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Craig S, Cao Y, McMahon J, Anderson T, Stark P, Brown Wilson C, Creighton L, Gonella S, Bavelaar L, Vlčková K, Mitchell G. Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review. Healthcare (Basel) 2023; 11:3166. [PMID: 38132056 PMCID: PMC10743280 DOI: 10.3390/healthcare11243166] [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: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents' holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.
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Affiliation(s)
- Stephanie Craig
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Yanting Cao
- The Shanghai Medical College, Fudan University, Shanghai 200437, China;
- Stellar Care NW Ltd., Ellesmere Port CH65 1A, UK
| | - James McMahon
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Tara Anderson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Patrick Stark
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Christine Brown Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Laura Creighton
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy;
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Gary Mitchell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
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Pergolizzi D, Crespo I. The past and future of uncertainty in advanced illness: a systematic scoping review of underlying cognitive processes. ANXIETY, STRESS, & COPING 2022; 36:415-433. [DOI: 10.1080/10615806.2022.2134566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Joad ASK, Hota A, Agarwal P, Patel K, Patel K, Puri J, Shin S. “I want to live, but …” the desire to live and its physical, psychological, spiritual, and social factors among advanced cancer patients: evidence from the APPROACH study in India. BMC Palliat Care 2022; 21:153. [PMID: 36045352 PMCID: PMC9429624 DOI: 10.1186/s12904-022-01041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
The limited access to palliative care resources along with the social stigma around cancer largely explains the poor quality of life (QoL) of Indian advanced cancer patients. As advanced cancer patients with poor QoL often harbour a desire for hastened death (DHD), it is imperative to understand factors affecting DHD, or the desire to live (DTL) among advanced cancer patients in India. We aim to examine the relationship between DTL and physical, psychological, spiritual, and social factors measuring patients’ QoL alongside their awareness of their late cancer stage.
Methods
We surveyed 200 patients from a tertiary cancer hospital in India to collect their DTL, awareness of cancer stage, demographic characteristics, and standardized measures for patients’ QoL. We used a linear probability regression model to quantify the association between these factors and patients’ DTL among the final sample of 192 patients with no missing information for the variables of interest.
Results
Among the various domains affecting cancer patients’ QoL, we found that the pain severity score (ranging from 0 to 10) and psychological distress score (ranging from 0 to 42) are negatively associated with the DTL. One point increase in each score reduced the DTL by 2.2% (p < 0.05) and 0.7% (p < 0.05), respectively. Our results also showed that patients whose perceived socio-economic status (SES) is poor have a 16% (p < 0.05) lower probability of DTL, compared to those with higher SES (lower middle class, upper middle class, and wealthy). Controlling for caste, religion, gender, age, marital status and years of education, we found psychological distress is statistically higher among patients belonging to this bottom SES.
Conclusions
We found that pain severity, psychological distress and perceived low SES are negatively associated with the desire to live in advanced cancer patients. Future research should focus on developing interventions to improve physical pain and psychological distress, particularly for patients who are socially and economically disadvantaged.
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Muruthi JR, Spafford SG, Osa ML, DeLouize A, Kowal P, Biritwum R, Snodgrass JJ. Suicidal ideation in older Ghanaian women: The roles of bodily pain, functional limitation, and chronic health conditions. Int J Soc Psychiatry 2022; 68:555-563. [PMID: 33541175 DOI: 10.1177/0020764021991179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although approximately 79% of the world's suicides occur in low- and middle-income countries (LMICs), the limited research in these regions has primarily focused on the rates of suicide attempts (SA) and ideation among men and younger members of the population. AIM This study investigated the associations between bodily pain, functional limitation, chronic health conditions, and suicidal ideation among older Ghanaian women with a positive screen for depression. METHODS Data was obtained from the World Health Organization's Study on global AGEing and adult health (SAGE) Ghana Wave 1, a nationally representative sample. Based on the interpersonal theory of suicide, we used logistic regression analysis to investigate the associations between the variables. RESULTS Functional limitation, bodily pain, hopelessness, and hypertension were significantly associated with a higher risk of suicidal ideation after accounting for sociodemographic and other confounding factors. CONCLUSIONS Early interventions designed to decrease hopelessness, hypertension, and functional limitations may lead to reduced suicide ideation among older Ghanaian women who screen positive for depression.
