clinical Research, University of the West of England, Glenside Campus, BS16 1DD., Bristol, United Kingdom.
| | - C F Dowrick
- Emeritus Professor, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX., Liverpool, United Kingdom
| | - M Lloyd-Williams
- Professor & Honorary Consultant in Palliative Medicine, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX, Liverpool, United Kingdom
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12
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Daneault S, Azri M, Ummel D, Vinit F, Côté A, Leclerc-Loiselle J, Laperle P, Gendron S. Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives. J Palliat Care 2022; 37:518-525. [PMID: 35234108 PMCID: PMC9465553 DOI: 10.1177/08258597221083421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Suffering is intimately linked to the experience of illness, and its relief is a mandate of medicine. Advances in knowledge around terminal illness have enabled better management of the somatic dimension. Nevertheless, there is what can be called "non-somatic" suffering which in some cases may take precedence. Inspired by Paul Ricoeur's thinking on human suffering, our aim in this qualitative study was to better understand the experience of non-somatic suffering. Methods: Semi-structured interviews were conducted with 19 patients. The results were qualitatively analyzed following a continuous comparative analysis approach inspired by grounded theory. Results: Three key themes synthesize the phenomenon: "the being enduring the suffering", "the being whose agency is constrained", and "the being in relationship with others." The first describes what patients endure, the shock and fears associated with their own finitude, and the limits of what can be tolerated. The second refers to the experience of being restricted and of mourning the loss of their capacity to act. The last describes a residual suffering related to their interactions with others, that of loneliness and of abandoning their loved ones, two dimensions that persist even when they have accepted their own death. Conclusions: Non-somatic suffering can be multifarious, even when minimized by the patient. When evaluating suffering, we must keep in mind that patients can reach a "breaking point" that signals the state of unbearable suffering. In managing it, we probably need to make more room for family and friends, as well as a posture of caring based more on presence and listening.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de
Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal,
Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke,
Sherbrooke, Canada
| | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal,
Montreal, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal,
Canada
| | - Sylvie Gendron
- Faculty of Nursing Science, Université de Montréal, Montreal,
Canada
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13
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Abstract
Consumer medicine consists of medical interventions pursued for non-health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non-health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non-health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine's origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health's redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.
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Affiliation(s)
- Christopher J. Lisanti
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Radiology and Radiological Sciences, USUHS, Bethesda, MD, USA
- Pregnancy Care Center, San Antonio, TX, USA
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14
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Tan SB, Tan TT, Tan MP, Loo KK, Lim PK, Ng CG, Loh EC, Lam CL. Contributing and Relieving Factors of Suffering in Palliative Care Cancer Patients: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:732-752. [DOI: 10.1177/0030222820942642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.
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Affiliation(s)
- Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ting Ting Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Kim Kee Loo
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Poh Khuen Lim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ee Chin Loh
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chee Loong Lam
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
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15
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Robinson KL, Connelly CD, Georges JM. Pain and Spiritual Distress at End of Life: A Correlational Study. J Palliat Care 2022; 37:526-534. [PMID: 35535413 DOI: 10.1177/08258597221090482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.
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Affiliation(s)
| | | | - Jane M Georges
- Hahn School of Nursing and Health Science, University of San Diego, USA
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16
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17
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Edelen MO, Rodriguez A, Huang W, Gramling R, Ahluwalia SC. A novel Scale to Assess Palliative Care Patients' Experience of Feeling Heard and Understood. J Pain Symptom Manage 2022; 63:689-697.e1. [PMID: 35017018 DOI: 10.1016/j.jpainsymman.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/06/2023]
Abstract
CONTEXT Patient experience of palliative care serves as an important indicator of quality and patient-centeredness. OBJECTIVES To develop a novel patient-reported scale measuring ambulatory palliative care patients' experience of feeling heard and understood by their providers. METHODS We used self-reported patient experience data collected via mixed-mode survey administration. We conducted an exploratory factor analysis (EFA) and an expert panel ranking exercise to reduce the 10-item set based on underlying dimensionality. We then used item response theory (IRT) to calibrate remaining items based on psychometric properties and test information and precision. We considered item-level fit and examined the standardized local dependence chi-square statistics. We evaluated candidate items for differential item functioning by survey mode. We evaluated the test-retest reliability and validity of the final scale. RESULTS The EFA yielded a single factor (9/10 items had loadings > 0.80 on the single factor). We removed two items with the lowest factor loadings and ranked by the expert panel as being least reflective of the overall construct. IRT calibration of the remaining eight items showed high slopes (range 2.66 - 5.18); location parameters were all negative (range -0.90 - -0.36). We removed two more items based on local dependence indices and item-level fit. Combining psychometric information with the expert ratings we established the final 4-item scale, which was reliable (Cronbach's alpha = 0.84; polychoric correlation coefficient = 0.72) and had good convergent validity. CONCLUSIONS This novel multi-item Feeling Heard and Understood scale can be used to measure and improve ambulatory palliative care patient experience.
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Affiliation(s)
- Maria O Edelen
- Behavioral & Policy Sciences Department, RAND Corporation, Boston, Massachusetts, USA
| | - Anthony Rodriguez
- Behavioral & Policy Sciences Department, RAND Corporation, Boston, Massachusetts, USA
| | - Wenjing Huang
- Behavioral & Policy Sciences Department, RAND Corporation, Boston, Massachusetts, USA
| | - Robert Gramling
- University of Vermont, Department of Family Medicine, Burlington, Vermont
| | - Sangeeta C Ahluwalia
- Behavioral & Policy Sciences Department, RAND Corporation, Santa Monica, California, USA.
