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Nysaeter TM, Olsson C, Sandsdalen T, Hov R, Larsson M. Family caregivers' preferences for support when caring for a family member with cancer in late palliative phase who wish to die at home - a grounded theory study. BMC Palliat Care 2024; 23:15. [PMID: 38212707 PMCID: PMC10782637 DOI: 10.1186/s12904-024-01350-5] [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: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Family caregivers are essential in end-of-life care for cancer patients who wish to die at home. The knowledge is still limited regarding family caregivers needs and preferences for support and whether the preferences change during the patient's illness trajectory. Therefore, the aim was to explore family caregivers' preferences for support from home care services over time when caring for a family member with cancer at the end of life who wished to die at home. METHODS A qualitative method was applied according to Grounded Theory. Data was collected longitudinally over the illness trajectory by means of repeated individual interviews (n = 22) with adult family caregivers (n = 11). Sampling, data collection and data analysis were undertaken simultaneously in line with the constant comparative method. RESULTS The findings are captured in the core category "hold out in duty and love". The categories "having control and readiness for action" and "being involved in care" describe the family caregivers' preferences for being prepared and able to handle procedures, medical treatment and care, and to be involved by the healthcare personnel in the patient's care and decision making. The categories "being seen and confirmed" and "having a respite" describe family caregivers' preferences for support according to their own needs to be able to persevere in the situation. CONCLUSION Despite deterioration in the patient's illness and the increasing responsibility family caregiver struggle to hold out and focus on being in the present. Over time together with deterioration in the patient's illness and changes in the situation, they expressed a need for more intense and extensive support from the home care services. To meet the family caregivers' preferences for support a systematic implementation of a person-centred care model and multicomponent psycho- educational interventions performed by nurses can be proposed. Moreover, we suggest developing a tool based on the conceptual model generated in this study to identify and map family caregivers' needs and preferences for support. Such a tool can facilitate communication and ensure person-centred interventions.
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Affiliation(s)
- Toril Merete Nysaeter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
- Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
- Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Hamar, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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Ongko E, Philip J, Zomerdijk N. Perspectives in preparedness of family caregivers of patients with cancer providing end-of-life care in the home: A narrative review of qualitative studies. Palliat Support Care 2023:1-11. [PMID: 37496385 DOI: 10.1017/s1478951523001013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Many patients with advanced cancer identify home as being their preferred place of death. A critical component in achieving a home death is the support of family members, who often take on responsibilities for which they feel insufficiently prepared with subsequent impacts upon their health and well-being. OBJECTIVES This study sought to review existing qualitative literature on family carers' experiences in providing end-of-life care at home for patients with advanced cancer, with an emphasis on exploring factors that influence how prepared they feel for their role. METHODS A narrative review was chosen to provide an overview and analysis of qualitative findings. MEDLINE, PubMed, PsychINFO, and EMBASE databases were searched with the following search terms: "Cancer," "Caregiver," "End of Life Care," "Home," and "Qualitative." Inclusion criteria were as follows: English language, empirical studies, adult carers, and articles published between 2011 and 2021. Data were abstracted, and study quality was assessed using the Critical Appraisal Skills Programme checklist for qualitative research. RESULTS Fourteen relevant articles were included. Three overarching themes reflecting the factors influencing family preparedness for their role were identified: "motivations for providing care," "interactions with health-care professionals," and "changes during the caring process." SIGNIFICANCE OF RESULTS Inadequate preparation of family carers is apparent with regard to their role in providing end-of-life care at home for patients with advanced cancer. There is a need for health-care workers to more effectively identify the information and support needs of families, and utilize evidence-based strategies that have emerged to address these needs.
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Affiliation(s)
- Emily Ongko
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nienke Zomerdijk
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
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Challenges and Facilitators for Psychosocial Support when Aging and Dying in Place: A Rapid Review of the Literature. Can J Aging 2023; 42:135-153. [PMID: 35762308 DOI: 10.1017/s071498082200023x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Most seniors in Canada live at home and consistently indicate that they prefer to stay there for as long as possible. Consequently, this desire places increasing pressure on supports such as informal caregivers and community services. The current rapid review set out to examine the psychosocial aspects of aging and dying in place that point to gaps in programs and services to support this preference. We searched PubMed, PsycInfo, and Google Scholar for peer-reviewed entries, and identified 42 articles for analysis, which we charted on a form we created and tested. Lack of attention to the whole person, lack of preparation for the journey ahead, and difficulties establishing collaborative and trusting relationships were, broadly, the challenges identified. A blend of initiatives in the community combined with an integrated palliative approach to care may mitigate some of the challenges that limit options for aging and dying in place.