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Affiliation(s)
- James R Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Sarah G Spafford
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Maggie L Osa
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Alicia DeLouize
- Department of Anthropology, University of Oregon, Eugene, USA
| | - Paul Kowal
- Department of Anthropology, University of Oregon, Eugene, USA
| | - Richard Biritwum
- Department of Community Health, University of Ghana, Legon, Greater Accra, Ghana
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Green G. How End-of-Life Blogs Re-Affirm the "Power to be Oneself". FRONTIERS IN SOCIOLOGY 2022; 6:775279. [PMID: 35097060 PMCID: PMC8795734 DOI: 10.3389/fsoc.2021.775279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
Powerlessness generally denotes loss of control and may be experienced among those with a terminal diagnosis and, as such, empowerment is a dominant discourse in end-of-life policy in the western Anglo-Saxon world. This paper analyzes thematically blogs authored by three people with a terminal diagnosis to examine the "power to be oneself," a concept which was identified in the "Ethics of Powerlessness" project conducted in the UK. The analysis demonstrates that the bloggers assert the "power to be themselves" which is expressed in three principal ways. Firstly, through assertion of agency to promote self-affirmation and control. Secondly, through claiming a "moral authority" expressed by providing advice not just on illness and death but also on how life should be lived. Thirdly, through discussing ideas about the future and creating a legacy. The blogs are a mechanism used to express and reinforce self-identity and to carve out a "sacred space" between life and death to nurture personal change and to project this onto a public arena. This analysis demonstrates the key role patient empowerment plays in constructing an identity with a terminal diagnosis, an element that is often overlooked in end-of-life policy.
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Abstract
OBJECTIVE To explore family members' experiences of advance care planning in nursing homes. DESIGN Individual interviews. Thematic analysis. SETTING Four nursing homes in Sweden. SUBJECTS Eighteen family members of deceased nursing home patients. MAIN OUTCOME MEASURES Family members' experiences of advance care planning in nursing homes. RESULTS Family members' experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patient's preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patient's wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physician's absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions. CONCLUSION Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patient's wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning. Key points Knowledge on advance care planning (ACP) in a nursing home (NH) context from the perspective of family members is limited. Role of the nurse in ACP is seen as central, whereas physician involvement is often perceived to be lacking. Significance of small details, perceive to symbolize staff competence and respect for patient autonomy. To limit family members' feeling of guilt, communicating end-of-life issues is important in order to align ACP with patient preferences.
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Affiliation(s)
- Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Center in Ljungsbro, Linköping University, Linköping, Sweden
- CONTACT Lisa Kastbom Department of Health, Medicine and Caring Sciences, Linköping University, pl 14, Linköping, S-581 83, Sweden
| | - Marit Karlsson
- Department of Advanced Home Care in Linköping, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Magnus Falk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Center in Kärna, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Advanced Home Care in Norrköping, Linköping University, Linköping, Sweden
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Paladino J, Koritsanszky L, Nisotel L, Neville BA, Miller K, Sanders J, Benjamin E, Fromme E, Block S, Bernacki R. Patient and clinician experience of a serious illness conversation guide in oncology: A descriptive analysis. Cancer Med 2020; 9:4550-4560. [PMID: 32363775 PMCID: PMC7333843 DOI: 10.1002/cam4.3102] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVE Oncology guidelines recommend earlier communication with patients about prognosis and goals-of-care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG). DESIGN/SETTING Secondary analysis from a cluster-randomized clinical trial in a northeastern cancer center. PARTICIPANTS Physicians, advanced practice clinicians, and patients with advanced cancer who received the intervention. INTERVENTION SICG, clinician training, systems-changes. MAIN OUTCOMES AND MEASURES The patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role. RESULTS We enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role. CONCLUSION Conversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
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Affiliation(s)
- Joanna Paladino
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Luca Koritsanszky
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Nisotel
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bridget A Neville
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Kate Miller
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Justin Sanders
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Evan Benjamin
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Erik Fromme
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Susan Block
- Harvard Medical School, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachelle Bernacki