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18
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Marina S, Wainwright T, Pereira HP, Ricou M. Trends in hastened death decision criteria: A review of official reports. Health Policy 2022; 126:643-651. [DOI: 10.1016/j.healthpol.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
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19
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Pesut B, Wright DK, Thorne S, Hall MI, Puurveen G, Storch J, Huggins M. What's suffering got to do with it? A qualitative study of suffering in the context of Medical Assistance in Dying (MAID). BMC Palliat Care 2021; 20:174. [PMID: 34758799 PMCID: PMC8582137 DOI: 10.1186/s12904-021-00869-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intolerable suffering is a common eligibility requirement for persons requesting assisted death, and although suffering has received philosophic attention for millennia, only recently has it been the focus of empirical inquiry. Robust theoretical knowledge about suffering is critically important as modern healthcare provides persons with different options at end-of-life to relieve suffering. The purpose of this paper is to present findings specific to the understanding and application of suffering in the context of MAID from nurses' perspectives. METHODS A longitudinal qualitative descriptive study using semi-structured telephone interviews. Inductive analysis was used to construct a thematic account. The study received ethical approval and all participants provided written consent. RESULTS Fifty nurses and nurse practitioners from across Canada were interviewed. Participants described the suffering of dying and provided insights into the difficulties of treating existential suffering and the iatrogenic suffering patients experienced from long contact with the healthcare system. They shared perceptions of the suffering that leads to a request for MAID that included the unknown of dying, a desire for predictability, and the loss of dignity. Eliciting the suffering story was an essential part of nursing practice. Knowledge of the story allowed participants to find the balance between believing that suffering is whatever the persons says it is, while making sure that the MAID procedure was for the right person, for the right reason, at the right time. Participants perceived that the MAID process itself caused suffering that resulted from the complexity of decision-making, the chances of being deemed ineligible, and the heighted work of the tasks of dying. CONCLUSIONS Healthcare providers involved in MAID must be critically reflective about the suffering histories they bring to the clinical encounter, particularly iatrogenic suffering. Further, eliciting the suffering stories of persons requesting MAID requires a high degree of skill; those involved in the assessment process must have the time and competency to do this important role well. The nature of suffering that patients and family encounter as they enter the contemplation, assessment, and provision of MAID requires further research to understand it better and develop best practices.
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Affiliation(s)
- Barbara Pesut
- School of Nursing, University of British Columbia Okanagan, ARTS 3rd Floor, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | | | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, BC, V6T 2B5, Canada
| | - Margaret I Hall
- Society of Notaries Public of BC, Chair in Applied Legal Studies, School of Criminology, Simon Fraser University, Surrey, BC, V5A 1S6, Canada
| | - Gloria Puurveen
- School of Nursing, University of British Columbia Okanagan, ARTS 3rd Floor, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Janet Storch
- School of Nursing, University of Victoria, Victoria, BC, V8P 5C2, Canada
| | - Madison Huggins
- School of Nursing, University of British Columbia Okanagan, ARTS 3rd Floor, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
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20
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Sánchez-Guardiola Paredes C, Aguaded Ramírez EM, Rodríguez-Sabiote C. Content Validation of a Semi-Structured Interview to Analyze the Management of Suffering. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11393. [PMID: 34769919 PMCID: PMC8583067 DOI: 10.3390/ijerph182111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
This work involves the content validation of a semi-structured interview, whose objective is to learn about the management of suffering in people. The interview items have been classified into several categories that define the suffering construct. For the content validation of the instrument, in addition to initially conducting a scientific review on the subject, the procedure known as expert judgement has been used. The results obtained in terms of the content validity achieved in the dimensions and areas assessed are, in general, satisfactory. However, some of these dimensions and certain areas have not exceeded the required minimum values for content validity. Therefore, it is necessary to modify the items comprising these dimensions in the areas evaluated with the additional incorporation of the qualitative suggestions for improvement indicated by the experts. As for agreement among experts, the results point to moderate agreement, which, moreover, is not due to chance.
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Affiliation(s)
- Carmen Sánchez-Guardiola Paredes
- Department of Methodology in Research and Diagnostic in Education, Universidad de Granada, 18071 Granada, Spain; (E.M.A.R.); (C.R.-S.)
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21
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Kang Y. Why Are Dying Individuals Stigmatized and Socially Avoided? Psychological Explanations. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:317-348. [PMID: 34039235 DOI: 10.1080/15524256.2021.1930330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Extant research on the topic of death and dying in modern society frequently includes the observation that death is now rendered invisible, and dying individuals are stigmatized and socially avoided. The current research speculated that lack of contact with a dying individual may promote negative perceptions of the dying, and this may in turn lead to further avoidance of them. Three studies were conducted: The first study examined how frequently the current U.S. participants had social contact with a dying individual; the second study investigated what perceptions they have of the dying, and the third study tested for potential causal links between negative perceptions of the dying and social avoidance of them. The results indicated: Only a small number of the U.S. participants ever had frequent social contact with a dying individual outside their family; they, nevertheless, shared several common negative perceptions of the dying; and those negative perceptions exerted different effects on one's avoidant attitude toward a dying individual-only making males more avoidant, especially in a physically close social relationship. Two concepts, medicalization and masculinism, were suggested as possible explanations for why dying individuals are stigmatized and avoided in modern society.
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Affiliation(s)
- Youngjin Kang
- New Mexico State University Board of Regents, Las Cruces, NM, USA
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22
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Ramírez-Rodríguez C, Grau-Valdes Y, Grau-Abalo JA. Síntomas asociados al sufrimiento en pacientes con enfermedad renal crónica en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Los síntomas insuficientemente controlados pueden constituir un factor determinante o agravante del sufrimiento en los pacientes sometidos a hemodiálisis; sin embargo, escasean las investigaciones que aborden este tema. Objetivos: El presente estudio tiene como objetivo describir el sufrimiento según la severidad de determinados síntomas en pacientes con enfermedad renal crónica en hemodiálisis. Material y Método: El estudio es observacional descriptivo transversal, con algunas tareas de correlación en una muestra de 31 pacientes. Se emplearon la entrevista, el instrumento para detección de bienestar/malestar propuesto por Bayés y colaboradores y una serie de sub-escalas de la Escala de Evaluación de Síntomas de Edmonton/ESAS para identificar la presencia de síntomas (intensidad y frecuencia) que pudieran estar asociados al sufrimiento. Resultados: El 87,1 % del total mostró un bajo predominio de síntomas con severa intensidad asociados al sufrimiento en las últimas 24 horas, el 77,4 % bajo predominio en la semana anterior y el 61,3 % un bajo predominio en un periodo de un mes. No se encontró asociación significativa entre el predominio de los síntomas con intensidad severa asociados al sufrimiento en 24 horas. Conclusiones: En la mayoría de los sujetos predominó el bajo predominio de síntomas con severa intensidad asociados al sufrimiento; la magnitud de la sintomatología no constituyó un factor importante asociado al sufrimiento en estos pacientes.