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Huang RY, Lee TT, Lin YH, Liu CY, Wu HC, Huang SH. Factors Related to Family Caregivers’ Readiness for the Hospital Discharge of Advanced Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138097. [PMID: 35805756 PMCID: PMC9266053 DOI: 10.3390/ijerph19138097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023]
Abstract
Background: Many family caregivers of advanced cancer patients worry about being unable to provide in-home care and delay the discharge. Little is known about the influencing factors of discharge readiness. Methods: This study aimed to investigate the influencing factors of family caregivers’ readiness, used a cross-sectional survey, and enrolled 123 sets of advanced cancer patients and family caregivers using convenience sampling from four oncology wards in a medical centre in northern Taiwan. A self-developed five-point Likert questionnaire, the “Discharge Care Assessment Scale”, surveyed the family caregivers’ difficulties with providing in-home care. Results: The study showed that the discharge readiness of family caregivers affects whether patients can be discharged home. Moreover, the influencing factors of family caregivers’ discharge readiness were the patient’s physical activity performance status and expressed discharge willingness; the presence of someone to assist family caregivers with in-home care; and the difficulties of in-home care. The best prediction model accuracy was78.0%, and the Nagelkerke R2 was 0.52. Conclusion: Discharge planning should start at the point of admission data collection, with the influencing factors of family caregivers’ discharge readiness. It is essential to help patients increase the likelihood of being discharged home.
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Affiliation(s)
- Ru-Yu Huang
- Department of Nursing, Mackay Memorial Hospital Tamsui Branch, New Taipei City 25160, Taiwan; (R.-Y.H.); (H.-C.W.)
| | - Ting-Ting Lee
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Yi-Hsien Lin
- Division of Radiotherapy, Cheng Hsin General Hospital, Taipei 11220, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Hsiu-Chun Wu
- Department of Nursing, Mackay Memorial Hospital Tamsui Branch, New Taipei City 25160, Taiwan; (R.-Y.H.); (H.-C.W.)
| | - Shu-He Huang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Correspondence: ; Tel.: +886-2-2826-7227; Fax: +886-2-2822-9973
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Haan MM, van Gurp JL, Knippenberg M, Olthuis G. Facilitators and barriers in using comics to support family caregivers of patients receiving palliative care at home: A qualitative study. Palliat Med 2022; 36:994-1005. [PMID: 35502800 PMCID: PMC9174613 DOI: 10.1177/02692163221093513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregiving at home is highly important for people receiving palliative treatment, but also a complex experience, subject to implicit social expectations. This study empirically explored the claim that comics benefit palliative care practice, through evaluating a graphic novel's value as an aid in supportive conversations with family caregivers. AIM To identify facilitators and barriers in using Naasten (Loved ones), a Dutch research-based graphic novel about family caregivers providing care at the end-of-life. DESIGN Qualitative study, following thematic content analysis. PARTICIPANTS Three focus groups with family caregiver consultants, palliative care volunteers, and healthcare professionals (total N = 23) who supported family caregivers; and individual telephone interviews with family caregivers to whom the book was presented (N = 4). RESULTS Barriers and facilitators related to: (1) the family caregiver, (2) impact on the family caregiver, (3) impact on the conversation between the person who provides support and the family caregiver, (4) their relationship, and (5) the person who provides support. Naasten was reported as recognizable and supportive, and powerful in raising emotions, awareness and conversation. Barriers concerned the book's impact due to its style and guidance of a conversation, and doubts about its surplus-value. CONCLUSIONS Emotionally impactful comics may support bereaved family caregivers, but should be introduced with care among current family caregivers, for example, ensuring a right fit, introduction, and follow-up-while taking into account a caregiver's individual situation, needs, abilities, and affinity with the medium. Comics are preferably used in educational settings, contributing to professional awareness and tailored support of family caregivers.
