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Kodama K, Kanke S, Kassai R. Palliative care practices and their relationship to training: A cross-sectional study of community-oriented physicians. Fukushima J Med Sci 2024; 70:141-151. [PMID: 39034142 PMCID: PMC11330264 DOI: 10.5387/fms.23-00007] [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] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the training methods family physicians (FPs) use to enhance their professional development in palliative care. We also determined the relationship between these methods and palliative care practice. METHODS A questionnaire survey was administered to 557 FPs. Palliative care practices were measured using the palliative care self-reported practices scale (PCPS;range 1-5), and associations among the eight indicators of FP palliative care training were considered. Quantile regression analysis was used for the analysis. RESULTS Valid responses were received from 307 FPs:99.4% of the FPs provided palliative care and home visits, and 92.8% received palliative care training. The PCPS score was higher in participants who reported having received palliative care training (adjusted coefficient, 0.4 [95% CI, 0.12-0.68]; P=0.004). The palliative care training method was found to be significantly associated with the PCPS score "Self-study through literature" (adjusted coefficient 0.18 [95% CI, 0.01-0.34]; P=0.03) and "Reflection on the practices" (adjusted coefficient 0.24 [95% CI, 0.08-0.4]; P=0.004). CONCLUSIONS FPs actively provided palliative care in their communities and used various palliative care training methods for professional development. "Reflection on the practices" and "Self-study through literature" were important elements of community-based palliative care practice.
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Affiliation(s)
- Kuniko Kodama
- Major in Community and Family Medicine, Fukushima Medical University Graduate School of Medicine
- Department of Nursing Sciences, Tokyo Metropolitan University Graduate School of Human Health Sciences
| | - Satoshi Kanke
- Department of Community and Family Medicine, Fukushima Medical University School of Medicine
- Fukushima Centre for General Physicians, Fukushima Medical University School of Medicine
| | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University School of Medicine
- World Organization of Family Doctors
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Ye Z, Jing L, Zhang H, Qin Y, Chen H, Yang J, Zhu R, Wang J, Zhang H, Xu Y, Chu T. Attitudes and influencing factors of nursing assistants towards hospice and palliative care nursing in chinese nursing homes: a cross-sectional study. BMC Palliat Care 2023; 22:49. [PMID: 37098562 PMCID: PMC10127064 DOI: 10.1186/s12904-023-01175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/14/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Hospice and palliative care nursing (HPCN) in China is mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in HPCN multidisciplinary teams, but little is known about their attitudes towards HPCN and related factors. METHODS A cross-sectional study was designed to evaluate NAs' attitudes towards HPCN with an indigenised scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of four parts: demographic characteristics, attitudes (20 items with four sub-concepts), knowledge (nine items), and training needs (nine items). Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson's correlation, and multiple linear regression were performed to analyse NAs' attitudes, influencing factors, and their correlations. RESULTS A total of 156 questionnaires were valid. The mean score of attitudes was 72.44 ± 9.56 (range:55-99), with a mean item score of 3.6 ± 0.5 (range:1-5). The highest score rate was "perception of the benefits for the life quality promotion" (81.23%), and the lowest score rate was "perception of the threats from the worsening conditions of advanced patients" (59.92%). NAs' attitudes towards HPCN were positively correlated with their knowledge score (r = 0.46, P < 0.01) and training needs (r = 0.33, P < 0.01). Marital status (β = 0.185), previous training experience (β = 0.201), location of NHs (β = 0.193), knowledge (β = 0.294), and training needs (β = 0.157) for HPCN constituted significant predictors of attitudes (P < 0.05), which explained 30.8% of the overall variance. CONCLUSION NAs' attitudes towards HPCN were moderate, but their knowledge should be improved. Targeted training is highly recommended to improve the participation of positive and enabled NAs and to promote high-quality universal coverage of HPCN in NHs.