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Affiliation(s)
- Claudia Ramírez-Rodríguez
- Servicio de Nefrología. Hospital Docente Clínico Quirúrgico “Doctor Salvador Allende”. La Habana. Cuba
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23
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Malhotra C, Malhotra R, Bundoc F, Teo I, Ozdemir S, Chan N, Finkelstein E. Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer. J Natl Compr Canc Netw 2021; 19:1264-1271. [PMID: 34492633 DOI: 10.6004/jnccn.2021.7014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/23/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancer during their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffering in the last year of life among patients with a solid metastatic cancer. PATIENTS AND METHODS We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients' psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient's life. RESULTS We identified 5 trajectories representing suffering: (1) persistently low (47% of the sample); (2) slowly increasing (14%); (3) predominantly spiritual (21%); (4) rapidly increasing (12%); and (5) persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05-11.59) education were more likely to have rapidly increasing versus persistently low suffering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rapidly increasing suffering had more hospital admissions (β=0.24; 95% CI, 0.00-0.47) and hospital days (β=0.40; 95% CI, 0.04-0.75) during the last year of life. Those with persistently high suffering had more hospital days (β=0.70; 95% CI, 0.23-1.17). CONCLUSIONS The course of suffering during the last year of life among patients with cancer is variable and related to patients' hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce healthcare costs at the end of life.
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Affiliation(s)
- Chetna Malhotra
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
| | - Rahul Malhotra
- 2Program in Health Services and Systems Research, and.,3Centre for Ageing Research and Education, Duke-NUS Medical School
| | | | - Irene Teo
- 1Lien Centre for Palliative Care.,4National Cancer Centre Singapore; and
| | - Semra Ozdemir
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
| | - Noreen Chan
- 5Division of Palliative Care, National University Cancer Institute, Singapore
| | - Eric Finkelstein
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
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Increasing our understanding of nonphysical suffering within palliative care: A scoping review. Palliat Support Care 2021; 20:417-432. [DOI: 10.1017/s1478951521001127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering — both physical and nonphysical — little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap.
Method
Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR “end of life” OR “end-of-life” OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria.
Results
Losses, worries, and fears comprise patients’ primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients’ experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering.
Significance of results
This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.
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Cowden RG, Davis EB, Counted V, Chen Y, Rueger SY, VanderWeele TJ, Lemke AW, Glowiak KJ, Worthington EL. Suffering, Mental Health, and Psychological Well-being During the COVID-19 Pandemic: A Longitudinal Study of U.S. Adults With Chronic Health Conditions. WELLBEING, SPACE AND SOCIETY 2021; 2:100048. [PMID: 34746895 PMCID: PMC8562865 DOI: 10.1016/j.wss.2021.100048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/10/2021] [Accepted: 07/13/2021] [Indexed: 05/24/2023]
Abstract
Suffering has been a topic of considerable discussion in the fields of medicine and palliative care, yet few studies have reported causal evidence linking the experience of suffering to health and well-being. In this three-wave prospective cohort study, we explore the potential psychological implications of suffering during the COVID-19 pandemic by examining relations among suffering, mental health, and psychological well-being in a sample of U.S. adults living with chronic health conditions. We analyzed data from n = 184 participants who completed assessments one month before the SARS-CoV-2 outbreak was declared a pandemic by the World Health Organization (February 2020) and then two months (April 2020) and four months later (May/June 2020). Analyses controlled for a range of factors, including sociodemographic characteristics, physical health, religious/spiritual factors, psychological characteristics, and prior values of the predictor and each of the outcomes assessed one month before the COVID-19 pandemic. Results of the primary analysis indicated that greater overall suffering assessed one month into the COVID-19 pandemic was associated with lower psychological well-being (β = -.17, 95% CI: -.29, -.05) and higher levels of anxiety (β = .27, 95% CI: .13, .41) and depression (β = .16, 95% CI: .03, .29) two months later. In a secondary analysis that explored anxiety, depression, and psychological well-being as candidate antecedents of suffering, depression assessed one month into the COVID-19 pandemic was most strongly associated with worse overall suffering two months later. We highlight the implications of the findings for high-risk populations who are suffering amidst the challenges of the COVID-19 pandemic. Potential benefits of both integrating assessments of suffering into screening procedures and addressing experiences of suffering in mental health service settings are discussed.
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Affiliation(s)
- Richard G Cowden
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
| | - Edward B Davis
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | | | - Ying Chen
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
| | - Sandra Y Rueger
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | - Tyler J VanderWeele
- Harvard University, Human Flourishing Program, Institute for Quantitative Social Science
- Harvard T. H. Chan School of Public Health, Department of Epidemiology
| | - Austin W Lemke
- Wheaton College, School of Psychology, Counseling, and Family Therapy
| | - Kevin J Glowiak
- Wheaton College, School of Psychology, Counseling, and Family Therapy
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Malhotra C, Hazirah M, Tan LL, Malhotra R, Yap P, Balasundaram B, Tong KM, Pollak KI. Family Caregiver Perspectives on Suffering of Persons With Severe Dementia: A Qualitative Study. J Pain Symptom Manage 2021; 62:20-27.e2. [PMID: 33246072 DOI: 10.1016/j.jpainsymman.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Dementia involves suffering. Assessing the experience of suffering among persons with severe dementia is instrumental to delivering quality end-of-life care to them and their caregivers. OBJECTIVES We aimed to assess dimensions of suffering from the perspective of family caregivers and the resulting impact on their decisions for the care of persons with severe dementia. METHODS Between July 2018 and February 2019, we conducted qualitative in-depth interviews with 27 family caregivers of community-dwelling persons with severe dementia with Functional Assessment Staging Test staging 7. We asked caregivers if they perceived persons with severe dementia to be suffering and explored reasons for their perceptions. We analyzed data using principles of reflexive thematic analysis. RESULTS We conceptualized five dimensions of suffering among persons with severe dementia from the perspective of their caregivers: 1) untreated physical or behavioral symptoms, 2) emotional pain, 3) loss of agency, 4) loss of engagement with society, and 5) loss of personhood. Suffering among persons with severe dementia influences their caregivers' expression of a wish for their death and caregivers' decision regarding the use of life-prolonging interventions for them. CONCLUSION Findings suggest that suffering among persons with severe dementia can occur independent of physical symptoms and requires provision of person-centered care. The study adds to the understanding of end-of-life care in persons with severe dementia and their caregivers.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Mohamad Hazirah
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Lay Ling Tan
- Department of Psychological Medicine, Psychogeriatric Service, Changi General Hospital, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Philip Yap
- Geriatric Centre, Khoo Teck Puat Hospital, Singapore
| | | | | | - Kathryn I Pollak
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
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27