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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Xu X, Cheng Q, Ou M, Li S, Xie C, Chen Y. Pain acceptance in cancer patients with chronic pain in Hunan, China: A qualitative study. Int J Nurs Sci 2019; 6:385-391. [PMID: 31728390 PMCID: PMC6838986 DOI: 10.1016/j.ijnss.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The purpose of this qualitative study was to describe the experiences of pain acceptance in Chinese cancer patients with chronic pain. Methods Twelve hospitalized cancer patients with chronic pain participated in this qualitative descriptive study from August to November 2017. In-person semi-structured interviews were conducted, recorded, transcribed, and analyzed using Colaizzi's seven-step method. Results The following four main themes and 15 subthemes emerged. Theme 1 (adaptation): pain is overwhelming and pain relief is a top priority, avoidance of pain-inducing factors, and resignation; theme 2 (emotional reactions to pain): feeling misunderstood, hopelessness, frustration, irritability, and concern for loved ones; theme 3 (functional limitations): daily life activities, social communication, and work; theme 4 (coping strategies): pharmacological therapies, behavioral strategies, social support strategies, and spiritual strategies. Conclusions This study provides a description of cancer patients' experiences related to the need for pain acceptance. These findings provide insight into the essential role of pain acceptance and underline the need to apply acceptance-based cognitive behavioral interventions as adjunctive non-pharmacological alternatives for chronic cancer pain.
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Affiliation(s)
- Xianghua Xu
- Head & Neck Plastic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Qinqin Cheng
- Pain Ward, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Meijun Ou
- Head & Neck Plastic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Shaping Li
- Nursing Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Chanjuan Xie
- Nursing Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Yongyi Chen
- Nursing Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
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Shady K, Nair J, Crannell C. Lavender Aromatherapy: Examining the Effects of Lavender Oil Patches on Patients in the Hematology-Oncology Setting. Clin J Oncol Nurs 2019; 23:502-508. [DOI: 10.1188/19.cjon.502-508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hemberg J, Bergdahl E. Dealing with ethical and existential issues at end of life through co-creation. Nurs Ethics 2019; 27:1012-1031. [PMID: 31522601 DOI: 10.1177/0969733019874496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient's quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients' and their relatives' needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life. AIM The aim of this study was to explore nurses' experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. ETHICAL CONSIDERATIONS Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. FINDINGS A main theme and four subthemes emerged. The main theme was "Deep co-creative relationships are needed to manage ethical and existential issues at the end of life." A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. DISCUSSION Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses' ethical competence within this context. CONCLUSION The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients' perspective.
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Hussain FA. Using a frame of reference for talking to patients about death and dying. ACTA ACUST UNITED AC 2019; 28:1069-1075. [DOI: 10.12968/bjon.2019.28.16.1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent years have seen a recognition of the importance of talking openly to patients at the end of life about death and dying. This article aims to add to the existing body of literature on this subject. Conversations at the end of life can be difficult, particularly if the patient is experiencing mental distress alongside their terminal illness. A number of factors can disrupt a constructive and supportive conversation around death and dying. This article offers a frame of reference for nurses to consider when having such conversations.
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Affiliation(s)
- Feryad A Hussain
- Clinical Psychologist, North East London NHS Foundation Trust, London, at time of writing
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12
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Tarbi EC, Meghani SH. A concept analysis of the existential experience of adults with advanced cancer. Nurs Outlook 2019; 67:540-557. [PMID: 31040052 PMCID: PMC6764914 DOI: 10.1016/j.outlook.2019.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention to the existential dimension of an individual's experience during serious illness is important. However, existential concerns continue to be poorly defined in literature, leading to neglect in the clinical realm. PURPOSE This concept analysis seeks to clarify the concept of the existential experience within the context of adults with advanced cancer. METHODS Rodgers' evolutionary method of concept analysis was used. DISCUSSION Existential experience in adults with advanced cancer is a dynamic state, preceded by confronting mortality, defined by diverse reactions to shared existential challenges related to the parameters of existence (body, time, others, and death), resulting in a dialectical movement between existential suffering and existential health, with capacity for personal growth. Personal factors and the ability to cope appear to influence this experience. CONCLUSION These findings can drive future research and enhance clinician ability to attend to the existential domain, thereby improving patient experience at end-of-life.