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Affiliation(s)
- Zhuojun Ye
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China.
| | - Haoyu Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yongfa Qin
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Hangqi Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jiying Yang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Ruize Zhu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jingrong Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Huiwen Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Tianshu Chu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
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Volunteers' spiritual care competence and its relationship with attitudes toward palliative care: A cross-sectional study. Palliat Support Care 2023:1-7. [PMID: 36912179 DOI: 10.1017/s1478951523000123] [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: 03/14/2023]
Abstract
OBJECTIVES Given the rising burden of palliative care and the limited human resources for its facilitation in China, volunteers are becoming increasingly indispensable. In particular, there is a high demand for volunteers who can serve as spiritual caregivers. However, a volunteer's ability to provide good spiritual care in a palliative setting may be influenced by their attitude toward palliative care. To uncover the current state of spiritual caregiving in palliative settings in China and insights into best practices for its improvement, this study measured spiritual care competence and identified its influencing factors and explored its relationship with attitudes toward palliative care among volunteers. Notably, this study is the first to consider spiritual care competence alongside attitudes toward palliative care. METHODS A descriptive cross-sectional study using online survey methods was conducted with 385 volunteers in Shanghai, China. Data were collected using a structured questionnaire. RESULTS Volunteers demonstrated relatively low levels of spiritual care competence (58.50 ± 10.92). Statistically significant correlations were found between spiritual care competence and the following variables: age, educational background, marital status, religious beliefs, occupational status, and relevant training and practical experience. Attitude toward palliative care significantly correlated with spiritual care competence (r = 0.49, p < 0.001). SIGNIFICANCE OF RESULTS To continually improve volunteers' spiritual care competence, diversified education and training programs about spiritual care should be designed for different kinds of volunteers; moreover, because attitude toward palliative care significantly impacted spiritual care competence, such programs should encourage positive attitudes toward palliative care.
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Teng X, Tang M, Jing L, Xu Y, Shu Z. Healthcare Provider Knowledge, Attitudes, and Practices in Hospice Care and Their Influencing Factors: A Cross-sectional Study in Shanghai. Int J Health Policy Manag 2022; 11:3090-3100. [PMID: 35988031 PMCID: PMC10105208 DOI: 10.34172/ijhpm.2022.6525] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2017, the Chinese government launched a pilot project in hospice care (HC), in which Shanghai was a pioneer. Healthcare provider knowledge, attitudes, and practices in hospice care (KAPHC) may facilitate or hinder HC development. To determine how to design targeted training for healthcare providers and policies to improve their KAPHC, we conducted an original study based on an indigenized KAPHC scale to (a) comprehensively measure the KAPHC baseline of healthcare providers in Shanghai and (b) explore its influencing factors. METHODS A cross-sectional study was designed to evaluate healthcare providers' KAPHC with the indigenized KAPHC scale. Descriptive analysis, linear regression, and Pearson's (r) correlation analysis were performed to uncover providers' KAPHC, its influencing factors, and their correlations. RESULTS The KAPHC scale proved applicable to the knowledge, attitudes, and practices of the large sample of providers we surveyed. The 7027 KAPHC scaling results revealed that 42.44% of participants had HC experience and 57.49% were willing to provide HC. The mean accuracy of the responses related to knowledge was 59.30%. Scoring rates for attitudes, confidence, and self-reported practices were 74.20%, 73.96%, and 75.55%, respectively. The linear regression revealed that higher KAPHC scores were associated with experience and willingness and varied with professional specializations. The Pearson's (r) correlation evidenced that HC practices were strongly correlated with confidence (r = 0.648, P<.001) and moderately correlated with attitudes (r = 0.463, P<.001). CONCLUSION We uncovered that targeted training for enhancing healthcare provider KAPHC in Shanghai should focus on psychological and spiritual care, the management of pain and other symptoms, and traditional Chinese medicine (TCM). Additionally, training should be scaled up for providers with different characteristics. Meanwhile, policy should encourage providers to work enthusiastically in HC-universal high-quality HC requires well-trained, supported, and motivated providers.