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Featherstone I, Hosie A, Siddiqi N, Grassau P, Bush SH, Taylor J, Sheldon T, Johnson MJ. The experience of delirium in palliative care settings for patients, family, clinicians and volunteers: A qualitative systematic review and thematic synthesis. Palliat Med 2021; 35:988-1004. [PMID: 33784915 PMCID: PMC8189008 DOI: 10.1177/02692163211006313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Delirium is common in palliative care settings and is distressing for patients, their families and clinicians. To develop effective interventions, we need first to understand current delirium care in this setting. AIM To understand patient, family, clinicians' and volunteers' experience of delirium and its care in palliative care contexts. DESIGN Qualitative systematic review and thematic synthesis (PROSPERO 2018 CRD42018102417). DATA SOURCES The following databases were searched: CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase, MEDLINE and PsycINFO (2000-2020) for qualitative studies exploring experiences of delirium or its care in specialist palliative care services. Study selection and quality appraisal were independently conducted by two reviewers. RESULTS A total of 21 papers describing 16 studies were included. In quality appraisal, trustworthiness (rigour of methods used) was assessed as high (n = 5), medium (n = 8) or low (n = 3). Three major themes were identified: interpretations of delirium and their influence on care; clinicians' responses to the suffering of patients with delirium and the roles of the family in delirium care. Nursing staff and other clinicians had limited understanding of delirium as a medical condition with potentially modifiable causes. Practice focused on alleviating patient suffering through person-centred approaches, which could be challenging with delirious patients, and medication use. Treatment decisions were also influenced by the distress of family and clinicians and resource limitations. Family played vital roles in delirium care. CONCLUSIONS Increased understanding of non-pharmacological approaches to delirium prevention and management, as well as support for clinicians and families, are important to enable patients' multi-dimensional needs to be met.
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Affiliation(s)
| | - Annmarie Hosie
- School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia
- The Cunningham Centre for Palliative Care, St Vincent’s Health Network, Sydney, NSW, Australia
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Pamela Grassau
- School of Social Work, Carleton University, Ottawa, ON, Canada
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Palliative Care, Bruyere Continuing Care, Ottawa, ON, Canada
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Trevor Sheldon
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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28
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Martinez I, Hoppmann A, Perna S, Byrd P, Wolfe J, Aye J, Johnston EE. To Disclose or Not to Disclose: A Case Highlighting the Challenge of Conflicts in Pediatric Disclosure. J Pain Symptom Manage 2021; 61:211-215. [PMID: 32890630 PMCID: PMC8097844 DOI: 10.1016/j.jpainsymman.2020.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Isaac Martinez
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anna Hoppmann
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sam Perna
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Byrd
- Pastoral Care Department, Children's of Alabama, Birmingham, Alabama, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jamie Aye
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily E Johnston
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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29
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Affiliation(s)
- Margaret O’Connor
- Monash University, Peninsula Campus, Melbourne, Victoria, Australia
- Melbourne City Mission Palliative Care, Victoria, Australia
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30
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Malhotra C, Krishnan A, Yong JR, Teo I, Ozdemir S, Ning XH, Hapuarachchi T, Palat G, Bhatnagar S, Joad AK, Tuong PN, Ssu WM, Finkelstein E. Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries. Int J Equity Health 2020; 19:158. [PMID: 32912232 PMCID: PMC7488341 DOI: 10.1186/s12939-020-01274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic understanding of socio-economic inequalities in end-of-life (EOL) suffering among advanced cancer patients is required to inform efforts to reduce these inequalities as part of Universal Health Coverage goals. Aims To assess inequalities in multiple domains of EOL suffering among advanced cancer patients – physical, functional, psychological, social, and spiritual –, using two socio-economic status (SES) indicators, education and perceived economic status of the household. Methods We used cross-sectional data from surveys of stage IV cancer patients (n = 1378) from seven hospitals across five countries (China, Sri Lanka, India, Vietnam and Myanmar). We conducted separate multivariable linear regression models for each EOL suffering domain. We also tested interactions between the two SES indicators and between each SES indicator and patient age. Results Patients living in low economic status households /with fewer years of education reported greater suffering in several domains. We also found significant interaction effects between economic status of the household and years of education for all EOL suffering outcomes. Age significantly moderated the association between economic status of the household and social suffering and between years of education and psychological, social, and spiritual suffering (p < 0.05 for all). Conclusion Results highlight that SES inequalities in EOL suffering vary depending on the suffering domain, the SES indicator assessed, and by patient age. Greater palliative care resources for patients with low SES may help reduce these inequalities.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore. .,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Anirudh Krishnan
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore
| | - Jing Rong Yong
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Xiao Hong Ning
- Geriatric Department, Peking Union Medical College Hospital, Beijing, China
| | | | - Gayatri Palat
- Department of Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India
| | - Sushma Bhatnagar
- Unit of Anesthesiology, Pain and Palliative Care, All India Institute of Medical Sciences, Delhi, India
| | - Anjum Khan Joad
- Department of Anesthesiology and Palliative Medicine, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, India
| | - Pham Nguyen Tuong
- Oncology Center, Hue Central Hospital, 16 Le Loi, Hue City, Hue, Vietnam
| | - Wynn Mon Ssu
- Clinical Research Division, Yangon General Hospital, Yangon, Myanmar
| | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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31
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Milberg A, Liljeroos M, Wåhlberg R, Krevers B. Sense of support within the family: a cross-sectional study of family members in palliative home care. BMC Palliat Care 2020; 19:120. [PMID: 32767973 PMCID: PMC7414563 DOI: 10.1186/s12904-020-00623-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite evidence that family members’ support to each other can be of importance to its members, there are limited studies of factors related to family members’ sense of such support during palliative care. Aim Based on the family systems approach, we evaluated which factors were associated with family members’ sense of support within their closest family in a palliative home care context and developed a model that predicts such sense of support. Design A cross-sectional design was used. We interviewed 209 adult family members (69% of eligible) of adult patients with expected short survival receiving palliative home care. Methods Generalised linear models were used to evaluate individual factors related to family members’ sense of support within their closest family during palliative care. The Akaike Information Criterion (AIC) was applied in the model-building analyses. Results Nineteen variables were identified that were significantly associated with the family members’ sense of support within the closest family. Model building selected six variables for predicting this sense of support (decreasing Wald values): family member perceiving support from other more distant family members; feeling secure with the provided palliative home care; possibility of respite if family member needed a break; family member living alone; being a child of the patient (inverse relationship); perceiving that the patient was supported by other family members. Conclusions Our findings support clinical application of the Family Systems Theory in the context of palliative care. The factors identified may be of value in assisting practitioners in detecting and treating family members sensing a low level of support within the closest family.