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Affiliation(s)
- Maaike M Haan
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jelle Lp van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Marjan Knippenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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Castro AR, Arnaert A, Moffatt K, Kildea J, Bitzas V, Tsimicalis A. Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study. JMIR Res Protoc 2021; 10:e34652. [PMID: 34898464 PMCID: PMC8713105 DOI: 10.2196/34652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Québec, Canada. Methods This user-centered design research comprises the core component of the iRespite Services iRépit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results We anticipate that preliminary results will be available by Spring 2022. Conclusions An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Québec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID) PRR1-10.2196/34652
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Affiliation(s)
- Aimee R Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - John Kildea
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Wilson E, Caswell G, Pollock K. The 'work' of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives'. Palliat Med 2021; 35:1941-1950. [PMID: 34252329 PMCID: PMC8640265 DOI: 10.1177/02692163211030113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Managing medications can impose difficulties for patients and families which may intensify towards the end of life. Family caregivers are often assumed to be willing and able to support patients with medications, yet little is known about the challenges they experience or how they cope with these. AIM To explore patient and family caregivers' views of managing medications when someone is seriously ill and dying at home. DESIGN A qualitative design underpinned by a social constructionist perspective involving interviews with bereaved family caregivers, patients and current family caregivers. A thematic analysis was undertaken. SETTING/PARTICIPANTS Two English counties. Data reported in this paper were generated across two data sets using: (1) Interviews with bereaved family caregivers (n = 21) of patients who had been cared for at home during the last 6 months of life. (2) Interviews (n = 43) included within longitudinal family focused case studies (n = 20) with patients and current family caregivers followed-up over 4 months. RESULTS The 'work of managing medications' was identified as a central theme across the two data sets, with further subthemes of practical, physical, emotional and knowledge-based work. These are discussed by drawing together ideas of illness work, and how the management of medications can substantially add to the burden placed on patients and families. CONCLUSIONS It is essential to consider the limits of what it is reasonable to ask patients and families to do, especially when fatigued, distressed and under pressure. Focus should be on improving support via greater professional understanding of the work needed to manage medications at home.
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Affiliation(s)
- Eleanor Wilson
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
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Haan MM, Olthuis G, van Gurp JLP. Feeling called to care: a qualitative interview study on normativity in family caregivers' experiences in Dutch home settings in a palliative care context. BMC Palliat Care 2021; 20:183. [PMID: 34837984 PMCID: PMC8626934 DOI: 10.1186/s12904-021-00868-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers, such as partners or other family members, are highly important to people who desire to stay at home in the last phase of their life-limiting disease. Despite the much-investigated challenges of family caregiving for a patient from one's direct social network, lots of caregivers persevere. To better understand why, we aimed to specify how normative elements - i.e. what is considered good or valuable - shape family caregivers' experiences in Dutch home settings. METHODS From September 2017 to February 2019, a total of 15 family caregivers, 13 bereaved family caregivers, and 9 patients participated in one-time in-depth interviews. The data were qualitatively analyzed following a grounded theory approach. RESULTS Central to this study is the persistent feeling of being called to care. By whom, why, and to what? Family caregivers feel called by the patient, professionals entering normal life, family and friends, or by oneself; because of normative elements of love, duty, or family dynamics; to be constantly available, attentive to the patient while ignoring their own needs, and assertive in managing the caring situation. The prospect of death within the palliative care context intensifies these mechanisms with a sense of urgency. CONCLUSIONS Our analysis showed a difference between feeling called upon in the caring situation on the one hand, and how caregivers tend to respond to these calls on the other. Taking into account the inherent normative and complex nature of family caregiving, the pressing feeling of being called cannot - and perhaps should not - simply be resolved. Caring might be something families just find themselves in due to being related. Rather than in feeling called upon per se, the burden of care might lie in the seeming limitlessness to which people feel called, reinforced by (implicit) social expectations. Support, we argue, should enable caregivers to reflect on what norms and values guide their responses while acknowledging that caring, despite being burdensome, can be a highly important and rewarding part of the relationship between partners or family members.