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Affiliation(s)
- Xiaohan Teng
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maocheng Tang
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqun Shu
- Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Chu T, Zhang H, Xu Y, Teng X, Jing L. Predicting the behavioral intentions of hospice and palliative care providers from real-world data using supervised learning: A cross-sectional survey study. Front Public Health 2022; 10:927874. [PMID: 36249257 PMCID: PMC9561131 DOI: 10.3389/fpubh.2022.927874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Hospice and palliative care (HPC) aims to improve end-of-life quality and has received much more attention through the lens of an aging population in the midst of the coronavirus disease pandemic. However, several barriers remain in China due to a lack of professional HPC providers with positive behavioral intentions. Therefore, we conducted an original study introducing machine learning to explore individual behavioral intentions and detect factors of enablers of, and barriers to, excavating potential human resources and improving HPC accessibility. Methods A cross-sectional study was designed to investigate healthcare providers' behavioral intentions, knowledge, attitudes, and practices in hospice care (KAPHC) with an indigenized KAPHC scale. Binary Logistic Regression and Random Forest Classifier (RFC) were performed to model impacting and predict individual behavioral intentions. Results The RFC showed high sensitivity (accuracy = 0.75; F1 score = 0.84; recall = 0.94). Attitude could directly or indirectly improve work enthusiasm and is the most efficient approach to reveal behavioral intentions. Continuous practice could also improve individual confidence and willingness to provide HPC. In addition, scientific knowledge and related skills were the foundation of implementing HPC. Conclusion Individual behavioral intention is crucial for improving HPC accessibility, particularly at the initial stage. A well-trained RFC can help estimate individual behavioral intentions to organize a productive team and promote additional policies.
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Kim S, Lee K, Kim C, Choi J, Kim S. How Do We Start Palliative Care for Patients With End-Stage Liver Disease? Gastroenterol Nurs 2022; 45:101-112. [PMID: 34269708 PMCID: PMC8963522 DOI: 10.1097/sga.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Patients with end-stage liver disease undergo repetitive patterns of recovery and deterioration and are burdened with uncertainty. Although quality of life is low in patients with end-stage liver disease and their family members, few studies have been conducted to identify what palliative care should be provided for them. This integrative review aimed to explore palliative care for patients with end-stage liver disease, focusing on the components and outcome measurements for further research. After searching for studies on palliative care for end-stage liver disease published between 1995 and 2017, 12 studies that met the inclusion criteria were analyzed. The common components of palliative care for patients with liver disease were: (a) an interdisciplinary approach, (b) early palliative care, (c) discussion goals of care with patient and family members, (d) symptom management, and (e) psychosocial support. It was reported that patients who were provided palliative care had improved itching, well-being, appetite, anxiety, fatigue, and depression, increased the number of do-not-resuscitate orders, palliative care consultations, and decreased length of stay. These findings could guide the development of palliative care for end-stage liver disease patients.
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Affiliation(s)
- Sookyung Kim
- Correspondence to: Sanghee Kim, PhD, RN, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea ()
| | - Kyunghwa Lee
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Changhwan Kim
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jahyun Choi
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Sanghee Kim
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Predictors of At-Home Death for Cancer Patients in Rural Clinics in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312703. [PMID: 34886428 PMCID: PMC8656844 DOI: 10.3390/ijerph182312703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The prediction of at-home deaths has become an important topic in rural areas of Japan with an advanced aging society. However, there are no well-established predictors to explain how these factors influence intention. This study aims to investigate the possible predictors of at-home death for cancer patients in rural clinics in Japan. METHODS This is a nationwide cross-sectional survey. A self-administered questionnaire was sent to 493 rural clinics in Japan. The main outcome was the realization of at-home deaths for cancer patients. RESULTS Among the 264 clinics (54%) that responded to the survey, there were 194 clinics with the realization of at-home death. The use of a clinical pathway (adjusted odds ratio 4.19; 95% confidence interval 1.57-11.19) and the provision of organized palliative care (adjusted odds ratio 19.16; 95% confidence interval 7.56-48.52) were associated with the prediction of at-home death, irrespective of island geography or the number of doctors and nurses. CONCLUSIONS Having a clinical pathway and systematizing palliative care could be important to determine the possibility of at-home deaths for cancer patients in rural clinics in Japan.