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Affiliation(s)
- Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Advanced Home Care, Linköping University, Norrköping, Sweden
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. .,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden. .,Medical department, Mälarsjukhuset hospital, 631 88, Eskilstuna, Sweden.
| | - Rakel Wåhlberg
- Department of Advanced Home Care, Linköping University, Norrköping, Sweden
| | - Barbro Krevers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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32
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Iani L, De Vincenzo F, Maruelli A, Chochinov HM, Ragghianti M, Durante S, Lombardo L. Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial. Front Psychol 2020; 11:1468. [PMID: 32670169 PMCID: PMC7330164 DOI: 10.3389/fpsyg.2020.01468] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.
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Affiliation(s)
- Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Alice Maruelli
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | | | - Matilde Ragghianti
- Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy
| | - Sieva Durante
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Luigi Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
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33
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Yash Pal R, Kuan WS, Tiah L, Kumar R, Wong YKY, Shi L, Zheng CQ, Lin J, Liang S, Segara UC, Yong WC, Chan NGC, Chua MT, Ibrahim I. End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study. BMJ Open 2020; 10:e036598. [PMID: 32350018 PMCID: PMC7213875 DOI: 10.1136/bmjopen-2019-036598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs. METHODS AND ANALYSIS This study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients' family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression. ETHICS AND DISSEMINATION The study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03906747.
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Affiliation(s)
- Rakhee Yash Pal
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ling Tiah
- Accident & Emergency Medicine, Changi General Hospital, Singapore
| | - Ranjeev Kumar
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | | | - Luming Shi
- Singapore Clinical Research Institute, Singapore
| | | | - Jingping Lin
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Sufang Liang
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Uma Chandra Segara
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Woon Chai Yong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore
| | - Noreen Guek Cheng Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
The time after diagnosis of a terminal illness can be demanding. It requires adjusting to change while trying to maintain some sense of normalcy. The purpose of this qualitative case study was to gain an understanding of how one person lived his life while facing death. During the interview, the researchers used photo elicitation to contextualize events in the participant's life. Thematic analysis identified three main themes: Finding Life's Purpose, Being (In)visible, and Illusion of Control. To better understand the participant's struggles and triumphs as he created a new existence, the researchers applied Parse's Theory of Human Becoming to the study's findings.
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Affiliation(s)
- Judith L Hold
- WellStar School of Nursing, Nursing at Kennesaw State University, Kennesaw, Georgia, USA
| | - Barbara J Blake
- Nursing at Kennesaw State University, Kennesaw, Georgia, USA
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35
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Seng Beng T, Ting Ting T, Karupiah M, Xin Ni C, Li Li H, Chong Guan N, Ee Chin L, Chee Loong L, Maw Pin T. Patterns of Suffering in Palliative Care: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:512-524. [PMID: 32019387 DOI: 10.1177/0030222820903221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suffering experiences are common phenomena in palliative care. In this study, we aim to explore the different patterns of suffering in palliative care. Adult palliative care patients were recruited from the University of Malaya Medical Centre. Suffering scores were charted 3 times a day for a week. The characteristics of the suffering charts were analyzed using SPSS. The patterns of suffering were analyzed using structural pattern recognition. A total of 53 patients participated. The overall trends of suffering were downward (64%), upward (19%), and stable (17%). Median minimum and maximum suffering scores were 2/10 and 6/10, with an average of 3.6/10. Nine patterns of suffering were recognized from categorizing two key characteristics of suffering (intensity and fluctuation)-named S1 to S9. Understanding the different patterns of suffering may lead to better suffering management.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tan Ting Ting
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Malathi Karupiah
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Cheah Xin Ni
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hong Li Li
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tan Maw Pin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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36
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Malhotra C, Harding R, Teo I, Ozdemir S, Koh GCH, Neo P, Lee LH, Kanesvaran R, Finkelstein E. Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study. Support Care Cancer 2019; 28:3781-3789. [PMID: 31832824 DOI: 10.1007/s00520-019-05208-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Universal Health Coverage goals call for access to affordable palliative care to reduce inequities in "total pain" and suffering. To achieve this, a patient-centred understanding of these inequities is required. AIM To assess association of total pain and suffering (i.e. physical, psychological, social, and spiritual health outcomes) and perceived health care quality with financial difficulties among stage IV solid malignancy patients. DESIGN Using baseline data from the COMPASS cohort study, we assessed total pain and suffering including physical (physical and functional well-being, pain, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual (spiritual well-being, hope) outcomes and perceived health care quality (physician communication, nursing care, and coordination/responsiveness). Financial difficulties were scored by assessing patient perception of the extent to which their resources were meeting expenses for their treatments, daily living, and other obligations. We used multivariable linear/logistic regression to test association between financial difficulties and each patient-reported outcome. SETTING/PARTICIPANTS Six hundred stage IV solid malignancy patients in Singapore. RESULTS Thirty-five percent reported difficulty in meeting expenses. A higher financial difficulties score was associated with worse physical, psychological, social, spiritual outcomes, and lower perceived quality of health care coordination and responsiveness (i.e. greater total pain and suffering) (all p < 0.05). These associations persisted after adjustment for socio-economic indicators. CONCLUSION Results identify advanced cancer patients with financial difficulties to be a vulnerable group with greater reported total pain and suffering. A holistic patient-centred approach to care at end-of-life may help meet goals for Universal Health Coverage.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Patricia Neo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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The relationship between the positive aspects of caring and the personal growth of caregivers of patients with advanced oncological illness : Postraumattic growth and caregiver. Support Care Cancer 2019; 28:3007-3013. [PMID: 31823055 DOI: 10.1007/s00520-019-05139-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/16/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Examine the relationship between the positive aspects of care and the personal growth of caregivers of patients with advanced oncological illness. METHODS This research was a quantitative study with a transversal design. One hundred (100) informal caregivers filled out self-applied questionnaire on resilience, aspects of care, emotional distress, spirituality, and posttraumatic growth. Descriptive statistics were applied to the data, later correlation, and regression, and comparative analyses were conducted. RESULTS The participants were mainly women (86%) with an average care period of 12 months. The average age was 46.52 years. The highest scores were evidenced in positive aspects of caretaking, spirituality, personal growth, and distress, while the lowest score was seen in questions related to resilience. There was a negative inverse correlation among emotional distress, resilience, spirituality, and posttraumatic growth (p < .05) and a positive correlation among resilience, spirituality, posttraumatic growth, and the positive aspects of caretaking (p < .01). There were significant differences among the items related to emotional distress, resilience, and posttraumatic growth. The linear regression analysis showed that as resilience, spirituality, and the positive aspects of care increased, so did posttraumatic growth. SIGNIFICANT RESULTS To promote the perception of benefits among caregivers, resilience and the identification of meaning in the caregiving experience of patients with advanced oncological illness can be considered protective factors favoring adaptation and reducing negative moods.