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Affiliation(s)
- Elise C Tarbi
- University of Pennsylvania School of Nursing, Philadelphia, PA.
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13
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Kastbom L, Milberg A, Karlsson M. 'We have no crystal ball' - advance care planning at nursing homes from the perspective of nurses and physicians. Scand J Prim Health Care 2019; 37:191-199. [PMID: 31122099 PMCID: PMC6567000 DOI: 10.1080/02813432.2019.1608068] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: To investigate clinicians' perspectives on the factors that shape the process of advance care planning in a nursing home context. Design: Interviews. Latent qualitative content analysis. Setting: Nine nursing homes in Sweden. Subjects: 14 physicians and 11 nurses working at nursing homes. Main outcome measures: Participants' views on advance care planning (ACP) at nursing homes. Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patient's readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patient's preferences and staff's and family member's views; Decision & documentation of the ACP, e.g. clear documentation in patient's medical records that are up-to-date and available for staff caring for the patient, and Implementation & re-evaluation of the ACP, e.g. nurse following up after ACP-appointment to confirm the content of the documented ACP. The latent theme, Establishing beneficence - defending oneself against tacit accusations of maleficence, emerged as a deeper meaning of all the four (manifest) parts of the ACP-process Conclusion: This study stresses the importance of involving patients, family members, and the team in the work with advance care planning in nursing homes. In addition, clear medical record documentation and proficiency in end-of-life communication related to advance care planning for physicians as well as nurses may also be factors that significantly shape advance care planning in a nursing home context. Key Points Advance care planning can help patients to receive care in line with their preferences and can positively impact quality of end-of-life care. Our results describe a process consisting of four manifest categories and one latent theme constituting the process of advance care planning, that may be considered in education in advance care planning. The significance of nurses and physicians perceiving beneficence as well as fear of accusations of maleficence are important factors to contemplate. The study has implications for healthcare staff caring for patients near the end of their lives, in particular patients in nursing homes.
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Affiliation(s)
- Lisa Kastbom
- Primary Health Center in Ljungsbro, and Department of Medical and Health Sciences, Linköping University, Ljungsbro, Sweden;
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;
- CONTACT Lisa Kastbom , Department of Medical and Health Sciences, Linköping University, pl 14, S-581 83Linköping, Sweden
| | - Anna Milberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;
- Department of Advanced Home Care, Linköping University, Norrköping, Sweden;
| | - Marit Karlsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;
- Department of Advanced Home Care, Linköping University, Linköping, Sweden
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14
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Mah K. Existential loneliness and the importance of addressing sexual health in people with advanced cancer in palliative care. Psychooncology 2019; 28:1354-1356. [DOI: 10.1002/pon.5092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario
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15
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Sjöberg M, Beck I, Rasmussen BH, Edberg AK. Being disconnected from life: meanings of existential loneliness as narrated by frail older people. Aging Ment Health 2018; 22:1357-1364. [PMID: 28714734 DOI: 10.1080/13607863.2017.1348481] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people. METHOD Data were collected through individual narrative interviews with 23 people 76-101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL. RESULT Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning. These intertwined themes were synthesized into a comprehensive understanding of EL as 'being disconnected from life'. CONCLUSION Illness and physical limitation affects access to the world. When being met with indifference and being unable to share one's thoughts and experiences of life with others, a sense of worthlessness is reinforced, triggering an experience of meaninglessness and EL, i.e. disconnection from life. It is urgent to develop support strategies that can be used by health care professionals to address older people in vulnerable situations, thereby facilitating connectedness.