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Shu Z, Wang Y, Li T, Jing L, Sun X. Instrument development of health providers' Knowledge, Attitude and Practice of Hospice Care Scale in China. Int J Health Plann Manage 2020; 36:364-380. [PMID: 33063349 DOI: 10.1002/hpm.3074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/25/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To match the reform of hospice development in China, this study aimed to construct an indigenized health providers' Knowledge, Attitude and Practice of Hospice Care (KAPHC) Scale in China with good validity and reliability. METHODS We used three steps to develop the scale, establishing items-pool firstly based on literature review and expert consultation, followed by forming a draft-scale design through synthetically consideration, and finally modifying the draft by conducting a self-administrative survey in sampled institution and testing the reliability and validity by statistical analysis. RESULTS The KAPHC Scale was comprised of 15 knowledge items, 24 attitude items and 22 practice items. In the part of knowledge, the Cronbach's α coefficient was 0.686, the average difficulty was 0.62 and average discrimination was 0.46. The attitude items were divided into four domains (KMO = 0.770), with Cronbach's α coefficient of 0.868. The practice items included confidence of practices and self-reported behaviors (KMO = 0.732), with Cronbach's α coefficient of 0.958. CONCLUSION The KAPHC Scale demonstrated good validity and reliability. As an effective tool, the scale may contribute to assessing health providers' KAP status of hospice care and exploring their future education needs in mainland China.
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Affiliation(s)
- Zhiqun Shu
- Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Yiting Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tiantian Li
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Clinic Medical College, Anhui Medical University, Anhui, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Sun
- Zhongshan Hospital, Fudan University, Shanghai, China.,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institution for Health Development, Shanghai, China
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Abstract
OBJECTIVE China is home to one-fifth of the world's population. In the setting of a growing and aging population as well as the designation of palliative care access as a human right in 2013, the implementation of palliative care in China gains special importance. Palliative care education is an important precondition to ensure a nationwide access to palliative care. This systematic review details the status of under- and postgraduate palliative care education in China, examining both the students' and physicians' perception, knowledge, and skills in palliative care, and the available educational interventions and programs. METHOD Four databases were searched in September 2018, using considered search terms. Titles, abstracts, and, if necessary, full texts were scanned to identify publications matching the inclusion criteria. RESULTS Nine publications were included. They revealed six findings: palliative care education is lacking in both under- and postgraduate medical education, only a few programs exist. Palliative care as a concept is well known, detailed knowledge, and practical skills are less developed. Chinese physicians consider palliative care an important field to be developed in cancer care, yet the majority of healthcare professionals are not willing to work in palliative care services. Communication should be a main emphasis in palliative care education, especially in undergraduate training. Finally, there is no highly qualified research on under- or postgraduate palliative care education in Mainland China. SIGNIFICANCE OF RESULTS These findings suggest that palliative care education in China is in demand and should be systematically integrated into medical education. Further research on the topic is urgently needed.
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Jabbari H, Azami-Aghdash S, Piri R, Naghavi-Behzad M, Sullman MJ, Safiri S. Organizing palliative care in the rural areas of Iran: are family physician-based approaches suitable? J Pain Res 2018; 12:17-27. [PMID: 30588076 PMCID: PMC6302809 DOI: 10.2147/jpr.s178103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The provision of palliative end-of-life care (P/EOLc) for patients, wherever they live, is an increasingly important service, particularly given the increasing rates of cancer and other life-threatening diseases in Iran. However, unfortunately, those living in the rural areas of Iran are greatly disadvantaged with respect to this type of care. Therefore, the present study explored the feasibility of organizing P/EOLc in the rural areas of Iran. METHODS In this qualitative study, two focus group (FG) discussions were held in Tabriz (Iran) with rural family physicians (FPs, n=23) and key P/EOLc stakeholders (n=13). The FG sessions were recorded, transcribed, and the transcriptions checked by participants before the data were subjected to content analysis. RESULTS While most FPs indicated that they did not have sufficient involvement in providing P/EOLc, they emphasized the necessity of providing P/EOLc through four main themes and 25 subthemes. The four main themes were labeled as "structures and procedures," "health care provider teams," "obstacles," and "strategies or solutions." Furthermore, according to the main themes and subthemes identified here, the key stakeholders believed that the Iranian health system and the FPs' team have the potential to provide P/EOLc services in rural areas. CONCLUSION The most feasible strategy for providing P/EOLc in Iranian rural areas would be to use the current health care framework and base the process around the FP.