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Poletti S, Razzini G, Ferrari R, Ricchieri MP, Spedicato GA, Pasqualini A, Buzzega C, Artioli F, Petropulacos K, Luppi M, Bandieri E. Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study. Complement Ther Med 2019; 47:102218. [PMID: 31780005 DOI: 10.1016/j.ctim.2019.102218] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To explore the impact of a Mindfulness-Based Stress Reduction (MBSR) intervention for people with metastatic cancer integrated in Early Palliative Care (EPC). DESIGN Mixed-method study. SETTINGS/LOCATION EPC Service integrated with Oncology Unit, Carpi General Hospital, Italy from January to October 2017. The MBSR intervention took place inside the hospital. SUBJECTS Study participation was offered to 25 consecutive people referred to the EPC service. INCLUSION CRITERIA people with metastatic cancer between 18 and 75 years old; informed consent. EXCLUSION CRITERIA Performance Status <60% according to Karnofsky scale; active psychiatric disorder. 20 patients were included in the study. INTERVENTION The adapted program consists of 8 meetings for 2.5 h once a week, a 4.5 h session between the 6th and 7th weeks and 0.5 h home practice daily. The following mindfulness practices were included during the training: formal sitting meditation, body scan, light yoga, walking meditation, and Aikido exercises. Participants were provided with materials for home practice. A qualified MBSR instructor conducted the program. Sessions were attended by a clinical psychologist and a physician trained in meditation, together with the palliative nurse as facilitators. OUTCOME MEASURES Feasibility and acceptability were assessed on 16 participants. In addition, pre-post measures of cancer pain and mood state were collected. Semi-structured, in-depth interviews were conducted on a subset of 8 participants at the end of the study and analysed using the Interpretative-Phenomenological approach. RESULTS MBSR attendance to meetings and adherence to home practice were 75%. MBSR intervention helped participants to develop an accepting attitude in respect to metastatic cancer disease helping them to face anxiety and cancer pain. MBSR improves self-regulation of mood state engendering feelings of compassion MBSR program supports participants in questioning and reconnecting with their values and spiritual beliefs. CONCLUSIONS A Mindfulness intervention integrated into EPC setting is feasible, well accepted and could help metastatic cancer patients to control cancer pain together with an opportunity of emotional and spiritual relief.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mario Luppi
- Department of Medical and Surgical Sciences, AOU, UNIMORE, Italy.
| | - Elena Bandieri
- Unit of Early Palliative Care, Carpi Civil Hospital, Italy.
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Rodrigues P, Menten J, Gastmans C. Physicians' perceptions of palliative sedation for existential suffering: a systematic review. BMJ Support Palliat Care 2019; 10:136-144. [PMID: 31481477 DOI: 10.1136/bmjspcare-2019-001865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Palliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians' perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention. AIM To gain deeper insight into physicians' perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it. DESIGN Systematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology. DATA SOURCES Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians' perceptions of PS-ES. RESULTS The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians' perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified. CONCLUSIONS To date, there is still no consensus on physicians' perceptions of PS-ES. Further research is necessary to understand factors that influence physicians' perceptions and philosophical-ethical presuppositions underlying this perceptions.
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Affiliation(s)
- Paulo Rodrigues
- ETHICS 7446 - Centre d'éthique médicale, Université Catholique de Lille, Lille, France
| | - Johan Menten
- Interfaculty Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Chris Gastmans
- Interfaculty Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
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Johnson LA, Bell CJ, Ridner S, Murphy B. Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best? OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:587-600. [PMID: 31237818 DOI: 10.1177/0030222819857871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospice health-care professionals (HCP) evaluate and manage cancer pain in patient homes. This study explores HCP's perceptions of barriers that affect pain management for home hospice cancer patients. A convenience sample of 20 experienced hospice HCP were recruited from a regional hospice agency. Data were collected through two focus groups using semistructured interviews and analyzed using a constant comparative approach to generate themes. An unexpected finding revealed patient's religious and cultural beliefs about suffering and family caregiver's beliefs that patients deserve to suffer due to past actions are barriers to pain management in home hospice. Hospice HCP can identify patients at risk for suffering at the end of life. Interventions targeting spiritual suffering and needs are needed. Home hospice HCP have an ethical obligation to address undue suffering through family's withholding of necessary pain medications and should consider alternative placement when home is not suitable for a peaceful death.
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Affiliation(s)
- Lee A Johnson
- College of Nursing, East Carolina University, Greenville, NC, USA
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Limonero JT, Maté-Méndez J, Mateo D, Gómez-Romero MJ, González-Barboteo J, Cladellas R, Ferris FD, Gómez-Batiste X. Caregiver emotional distress: external open-behaviour signs. BMJ Support Palliat Care 2019; 12:e585-e591. [PMID: 31239258 DOI: 10.1136/bmjspcare-2019-001774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether specific external signs of emotional distress (ESED) can be an indirect measure of emotional distress in caregivers. METHODS A cross-sectional multicentre design was used. 148 primary caregivers of advanced cancer patients attended in four Spanish palliative care units participated in this study. The emotional distress of caregivers was measured using both the Emotional Distress of Caregivers Scale and a psychological interview. Health professionals collected data using a standard clinical interview process after a brief training period. RESULTS More than half the caregivers (60%) presented with emotional distress. A positive correlation (r=0.566) was found between the intensity of ESED and emotional distress per se. Caregivers who presented emotional distress showed more ESED than those that did not (p<0.01). The study found significant differences for the categories 'visible signs of sadness, fear, crying, feeling overwhelmed' (p<0.001), 'difficulty in separating from the patient: family refuses to let the patient make decisions and insists on care' (p<0.001) and 'visible signs of anger, irritability or frequent disagreement with therapeutic measures' (p<0.001). No significant differences were found with respect to gender. The set of items to measure these external signs presented an adequate reliability assessed using Cronbach's alpha (α=0.773). CONCLUSIONS The assessment of ESED in caregivers could serve as a useful method to assess their emotional distress. Incorporating the systematic assessment of these external signs as part of the assessment of the emotional distress of primary caregivers could improve the overall assessment and treatment provided to these caregivers.