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Affiliation(s)
- Marina Sjöberg
- a Department of Care Science, Faculty of Health and Society , Malmö University , Malmö , Sweden.,b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
| | - Ingela Beck
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden.,c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,d Department of Clinical Sciences Lund, Division of Oncology, Faculty of Medicine , Lund University , Lund , Sweden
| | - Birgit H Rasmussen
- c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,e Department for Health Sciences, Faculty of Medicine, Unit of Older People's Health and Person Centred Care , Lund University , Lund , Sweden
| | - Anna-Karin Edberg
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
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Smith R, Burgess C, Sorinola I. The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: An interpretative phenomenological analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1726. [PMID: 29984436 DOI: 10.1002/pri.1726] [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] [Received: 04/03/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The poststroke upper limb continues to pose a myriad of physical and psychological challenges for patients and caregivers. To optimize existing services, this study firstly aimed to explore the experiences of both stroke survivors and caregivers and secondly identify their ongoing needs. METHODS A qualitative approach was utilized for this study. Six participants (three stroke survivors and three caregivers) were purposively sampled from community stroke groups. Semi structured interviews were utilized to collect experiential data, which were analysed using an interpretative phenomenological approach. RESULTS Three master themes emerged from data analysis: "Finding a way forwards from a poor start," "The battle with the upper-limb," and "Relationships with self and society." All participants, seemingly affected by disappointing services, expressed negative views of rehabilitation. Misplaced or persistent hope, losses in control, and reduced autonomy may have contributed to poor functional outcomes and perceptions of rehabilitation services. The complex physical and psychological impact of the experience of the dysfunctional upper limb was also associated with ongoing and unmet support needs for stroke survivors and carers. CONCLUSIONS Healthcare professionals may consider the varying impact of the dysfunctional upper limb during decision-making and treatment planning, particularly during acute rehabilitation. Future research could explore therapists' perceptions and experiences of upper-limb rehabilitation during this period.
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Affiliation(s)
| | - Caroline Burgess
- Primary Care and Public Health Sciences, King's College London, London, UK
| | - Isaac Sorinola
- Primary Care and Public Health Sciences, King's College London, London, UK
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Vehling S, Gerstorf D, Schulz-Kindermann F, Oechsle K, Philipp R, Scheffold K, Härter M, Mehnert A, Lo C. The daily dynamics of loss orientation and life engagement in advanced cancer: A pilot study to characterise patterns of adaptation at the end of life. Eur J Cancer Care (Engl) 2018; 27:e12842. [DOI: 10.1111/ecc.12842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - D. Gerstorf
- Department of Psychology; Humboldt University Berlin; Berlin Germany
| | - F. Schulz-Kindermann
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Oechsle
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - R. Philipp
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Scheffold
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Härter
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department of Medical Psychology and Sociology; University Medical Center Leipzig; Leipzig Germany
| | - C. Lo
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
- Department of Psychology; University of Guelph-Humber; Toronto ON Canada
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Ghodraty Jabloo V, Alibhai SMH, Fitch M, Tourangeau AE, Ayala AP, Puts MTE. Antecedents and Outcomes of Uncertainty in Older Adults With Cancer: A Scoping Review of the Literature. Oncol Nurs Forum 2018. [PMID: 28632247 DOI: 10.1188/17.onf.e152-e167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential.
. LITERATURE SEARCH MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging.
. DATA EVALUATION Extracted data included research aims; research design or analysis approach; sample size; mean age; type, stage, and duration of cancer; type and duration of treatment; uncertainty scale; and major results.
. SYNTHESIS Of 2,584 articles initially identified, 44 studies (30 qualitative, 12 quantitative, and 2 mixed-methods) were included. Evidence tables were developed to organize quantitative and qualitative data. Descriptive numeric and thematic analyses were used to analyze quantitative results and qualitative findings, respectively. Outcomes were reported under four main categories. CONCLUSIONS Uncertainty is an enduring and common experience in cancer survivorship. Uncertainty is affected by a number of demographic and clinical factors and affects quality of life (QOL) and psychological well-being.
. IMPLICATIONS FOR PRACTICE Uncertainty should be considered a contributing factor to psychological well-being and QOL in older adults with cancer. Nurses are in a unique position to assess negative effects of uncertainty and manage these consequences by providing patients with information and emotional support.
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Adams RN, Mosher CE, Rand KL, Hirsh AT, Monahan PO, Abonour R, Kroenke K. The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation. Qual Life Res 2017; 26:1901-1913. [PMID: 28236266 DOI: 10.1007/s11136-017-1518-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer. METHODS First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients. RESULTS The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures. CONCLUSIONS The resulting measures have both clinical and research utility.
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Affiliation(s)
- Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, 780 Welch Road, MC 5776, Palo Alto, CA, 94304, USA.