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Affiliation(s)
- Hossein Jabbari
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Piri
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark Jm Sullman
- School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran,
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
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Huang HL, Yao CA, Hu WY, Cheng SY, Hwang SJ, Chen CD, Lin WY, Lin YC, Chiu TY. Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey. J Pain Symptom Manage 2018; 55:843-850. [PMID: 29221846 DOI: 10.1016/j.jpainsymman.2017.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. METHODS This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. RESULTS Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death." CONCLUSION The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Dao Chen
- Department of Family Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chun Lin
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
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Sarra A, Feuz C. Examining the Prevalence of Compassion Fatigue and Burnout in Radiation Therapists Caring for Palliative Cancer Patients. J Med Imaging Radiat Sci 2018; 49:49-55. [DOI: 10.1016/j.jmir.2017.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/18/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
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Feuz C, Rosewall T, Willis S. Radiation Therapy Students' Knowledge, Attitudes, and Beliefs about Palliative and End-of-Life Care for Cancer Patients. J Med Imaging Radiat Sci 2015; 46:271-279. [PMID: 31052133 DOI: 10.1016/j.jmir.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Although radiation therapy students are highly interested in providing palliative and end-of-life care (PEOLC), students often lack understanding of what palliative care is and express a lack of confidence when interacting with palliative patients. This study examined radiation therapy students' existing knowledge, attitudes, and beliefs toward PEOLC for cancer patients and how professional and personal experiences influenced those factors. METHODS This study used a cross-sectional online questionnaire. After informed consent, data were collected from a sample of students in an undergraduate radiation therapy program in Canada. Questions were both quantitative and qualitative in nature. Responses were comprised of Likert scales and true or false responses, a case study-based vignette and several short open-ended questions. RESULTS Sixty-one students completed the questionnaire; the response rate was 42%. Responses indicate students had an incomplete understanding of PEOLC principles despite reporting positive views and interest in the topic. Professional and personal experiences improved students' knowledge regarding the role of PEOLC and attitudes and beliefs became more positive with increased real-life experiences. CONCLUSIONS Experiential learning influences students' knowledge, attitudes, and beliefs about PEOLC. To better prepare students for their future professional roles, it is necessary for radiation therapy undergraduate programs to include PEOLC educational initiatives in its curricula. These initiatives should emphasize holistic care to prepare students to be competent radiation therapists who can address patients' complex PEOLC needs.
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Affiliation(s)
- Carina Feuz
- Radiation Therapy Department, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Tara Rosewall
- Radiation Therapy Department, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Susan Willis
- Department of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Ilan S, Carmel S. Patient communication pattern scale: psychometric characteristics. Health Expect 2015; 19:842-53. [PMID: 26172267 PMCID: PMC5034838 DOI: 10.1111/hex.12381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In western societies, a shared decision-making model for doctor-patient relationships calling for open and collaborative communication is recommended. Research focuses mainly on the doctor's communication patterns, while research on patient communication patterns is rare. The purpose of this study was to develop a tool for evaluating patient's communication patterns - the Patient Communication Pattern Scale (PCPS). METHODS Interviews based on structured questionnaires were conducted with 251 cancer patients. In addition to the 14-item PCPS, the questionnaire included questions regarding education, religiosity and desirability of control in general and over one's own health in particular, for validating the scale. RESULTS The PCPS was found to be a valid and reliable tool for evaluating patients' communication patterns. Confirmatory factor analysis supported the PCPS designed structure of five facets: (1) Information, (2) Clarification, (3) Initiation, (4) Preferences and (5) Emotions. CONCLUSION The PCPS is a reliable scale for evaluating patient communication patterns. The use of this scale can assist in promoting related research and in developing interventions for enhancing open and collaborative doctor-patient communication.
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Affiliation(s)
- Sara Ilan
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sara Carmel
- Head Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Huang HL, Cheng SY, Yao CA, Hu WY, Chen CY, Chiu TY. Truth Telling and Treatment Strategies in End-of-Life Care in Physician-Led Accountable Care Organizations: Discrepancies Between Patients' Preferences and Physicians' Perceptions. Medicine (Baltimore) 2015; 94:e657. [PMID: 25906093 PMCID: PMC4602689 DOI: 10.1097/md.0000000000000657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients' attitudes toward truth telling and treatment preferences in end-of-life care and compare patients' attitudes with their ACOs physicians' perceptions.This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences.The data of 314 patients (effective response rate = 88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P < 0.001). Significant differences were also found in attitudes toward truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P < 0.001).Significant discrepancies exist between patients' preferences and physicians' perceptions toward truth telling and treatment strategies in end-of-life care. It is important to enhance physician-patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians' professional development would be helpful in the reform strategies of establishing accountable care around the world.