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Affiliation(s)
- Joaquín T Limonero
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain
| | - Jorge Maté-Méndez
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain.,Psycho-oncology Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Spain
| | - Dolors Mateo
- Palliative Care Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - María José Gómez-Romero
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain.,Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Terrassa, Spain
| | | | - Ramon Cladellas
- School of Psychology. Stress and Health Research Group, Universitat Autonoma de Barcelona Facultat de Psicologia, Bellaterra, Spain
| | - Frank D Ferris
- Palliative Medicine, Research & Education, OhioHealth, Columbus, Ohio, USA
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Spain.,Chair of Palliative Care, University of Vic, Vic, Spain
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42
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VanderWeele TJ. Suffering and response: Directions in empirical research. Soc Sci Med 2019; 224:58-66. [DOI: 10.1016/j.socscimed.2019.01.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 12/27/2022]
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Lee GL, Ramaswamy A. Physical, psychological, social, and spiritual aspects of end-of-life trajectory among patients with advanced cancer: A phenomenological inquiry. DEATH STUDIES 2018; 44:292-302. [PMID: 30569828 DOI: 10.1080/07481187.2018.1541944] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
The study examined and described the perspectives of people living with advanced cancer and the changes over time in their needs and experiences. This paper reports the accounts of 11 terminally-ill people who gave a total of 25 in-depth interviews. Participants were recruited when they began receiving home hospice care service, and they were followed up over time, as their disease progressed. Framework method was used to organize the data and identify themes. The findings highlighted that end-of-life care needs to be holistic, encompassing physical, psychological, social, and spiritual needs, as well as dynamic along the course of disease progression.
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Affiliation(s)
- Geok Ling Lee
- Department of Social Work, National University of Singapore, Singapore, Singapore
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Maté-Méndez J, González-Barboteo J, Calsina-Berna A, Mateo-Ortega D, Codorniu-Zamora N, Limonero-García JT, Trelis-Navarro J, Serrano-Bermúdez G, Gómez-Batiste X. The Institut Català D'Oncologia model of Palliative Care: An Integrated and Comprehensive Framework to Address the Essential needs of Patients with Advanced Cancer. J Palliat Care 2018. [DOI: 10.1177/082585971302900406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jorge Maté-Méndez
- X Gómez-Batiste (corresponding author) Department of Palliative Care, University of Vic, Vic and QUALY Observatory/WHO Collaborating Center for Public Health Palliative Care Programs, Institut Català d'Oncologia, Avinguda Gran Via de l’ Hospitalet 199–203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús González-Barboteo
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Research Group on Stress and Health, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Agnès Calsina-Berna
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Department of Palliative Care, University of Vic, Barcelona, Spain
| | - Dolors Mateo-Ortega
- Department of Palliative Care, University of Vic and QUALY Observatory/WHO Collaborating Center for Public Health Palliative Care Programs, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; N Codorniu-Zamora, G Serrano-Bermúdez: Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; JT Limonero-García: Research Group on Stress and Health, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain; J Trelis-Navarro:
| | - Núria Codorniu-Zamora
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Department of Palliative Care, University of Vic, Barcelona, Spain
| | - Joaquín T. Limonero-García
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Research Group on Stress and Health, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Trelis-Navarro
- Department of Palliative Care, University of Vic and QUALY Observatory/WHO Collaborating Center for Public Health Palliative Care Programs, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; N Codorniu-Zamora, G Serrano-Bermúdez: Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; JT Limonero-García: Research Group on Stress and Health, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain; J Trelis-Navarro:
| | - Gala Serrano-Bermúdez
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Department of Palliative Care, University of Vic, Barcelona, Spain
| | - Xavier Gómez-Batiste
- X Gómez-Batiste (corresponding author) Department of Palliative Care, University of Vic, Vic and QUALY Observatory/WHO Collaborating Center for Public Health Palliative Care Programs, Institut Català d'Oncologia, Avinguda Gran Via de l’ Hospitalet 199–203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
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Soto-Rubio A, Perez-Marin M, Tomas Miguel J, Barreto Martin P. Emotional Distress of Patients at End-of-Life and Their Caregivers: Interrelation and Predictors. Front Psychol 2018; 9:2199. [PMID: 30459695 PMCID: PMC6232454 DOI: 10.3389/fpsyg.2018.02199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Patients at the end of life and their families experience a strong emotional impact. The well-being of these patients and that of their family caregiver are related. Aim: To study the variables related with the emotional well-being of patients with and without cognitive impairment at the end of life and that of their primary family caregivers. Design: Cross- sectional study. Participants: Data was collected from 202 patients at the end of life with different diagnosis (COPD, cancer, and frail elderly) as well as from their respective 202 primary family caregivers. Results: Structural equation models indicated that the emotional state of the patients was best predicted by their functional independence and the burden of their family caregivers. In addition, the emotional state of the primary family caregiver was predicted by their burden and not by the cognitive state or the functional independence of the patient. Nevertheless, the burden of the family caregiver, which is the only variable predicting both the emotional state of the patient and that of the caregiver, was directly related with the functional independence of the patient and indirectly with the patient's cognitive state. Conclusion: The family caregiver's burden is an important factor to take into consideration when aiming to reduce the emotional distress of patients at the end of life with different diagnosis -whether or not they present significant cognitive impairment- and that of their family caregivers.
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Affiliation(s)
- Ana Soto-Rubio
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marian Perez-Marin
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Jose Tomas Miguel
- Department of Methodology of the Social Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Pilar Barreto Martin
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
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Hernández-Marrero P, Fradique E, Pereira SM. Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis. Nurs Ethics 2018; 26:1680-1695. [PMID: 29807491 DOI: 10.1177/0969733018774610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. OBJECTIVES To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices. DESIGN Qualitative secondary analysis. PARTICIPANTS/CONTEXT Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. ETHICAL CONSIDERATION Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. FINDINGS All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. DISCUSSION Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients' preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. CONCLUSION While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses' involvement and practices in end-of-life decision-making.