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202, USA
| | - Rafat Abonour
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Drive, Indiana Cancer Pavilion, Suite 446, Indianapolis, IN, 46202, USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc. (RF), 1101 West Tenth Street, RF 221, Indianapolis, IN, 46202, USA
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Gökdemir-Bulut BP, Bozo Ö. The Psychometric Validity and Reliability of the Turkish Version of the Existential Loneliness Questionnaire. CURRENT PSYCHOLOGY 2016. [DOI: 10.1007/s12144-016-9534-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Odh I, Löfving M, Klaeson K. Existential challenges in young people living with a cancer diagnosis. Eur J Oncol Nurs 2016; 24:54-60. [DOI: 10.1016/j.ejon.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 07/08/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
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Yaman S, Ayaz S. Psychological Problems Experienced by Women with Gynecological Cancer and How They Cope with It: A Phenomenological Study in Turkey. HEALTH & SOCIAL WORK 2016; 41:173-181. [PMID: 29206956 PMCID: PMC4985887 DOI: 10.1093/hsw/hlw030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 05/31/2023]
Abstract
This study was carried out to reveal, in detail, the psychosocial problems faced by women in Turkey during their illness with gynecological cancer, and how they cope with these problems. The phenomenological approach used for the methodology is consistent with that described by Clark Moustakas's transcendental phenomenology. The sample included 17 married women. A semistructured, in-depth question directive was used to collect the data. The psychological problems found in the women in the study included frustration and despair, depression, inability to control anger, disruption in body image, and problems with their sex lives. The women in the study stated that, among other activities, they prayed frequently. They also emphasized that social support from family and others was important in coping. The majority said that they were able to cope through denial. Women under treatment for gynecological cancer should be evaluated from a psychosocial standpoint, and spiritual care and social support should be provided as they frequently use these to cope with their illness. It is recommended that a team be created, consisting of nurses, psychiatrists or psychologists, and religious staff to meet these needs.
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Affiliation(s)
- Sengül Yaman
- Nursing Department, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Sultan Ayaz
- Nursing Department, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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Development and Preliminary Testing of a Meaning-Centered Program for Young Adults With Advanced-Stage Cancer. J Hosp Palliat Nurs 2015. [DOI: 10.1097/njh.0000000000000146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Udo C. The concept and relevance of existential issues in nursing. Eur J Oncol Nurs 2014; 18:347-54. [DOI: 10.1016/j.ejon.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/12/2014] [Accepted: 04/09/2014] [Indexed: 12/30/2022]
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Abstract
Purpose: End-of-life care is designed as response to patients' verbally communicated needs. The concept of dying as a process would allow us to improve care. This concept may combine the needs of the dying, their outburst of emotions, gradual maturation, family processes, acute problems such as decreasing independence, with their inner experience and transformation of perception. In this study we explored dying patients' mode of perception, and deeper reasons for anxiety and existential suffering. Methods: Dying inpatients of a major cancer centre treated by an interdisciplinary team were eligible. Psychotherapy records of cancer patients (course, reactions, discussions with nurses and physicians) provided the data. Participant observation and Interpretative Phenomenological Analysis (IPA) was applied. Results: Our data (pilot study N=80/follow-up-study N=600) suggest that patients undergo transition into another state of consciousness beyond anxiety, ego, and pain. Transition appears to have three stages. Anxiety, struggle, denial/acceptance, family processes, and maturation (ie, finding meaning and dignity, coping with trauma) may depend on the transitional process and also hinder or facilitate this transitional process. Conclusions: Understanding dying as transition may induce a radical reinterpretation of what patients need.