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Affiliation(s)
- Hsien-Liang Huang
- From the Department of Family Medicine (HLH), Cardinal Tien Hospital, and Fu-Jen Catholic University, New Taipei City; Department of Family Medicine (SYC, CAY, CYC, TYC); and School of Nursing (WYH), College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Lee PC, Lo C, Ko WJ, Huang SJ, Lee PH. When and how should physicians determine the need for palliative and hospice care for patients with end-stage liver disease?: an experience in Taiwan. Am J Hosp Palliat Care 2013; 31:454-8. [PMID: 23861543 DOI: 10.1177/1049909113495707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We analyzed one case of end-stage liver disease and discussed whether the palliative care should be considered for this case. The medical record of a 56-year-old woman with alcoholic liver cirrhosis admitted to our hospital due to hypovolemic shock and esophageal varices (EV) was reviewed. The EV with active bleeding were arrested by panendoscopic intervention. However, repeat surgery revealed transmural laceration over the cardia, and immediate surgery and splenectomy were needed. The patient died postoperatively in the surgical intensive care unit due to bleeding tendency and hypovolemic shock. We suggest that palliative care and/or hospice care should have been considered for this patient before the crisis developed and that physicians require education about timely palliative and hospice care for patients with end-stage nonmalignant disease.
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Affiliation(s)
- Po-Chu Lee
- 1Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
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Peng JK, Chiu TY, Hu WY, Lin CC, Chen CY, Hung SH. What influences the willingness of community physicians to provide palliative care for patients with terminal cancer? Evidence from a nationwide survey. Jpn J Clin Oncol 2013; 43:278-85. [PMID: 23288932 DOI: 10.1093/jjco/hys222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Community physicians have a vital role in delivering palliative care, yet their willingness and factors that influence its provision have rarely been explored. Our aims were to identify the willingness of community physicians to provide palliative care for patients with terminal cancer and to investigate the factors that influence their willingness to provide such care. METHODS Through a structured questionnaire, this nationwide study surveyed 708 community physicians who were potential pilots to provide palliative care. Four hundred and ten valid questionnaires (58.0%) were retrieved and analysed. RESULTS The majority of respondents expressed a willingness (92.4%) to provide palliative care if they encountered patients with terminal cancer. However, they would limit their services to consultation (83.4%) and referral (86.8%), and were less likely to see patients and prescribe medicine (62.0%), to provide phone follow-ups (45.6%), to provide home visits (42.2%) or to offer bereavement care for the family (35.1%). The results of stepwise logistic regression analysis for the willingness to provide home visits showed that 'less perception of barriers', 'family medicine specialist' and 'older than 50 years' significantly predicted higher willingness, while 'female' predicted lower willingness. There was no significant association between the willingness and the knowledge score. CONCLUSIONS Community physicians' beliefs and experience in palliative care rather than their knowledge influence their willingness to provide palliative care for patients with terminal cancer. Only through active participation in the real-world clinical setting and active health policy administration can community physicians overcome obstacles to providing palliative care.