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Affiliation(s)
| | - Emília Fradique
- Hospital de Santa Maria, Portugal; Instituto S. João de Deus, Portugal
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Mayahara M, Wilbur J, Fogg L, Breitenstein SM. Behavioral Pain Intervention for Hospice and Palliative Care Patients: An Integrative Review. Am J Hosp Palliat Care 2018; 35:1245-1255. [PMID: 29772922 DOI: 10.1177/1049909118775421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite the advances in pain management, achieving optimal pain control in hospice and palliative care is challenging. Patient/caregiver's lack of pain management knowledge, poor pain reporting, and poor adherence to pain management regimens are all associated with inadequate pain control. The purpose of this integrated review is to examine behavioral interventions designed for patients and caregivers to improve pain control in hospice and palliative care settings. Ten studies were identified through a database search. Seven of the 10 studies found significant improvement in at least 1 pain marker. Of the 7 studies that looked at changes in pain knowledge, 5 had significant improvements in at least 1 knowledge subscale. The 2 studies that looked at adherence to pain management found significant improvements. One limitation of the reviewed studies was that the delivery of them would not be efficient across all health-care settings, and, as a consequence, more technologically sophisticated delivery methods are needed. Therefore, while it is clear from the review that effective pain management interventions have been developed for hospice and palliative care patients, it is also clear that future research needs to focus on providing these same interventions through a more technologically sophisticated delivery method.
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Encarnação P, Oliveira CC, Martins T. Psychometric properties of the suffering assessment questionnaire in adults with chronic diseases or life-threatening illness. Scand J Caring Sci 2018; 32:1279-1287. [PMID: 29578241 DOI: 10.1111/scs.12569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suffering has been considered by many authors to be a difficult concept to assess and measure, as it is subjective and unique. However, to guide the diagnosis and decision-making of healthcare professionals, it is important to develop an instrument that differentiates the different suffering dimensions, namely, intra- and interpersonal suffering, awareness of suffering and spiritual suffering. AIM The aim of this study was thus to design and validate an instrument for the assessment of the dimensions of suffering in adult patients with chronic diseases or life-threatening illnesses. METHOD A methodological study was developed. The data were collected from two self-help organisations and a palliative care unit. The theoretical model was tested using confirmatory factor analysis. The study sample consisted of 251 patients with chronic diseases or life-threatening illnesses. The Sense of Coherence Scale, the Spiritual Assessment Scale and the Suffering Assessment Questionnaire in Adults with Chronic Diseases or Life-Threatening Illness (SAQ) were applied to each participant and were later returned for analysis. RESULTS An SAQ version with 12 items showed adequate psychometric characteristics of validity and internal consistency after being adapted to a four-dimensional structure that assesses the four dimensions of suffering. CONCLUSION The results of confirmatory analysis indicated a good model fit that suggested that the advocated theoretical model is plausible.
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Affiliation(s)
- Paula Encarnação
- ICBAS (Instituto de Ciências Biomédicas de Abel Salazar), University of Porto, Porto, Portugal.,School of Nursing, University of Minho, Braga, Portugal
| | | | - Teresa Martins
- Escola Superior de Enfermagem do Porto (Nursing School of Porto), Porto, Portugal and CINTESIS (CINTESIS - Center for Health Technology and Services Research)
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Zimmermann FF, Burrell B, Jordan J. The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: A systematic review. Complement Ther Clin Pract 2017; 30:68-78. [PMID: 29389483 DOI: 10.1016/j.ctcp.2017.12.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In spite of supportive care for people affected by cancer being well recognized as a priority for research, there is little solid evidence of the effectiveness of psychological interventions using mindfulness for those with advanced cancer. This systematic review aims to describe, evaluate and synthesize the acceptability and potential benefits of mindfulness-based interventions (MBIs) for the psychological well-being of people with advanced cancers. METHODS Eight databases were searched and terms related to advanced stages of cancer and mindfulness were combined systematically to identify relevant published literature. Inclusion criteria were studies with adults only and all types of cancer at stages III and IV. There was considerable variety in the MBI treatment packages including in the extent and centrality of mindfulness in the interventions. RESULTS Of 312 identified studies, only 8 included MBIs for people with advanced cancer rather than their families or carers. Results from these studies suggests that MBIs are acceptable and beneficial to the advanced cancer population, improving quality of life, use of mindfulness skills, acceptance of their cancer situation and reduction in depression and anxiety. Some adaptations were recommended however regarding delivery, simplified briefer MBIs, abbreviated session time, flexibility concerning locality of treatment and a minimized questionnaire burden for this group. CONCLUSIONS MBI packages reviewed in this study had evidence of acceptability and of effectiveness, indicating potential benefit for this population. Individualized, including home-based interventions may be optimal to allow critically ill patients to participate in treatment. In future, MBIs adapted to the needs of various advanced cancer patients are recommended to address the gap in the field and improve health care.
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Affiliation(s)
- Fernanda F Zimmermann
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Beverley Burrell
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, 4 Oxford Terrace, Christchurch, 8140, New Zealand.
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Hartogh GD. Suffering and dying well: on the proper aim of palliative care. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:413-424. [PMID: 28374105 PMCID: PMC5569128 DOI: 10.1007/s11019-017-9764-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In recent years a large empirical literature has appeared on suffering at the end of life. In this literature it is recognized that suffering has existential and social dimensions in addition to physical and psychological ones. The non-physical aspects of suffering, however, are still understood as pathological symptoms, to be reduced by therapeutical interventions as much as possible. But suffering itself and the negative emotional states it consists of are intentional states of mind which, as such, make cognitive claims: they are more or less appropriate responses to the actual circumstances of the patient. These circumstances often are such that it would rather be a pathological symptom not to be sad and not to suffer. Suffering, therefore, is sometimes and to some extent a condition to be respected. Although I do not dispute that the alleviation of suffering is the main aim of palliative care, in pursuing that aim we should acknowledge a constraint of realism.
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Affiliation(s)
- Govert den Hartogh
- University of Amsterdam, Staten Bolwerk 16, 2011 ML, Haarlem, The Netherlands.
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