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Affiliation(s)
- Monika Renz
- Psychooncology, Oncology, Cantonal Hospital, St.Gallen, Switzerland
| | | | - Daniel Bueche
- Palliative Center, Cantonal Hospital, St.Gallen, Switzerland
| | - Thomas Cerny
- Oncology, Cantonal Hospital, St.Gallen, Switzerland
| | - Florian Strasser
- Oncological Palliative Medicine, Cantonal Hospital, St.Gallen, Switzerland
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Gray H, Adam J, Brown D, McLaughlin P, Hill V, Wilson L. Visiting all hours: a focus group study on staff's views of open visiting in a hospice. Int J Palliat Nurs 2012; 17:552-60. [PMID: 22240633 DOI: 10.12968/ijpn.2011.17.11.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
St Columba's Hospice, Edinburgh, is a busy specialist palliative care unit with 30 inpatient beds. A previous publication reported the first strand of a qualitative exploratory study evaluating the impact of open visiting on patients at the hospice. This paper reports on the second strand, which sought to elicit the views of the hospice staff through focus group interviews. The main themes identified were valuing the family and friends as visitors, involving the family as part of the care team, patient powerlessness over visiting, shared rooms and their impact on visitors and patients, and the staff role as advocates or gatekeepers. Several strategies for developing a flexible and 'patient-controlled' visiting policy were identified, including quiet times without visitors, restriction of visitor numbers in shared rooms, and encouraging breaks from visiting. Since the study was completed, the hospice's visiting policy has been modified to ensure that it is patient-centred and meets the needs of patients and families.
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Affiliation(s)
- Helen Gray
- St Columba's Hospice, 15 Boseall Road, Edinburgh, EH5 3RW, Scotland.
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Protection against perceptions of powerlessness and helplessness during palliative care: The family members' perspective. Palliat Support Care 2011; 9:251-62. [DOI: 10.1017/s1478951511000204] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:Resilience in relation to coping with stress, loss, and bereavement has recently received increased attention. The aim of the current study was to describe aspects that are experienced as a protection against powerlessness and/or helplessness during advanced palliative home care (APHC) or as a help when coping with such perceptions.Method:Both family members during ongoing APHC and family members 3–9 months after the patient's death responded (in total, N = 233; response rate 72%) to a postal questionnaire with mainly open-ended questions. The text responses were analyzed using Manifest Content Analysis.Results:Protection against powerlessness and helplessness had been facilitated by a stable patient condition, the patient coping well, a trusting relationship with the patient, practical and emotional support from family and friends, access to palliative expertise, and staff support that was both individually-focused and cooperative. Other aspects that had helped or protected family members against powerlessness and helplessness were a belief that they had their own reliable knowledge to manage the difficult situation, talking to someone, doing good for the patient, distracting activities, acceptance, meaning and hope, and an inner feeling of security.Significance of results:The findings are discussed in relation to existential psychology, the dual process model of coping with bereavement, and repressive coping. Clinical implications are suggested.
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The glimmering embers: experiences of hope among cancer patients in palliative home care. Palliat Support Care 2011; 9:43-54. [PMID: 21352617 DOI: 10.1017/s1478951510000532] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The experience of hope among cancer patients in palliative care is important information for healthcare providers, but research on the subject is sparse. The aim of this article was to explore how cancer patients admitted to palliative home care experienced the significance of hope and used hope during 6 weeks throughout the last phase of their life, and to assess their symptoms and hope status during 6 weeks throughout the last phase of their lives. METHOD Eleven adult patients with cancer participated in 20 interviews and completed seven diaries. The participants were recruited from two palliative care units in the southeast of Sweden. The method used was Grounded Theory (GT), and analysis was based on the constant comparative method. RESULTS The core category, glimmering embers, was generated from four processes: (1) The creation of "convinced" hope, with a focus on positive events, formed in order to have something to look forward to; (2) The creation of "simulated hope," including awareness of the lack of realism, but including attempts to believe in unrealistic reasons for hope; (3) The collection of and maintaining of moments of hope, expressing a wish to "seize the day" and hold on to moments of joy and pleasure; and (4) "Gradually extinct" hope, characterized by a lack of energy and a sense of time running out. SIGNIFICANCE OF RESULTS The different processes of hope helped the patients to continue to live when they were close to death. Hope should be respected and understood by the professionals giving them support.