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Affiliation(s)
- Jen-Kuei Peng
- Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, No. 579 Sec. 2 Yunlin Road, Douliou City, Yunlin, Taiwan
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To Explore the Neonatal Nurses’ Beliefs and Attitudes Towards Caring for Dying Neonates in Taiwan. Matern Child Health J 2012. [DOI: 10.1007/s10995-012-1199-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Huang HL, Chiu TY, Lee LT, Yao CA, Chen CY, Hu WY. Family experience with difficult decisions in end-of-life care. Psychooncology 2012; 21:785-91. [PMID: 22619164 DOI: 10.1002/pon.3107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 09/11/2010] [Accepted: 12/01/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The difficult decisions encountered by family caregivers in the process of care for patients with terminal cancer are seldom studied. Investigating their experiences with difficult decisions may help relieve their psychological distress. The purpose of this study was to determine the frequency and difficulty of decisions experienced in end-of-life care and to identify related factors. METHODS A cross-sectional study using questionnaires was conducted with family caregivers of patients who died of cancer in a university hospital. Difficulty of decisions and relevant influencing variables including demographic data, knowledge in palliative care and the Natural Death Act, and beliefs on the Natural Death Act were measured. RESULTS A total of 302 bereaved family caregivers were included in the final analysis. The most difficult decisions commonly encountered in both hospice and non-hospice wards related to truth telling, place of care, and alternative treatments. Logistic regression analysis demonstrated that older age (odds ratio = 0.92, 95% confidence interval = 0.89-0.95), not being the main family caregiver (0.20, 0.06-0.62), and less perception of burdens regarding the Natural Death Act (0.61, 0.37-0.99) were negatively correlated with the difficulty of decisions. CONCLUSIONS Families frequently encountered difficult decisions while caring for terminally ill loved ones. Better communication with family members, particularly the main caregiver, to diminish negative perceptions of the Natural Death Act could help to decrease psychological distress.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Shih CY, Chiu TY, Lee LT, Yao CA, Chen CY, Hu WY. What Factors Are Important in Increasing Junior Doctors' Willingness To Provide Palliative Care in Taiwan? An Educational Intervention Study. J Palliat Med 2010; 13:1245-51. [DOI: 10.1089/jpm.2010.0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chih-Yuan Shih
- Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
- Division of Gerontology Research, National Health Research Institutes, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Hu WY, Huang CH, Chiu TY, Hung SH, Peng JK, Chen CY. Factors that influence the participation of healthcare professionals in advance care planning for patients with terminal cancer: A nationwide survey in Taiwan. Soc Sci Med 2010; 70:1701-4. [DOI: 10.1016/j.socscimed.2010.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 11/28/2022]
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Chiu TY, Hu WY, Huang HL, Yao CA, Chen CY. Prevailing Ethical Dilemmas in Terminal Care for Patients With Cancer in Taiwan. J Clin Oncol 2009; 27:3964-8. [DOI: 10.1200/jco.2008.21.4643] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The study aimed to investigate prevailing ethical dilemmas in terminal care for patients with cancer nationwide and identify related factors after the enactment of the Natural Death Act in Taiwan. Methods This multicenter study surveyed 800 physicians and nursing staff of oncology wards and hospices through a set questionnaire. A total of 505 respondents (63.1%) who had taken care of patients with terminal cancer were analyzed. Results The most frequently encountered ethical dilemmas were truth-telling (mean ± SD = 1.30 ± 0.63; range [never, occasional, often], 0 to 2) and place of care (1.19 ± 0.69), both of which were related to communication issues. Dilemmas related to clinical management were artificial nutrition and hydration (1.04 ± 0.66) and use of antimicrobial agents (0.94 ± 0.70). Logistic regression analyses revealed that positive attitudes about the Natural Death Act was negatively related to the extent of ethical dilemmas (odds ratio, 0.426; 95% CI, 0.256 to 0.710]. Conclusion The enactment of the Natural Death Act in Taiwan would contribute to improving the quality of end-of-life care, which suggests that this kind of law should be adopted in other countries. Educating cancer care professionals in building positive beliefs toward the act is strongly encouraged.
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Affiliation(s)
- Tai-Yuan Chiu
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Wen-Yu Hu
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Hsien-Liang Huang
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Chien-An Yao
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Ching-Yu Chen
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
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Peng JK, Hu WY, Hung SH, Yao CA, Chen CY, Chiu TY. What can family physicians contribute in palliative home care in Taiwan? Fam Pract 2009; 26:287-93. [PMID: 19395649 DOI: 10.1093/fampra/cmp023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family physicians in Taiwan have expressed low willingness to provide palliative home care. OBJECTIVE To explore the medical needs of terminal cancer patients in home care and thus clarify the role and tasks of family physicians in providing palliative home care. METHODS Seventy-seven terminal cancer patients discharged from a palliative care unit from July 2003 to July 2004 who had received family physician home visits were enrolled. A structured assessment form was applied to each visit. RESULTS Under the collaboration by the palliative home care team and family physicians, the average interval from discharge to the first physician visit was 20.3 days and the average interval between physician visits was 37.9 days. The patients had an average of 5.9 active medical problems: the most frequent problem was pain (58.4%), followed by anorexia (42.9%) and constipation (42.9%). Forty-four patients (58.7%) died at home, while 31 patients (41.3%) eventually died in the hospital. Through multiple logistic regression analysis, patients who had never been rehospitalized [odds ratio (OR) = 12.95, 95% confidence interval (CI) = 3.41-49.19], who preferred to die at home (OR = 4.68, 95% CI = 1.21-18.09) and who were most functionally dependent with an Eastern Cooperative Oncology Group scale = 4 (OR = 4.36, 95% CI = 1.02-18.64) were found to be most likely to die at home under this care model. CONCLUSION Through palliative home care with the participation of family physicians, patients' preference could be a significant determinant of home death. Our finding can be helpful to the establishment of an ethical care model for terminal cancer patients.