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Affiliation(s)
- Maaike M. Haan
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
| | - Jelle L. P. van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
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Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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11
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Rao SR, Gupta M, Salins N. The Concept of Respite in Palliative Care: Definitions and Discussions. Curr Oncol Rep 2021; 23:25. [PMID: 33559761 DOI: 10.1007/s11912-021-01015-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF THE REVIEW The definition of respite care remains unclear and its purpose and effectiveness are unproven till date. This paper reviews the current evidence regarding definition and efficacy of respite care, as well as the different programs, models, and interventions employed to deliver the same. RECENT FINDINGS A scoping search identified the relevant literature to be included in the review. The current evidence reiterates the lack of clarity in defining and delineating the purpose of respite care. Recent empirical evidence supports the effectiveness of respite care with clear benefits for the carers, patients, their families, and the healthcare system. Along with inpatient, home, and hospice care, respite care is considered as an essential component of palliative care. Evidence, although weak, supports the efficacy of respite care. High-quality studies with clear outlining of the scope of the services and resolution of ambiguities pertaining to its definition are warranted to fill the gaps in knowledge.
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Affiliation(s)
- Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care Kasturba Medical College and Hospital, Manipal Academy of Higher Education (MAHE), Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka, 576104, India. .,APHN Palliative Medicine Consultant for Lien Collaborative for Palliative Care, Singapore, Singapore. .,Honorary Tutor, School of Medicine, Cardiff University, Cardiff, UK.
| | - Mayank Gupta
- Department of Palliative Medicine and Supportive Care Kasturba Medical College and Hospital, Manipal Academy of Higher Education (MAHE), Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka, 576104, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care Kasturba Medical College and Hospital, Manipal Academy of Higher Education (MAHE), Tiger Circle Road, Madhav Nagar, Manipal, Udupi District, Karnataka, 576104, India.,Honorary Tutor, School of Medicine, Cardiff University, Cardiff, UK
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12
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Pepin E, Hébert J. Besoins des proches aidants qui accompagnent une personne en soins palliatifs et de fin de vie à domicile. Can Oncol Nurs J 2020; 30:141-146. [PMID: 33118984 DOI: 10.5737/23688076302141146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Le maintien à domicile d'une personne en soins palliatifs et de fin de vie (SPFV) dépend grandement de la présence quotidienne de proches aidants (PA) et de leur implication dans les soins. Or, les besoins des PA tout au long de la trajectoire d'accompagnement d'un proche en SPFV à domicile sont encore relativement méconnus. Objectifs et méthode Cette étude qualitative descriptive s'intéresse au rôle des PA qui ont accompagné une personne recevant des SPFV à domicile dans le but de décrire leurs besoins tout au long de la trajectoire d'accompagnement. Ainsi, 20 PA ont participé à des entrevues semi-dirigées. Résultats et discussion L'étude met en lumière les besoins multiples des PA qui accompagnent un proche en SPFV à domicile. Les besoins informationnels, émotionnels et psychosociaux démontrent que les PA connaissent des changements dans leur rôle auprès de la personne malade. Les besoins spirituels ont été rapportés en termes de sens donné à l'expérience d'accompagnement. Enfin, les besoins pratiques mettent de l'avant l'importance d'avoir accès aux services de SPFV 24 h/24 et le caractère essentiel du soutien de l'infirmière. Conclusion Les besoins des PA qui accompagnent une personne en SPFV à domicile sont peu satisfaits. Il importe d'en tenir compte dans la trajectoire de soins, parallèlement aux besoins de la personne malade, afin d'améliorer l'expérience d'accompagnement qui précède la période de deuil.
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Affiliation(s)
- Elizabeth Pepin
- Infirmière clinicienne, étudiante à la maîtrise, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Directrice de recherche, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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13
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Lowers J, Scardaville M, Hughes S, Preston NJ. Comparison of the experience of caregiving at end of life or in hastened death: a narrative synthesis review. BMC Palliat Care 2020; 19:154. [PMID: 33032574 PMCID: PMC7545566 DOI: 10.1186/s12904-020-00660-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background End-of-life caregiving frequently is managed by friends and family. Studies on hastened death, including aid in dying or assisted suicide, indicate friends and family also play essential roles before, during, and after death. No studies have compared the experiences of caregivers in hastened and non-hastened death. The study aim is to compare end-of-life and hastened death caregiving experience using Hudson’s modified stress-coping model for palliative caregiving. Method Narrative synthesis of qualitative studies for caregivers at end of life and in hastened death, with 9946 end-of life and 1414 hastened death qualitative, peer-reviewed research articles extracted from MEDLINE, CINAHL, Web of Science, and PsycINFO, published between January 1998 and April 2020. Results Forty-two end-of-life caregiving and 12 hastened death caregiving articles met inclusion criteria. In both end-of-life and hastened death contexts, caregivers are motivated to ease patient suffering and may put their own needs or feelings aside to focus on that priority. Hastened death caregivers’ expectation of impending death and the short duration of caregiving may result in less caregiver burden. Acceptance of the patient’s condition, social support, and support from healthcare professionals all appear to improve caregiver experience. However, data on hastened death are limited. Conclusion Caregivers in both groups sought closeness with the patient and reported satisfaction at having done their best to care for the patient in a critical time. Awareness of anticipated death and support from healthcare professionals appear to reduce caregiver stress. The modified stress-coping framework is an effective lens for interpreting caregivers’ experiences at end of life and in the context of hastened death.