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Karlsson M, Milberg A, Strang P. Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives. Support Care Cancer 2011; 20:1065-71. [PMID: 21573739 DOI: 10.1007/s00520-011-1186-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. METHODS Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. RESULTS The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. CONCLUSIONS Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
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Affiliation(s)
- Marit Karlsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Vehling S, Lehmann C, Oechsle K, Bokemeyer C, Krüll A, Koch U, Mehnert A. Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients. Psychooncology 2010; 21:54-63. [DOI: 10.1002/pon.1866] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/29/2010] [Accepted: 09/13/2010] [Indexed: 11/10/2022]
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Singer S, Götze H, Buttstädt M, Geue K, Momenghalibaf A, Böhler U. The effects of an art education program on competencies, coping, and well-being in outpatients with cancer—Results of a prospective feasibility study. ARTS IN PSYCHOTHERAPY 2010. [DOI: 10.1016/j.aip.2010.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ettema EJ, Derksen LD, van Leeuwen E. Existential loneliness and end-of-life care: a systematic review. THEORETICAL MEDICINE AND BIOETHICS 2010; 31:141-69. [PMID: 20440564 PMCID: PMC2866502 DOI: 10.1007/s11017-010-9141-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL-as a condition, as an experience, and as a process of inner growth-leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions-everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity-further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life.
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Affiliation(s)
- Eric J. Ettema
- Department of Metamedica, Section Philosophy and Medical Ethics, Vrije Universiteit Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Louise D. Derksen
- Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Evert van Leeuwen
- Department of IQ, Section Ethics, Philosophy and History of Medicine, Radboud University of Nijmegen, Nijmegen, The Netherlands
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Abstract
AbstractObjective:To deliver quality care at the end of life, understanding the impact of various changes and life transitions that occur in older age is essential. This review seeks to uncover potential sources of distress in an elder's physical, psychological, social, and spiritual well-being to shed light on the unique challenges and needs facing this age group.Methods:Papers relating to older adults (aged 65 years and older or a mean age of 65 years and older) with advanced/terminal cancer receiving palliative, hospice, or end-of-life care published after 1998 were reviewed.Results:Older adults with advanced cancer have unique needs related to changes in their physical, psychological, social, and spirituals well-being. Changes in each of these domains offer not only the risk of causing distress but also the potential for growth and development during the final stages of advanced cancer.Significance of results:Being aware of the various changes that occur with aging will help health care professionals tailor interventions to promote dignity-conserving care and greatly reduce the potential for suffering at the end of life.
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Van Wesemael Y, Cohen J, Onwuteaka-Philipsen BD, Bilsen J, Deliens L. Establishing specialized health services for professional consultation in euthanasia: experiences in the Netherlands and Belgium. BMC Health Serv Res 2009; 9:220. [PMID: 19961568 PMCID: PMC2797003 DOI: 10.1186/1472-6963-9-220] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 12/04/2009] [Indexed: 11/21/2022] Open
Abstract
Background The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives. Methods We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols). Results In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. Conclusion In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard the practice of euthanasia (as it can provide safeguards to adequate performance of euthanasia and assisted suicide).
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Affiliation(s)
- Yanna Van Wesemael
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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The existential experiences of receiving soft tissue massage in palliative home care--an intervention. Support Care Cancer 2009; 17:1203-11. [PMID: 19184127 DOI: 10.1007/s00520-008-0575-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Soft tissue massage is currently used in palliative care for the relief of anxiety and pain. Only few studies have focused on patients' deeper experience of receiving the massage. AIM The purpose of this study was to explore how patients with cancer in palliative home care experienced soft tissue massage. MATERIALS AND METHODS Twenty-two patients received soft tissue massage (hand or foot) nine times over a period of 2 weeks. Each session lasted for 25 min. Following the last massage session, a qualitative interview was conducted. The analysis was performed using a hermeneutic approach. FINDINGS Soft tissue massage generated feelings of existential respite with perceptions of being released from illness for a while. Two categories constituted the basis of the experiences: (1) "an experience of thoughtful attention" and (2) "a sensation of complete tranquility" resulting in the overarching theme "A time of existential respite." CONCLUSION The patients experienced the massage to give meaning and to be important as it generated feelings of an inner respite. RELEVANCE TO CLINICAL PRACTICE Soft tissue massage appears to be an appreciated source of support to dying patients in palliative home care. The method is easy to comprehend and relatively short (25 min) which may imply that it is a suitable complement in nursing care for this patient group.
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Bibliography. PROGRESS IN PALLIATIVE CARE 2008. [DOI: 10.1179/096992608x346198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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