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Affiliation(s)
- Jen-Kuei Peng
- Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Taiwan
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Reflections on an End-of-life Care Course for Preclinical Medical Students. J Formos Med Assoc 2009; 108:636-43. [DOI: 10.1016/s0929-6646(09)60384-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Robinson CA, Pesut B, Bottorff JL, Mowry A, Broughton S, Fyles G. Rural Palliative Care: A Comprehensive Review. J Palliat Med 2009; 12:10.1089/jpm.2008.0228. [PMID: 19216703 DOI: 10.1089/jpm.2008.0228] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Background: Access to integrated, palliative care regardless of location of residence is a palliative care standard yet we know such access is limited for those living in rural and remote settings. As a beginning step in the development of research aimed at informing policy and program development, a comprehensive review of the state of knowledge regarding palliative care in rural contexts is required. Purpose: To identify, evaluate and synthesize the published literature on rural palliative care. Design: Comprehensive review. Methods: Computer searches were conducted on PubBMed, ISI Web of Science, PsycInfo, CINAHL, and Ageline using the search terms palliative care, hospice, terminal care, end-of-life care, end-of-life, and rural or remote. Results: One hundred fifty-eight studies were retrieved. After screening using relevance and quality criteria, 79 studies were included in the review. Studies were grouped by subject matter into one of three categories: patient and caregiver perspectives; professional attitudes, knowledge and practice issues; and health care services. Conclusion: The body of research literature is small and eclectic, which means there is little strong evidence to inform palliative policy and service development in rural settings. Coordinated programs of research are clearly required to develop a body of knowledge that is adequate to support effective service and policy development.
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Affiliation(s)
- Carole A Robinson
- 1 Faculty of Health and Social Development, UBC Okanagan , Kelowna British Columbia., 2 School of Nursing, UBC Okanagan , Kelowna British Columbia., 3 Centre for Healthy Living and Chronic Disease Prevention, UBC Okanagan , Kelowna British Columbia., 4 Palliative Care Services, Peterborough Regional Health Centre , Peterborough, Ontario, Canada ., 5 BC Cancer Agency-Centre for the Southern Interior , Kelowna, British Columbia., 6 Pain & Symptom Management/Palliative Care Program, BC Cancer Agency-Centre for the Southern Interior , Kelowna, British Columbia
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Devi BCR, Tang TS, Corbex M. Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia. Ann Oncol 2008; 19:2061-6. [PMID: 18641007 DOI: 10.1093/annonc/mdn422] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. METHODS The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. RESULTS The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. CONCLUSION The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.
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Affiliation(s)
- B C R Devi
- Department of Radiotherapy and Oncology, Sarawak General Hospital, Sarawak, Malaysia.
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Yao CA, Hu WY, Lai YF, Cheng SY, Chen CY, Chiu TY. Does dying at home influence the good death of terminal cancer patients? J Pain Symptom Manage 2007; 34:497-504. [PMID: 17629664 DOI: 10.1016/j.jpainsymman.2007.01.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 01/09/2007] [Accepted: 01/10/2007] [Indexed: 11/21/2022]
Abstract
To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45 +/- 14.77 years. The total good-death score in the home-death group (n=307) was significantly higher than that in the hospital-death group (n=67), both at the time of admission (t= -5.741, P<0.001) and prior to death (t= -3.027, P<0.01). However, the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in the hospital-death group (P=0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in the hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P=0.132). Bereavement support (odds ratio=1.01, 95% confidence interval=0.62-1.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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