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Affiliation(s)
- Jane Lowers
- Emory University, Palliative Care Center, 1821 Clifton Road, Suite 1016, Atlanta, GA, 30329, USA.
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14
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Yoshioka S, Katayama H. Actual Situations and Factors Related to Nursing Activities in Supporting the Transition to Homecare Settings for End-Stage Cancer Patients in General Wards in Japan. Am J Hosp Palliat Care 2020; 38:750-757. [PMID: 32940540 DOI: 10.1177/1049909120959787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate actual situations of nursing activities in supporting the transition to homecare settings for end-stage cancer patients and to determine factors related to executing such nursing activities from the perspectives of communication skills and interprofessional collaboration. A cross-sectional study was conducted with 513 nurses who worked at designated cancer care hospitals in Japan. A total of 318 valid responses were obtained (valid response rate: 62.0%). Scores for nursing activities were higher for the following items: sharing information regarding the transition to homecare settings, intentionally engaging with patients after their medical conditions were explained, providing care for families, and understanding a patient's will about the transition to homecare settings. On the other hand, scores were lower for items that were related to guiding juniors and self-improvement. A multiple regression analysis was performed with nursing activities as the dependent variable. 8 factors related to nursing activities were determined: experience in supporting the transition to homecare settings as a primary nurse, contribution to a team (Team Approach Assessment Scale [TAAS]), years of nursing experience, function of a team (TAAS), regulation of interpersonal relationship (ENDCOREs communication skills scale), experience of participation in homecare nursing education or seminars, verbal communication skills for good communication (End-of-life Care Nurses' Communication Skills scale), and educational background. Future challenges include developing an educational program based on the results of the present study and promoting educational intervention studies.
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Affiliation(s)
- Saori Yoshioka
- Graduate School of Nursing for Health Care Science, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Harumi Katayama
- Department of Fundamental Nursing, 12898Hamamatsu University School of Medicine, Shizuoka, Japan
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15
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Werkander Harstäde C, Sandgren A. Constructing stability - a classic grounded theory of next-of-kin in palliative cancer care. BMC Palliat Care 2020; 19:78. [PMID: 32503506 PMCID: PMC7345519 DOI: 10.1186/s12904-020-00580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background Being next-of-kin to someone with cancer requiring palliative care involves a complex life situation. Changes in roles and relationships might occur and the next-of-kin thereby try to adapt by being involved in the ill person’s experiences and care even though they can feel unprepared for the care they are expected to provide. Therefore, the aim of this study was to develop a classic grounded theory of next-of-kin in palliative cancer care. Method Forty-two next-of-kin to persons with cancer in palliative phase or persons who had died from cancer were interviewed. Theoretical sampling was used during data collection. The data was analysed using classic Grounded Theory methodology to conceptualize patterns of human behaviour. Results Constructing stability emerged as the pattern of behaviour through which next-of-kin deal with their main concern; struggling with helplessness. This helplessness includes an involuntary waiting for the inevitable. The waiting causes sadness and frustration, which in turn increases the helplessness. The theory involves; Shielding, Acknowledging the reality, Going all in, Putting up boundaries, Asking for help, and Planning for the inescapable. These strategies can be used separately or simultaneously and they can also overlap each other. There are several conditions that may impact the theory Constructing stability, which strategies are used, and what the outcomes might be. Some conditions that emerged in this theory are time, personal finances, attitudes from extended family and friends and availability of healthcare resources. Conclusions The theory shows the complexities of being next-of-kin to someone receiving palliative care, while striving to construct stability. This theory can increase healthcare professionals’ awareness of how next-of-kin struggle with helplessness and thus generates insight into how to support them in this struggle.
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Affiliation(s)
- Carina Werkander Harstäde
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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16
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Pepin E, Hébert J. Needs of caregivers of patients receiving in-home palliative and end-of-life care. Can Oncol Nurs J 2020; 30:147-152. [PMID: 33118991 DOI: 10.5737/23688076302147152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Home support for patients receiving in-home palliative and end-of-life care (PELC) is greatly dependent on the daily presence of caregivers and their involvement in care delivery. However, the needs of caregivers throughout the care trajectory of a loved one receiving in-home PELC are still relatively unknown. Objectives and methodology This descriptive qualitative study focuses on the role of caregivers who have cared for a person receiving in-home PELC with the goal of describing their needs throughout the care trajectory. As part of this process, 20 caregivers took part in semi-directed interviews. Results and discussion This study sheds light on the multiple needs of caregivers of loved ones receiving in-home PELC. These informational, emotional, and psychosocial needs show that caregivers experience changes in their relationship with their loved one. Spiritual needs were expressed through the meaning ascribed to the home support experience. And the practical needs expressed by participants highlight the importance of round-the-clock access to PELC services and the essential importance of nursing support. Conclusion The needs of caregivers of loved ones receiving in-home PELC are not being met to a satisfactory degree. It is important to consider these needs in the care trajectory, alongside the needs of the patients themselves, in order to improve the support experience leading up to the bereavement period.
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Affiliation(s)
- Elizabeth Pepin
- Nurse Clinician, Master's Student, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Research Director, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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17
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Robinson CA, Bottorff JL, Pesut B, Zerr J. Development and Implementation of the Family Caregiver Decision Guide. QUALITATIVE HEALTH RESEARCH 2020; 30:303-313. [PMID: 31744378 DOI: 10.1177/1049732319887166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Care provided by family is the backbone of palliative care in Canada. The critical roles performed by caregivers can at the same time be intensely meaningful and intensely stressful. However, experiences of caregiving can be enhanced when caregivers feel they are making informed and reflective decisions about the options available to them. With this in mind, the purpose of this five-phase research project was to create a Family Caregiver Decision Guide (FCDG). The Guide entails four steps: thinking about the current caregiving situation, imagining how the caregiving situation may change, exploring available options, and considering best options if caregiving needs change. The FCDG was based on available evidence and was developed and refined using focus groups, cognitive interviewing, and a feasibility and acceptability study. Finally, an interactive version of the Guide was created for online use ( https://www.caregiverdecisionguide.ca ). In this article, we describe the development, evaluation, and utility of the FCDG.
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Affiliation(s)
- Carole A Robinson
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Barbara Pesut
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Janelle Zerr
- The University of British Columbia, Kelowna, British Columbia, Canada
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Caregiver burden and bereavement among family caregivers who lost terminally ill cancer patients. Palliat Support Care 2019; 17:515-522. [PMID: 30702057 DOI: 10.1017/s1478951518001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Family caregivers (FCs) in China provide hospice care to terminally ill cancer patients; however, few studies have been conducted in China on caregiver burden and bereavement experiences as a process that continues over time. The purpose of this study was to identify the main elements of caring and bereavement experiences for FCs caring for patients diagnosed with terminal cancer. METHOD Twenty in-depth qualitative semistructured interviews were conducted with FCs providing care in a hospice unit in Shenzhen, Southern China. Interview transcripts were analyzed via thematic content analysis. RESULT A framework based on the following eight principal themes was developed through content analysis of our FC interviews: symptoms of the illness, the truth-telling process, attitudes toward death, the "color" of death, social and professional support, the moment of death, and grief and loss. SIGNIFICANCE OF RESULTS The analysis showed that caregiving may positively or negatively influence the bereavement process.
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19
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Fjose M, Eilertsen G, Kirkevold M, Grov EK. "Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system. BMC Health Serv Res 2018; 18:745. [PMID: 30268149 PMCID: PMC6162914 DOI: 10.1186/s12913-018-3548-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient.
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Affiliation(s)
- Marianne Fjose
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Postboks 7030, 5020, Bergen, Norway.
| | - Grethe Eilertsen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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20
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Psychometric evaluation and cultural adaptation of the Spanish version of the "Scale for End-of Life Caregiving Appraisal". Palliat Support Care 2018; 17:314-321. [PMID: 30073939 DOI: 10.1017/s1478951518000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To translate, culturally adapt, and psychometrically evaluate the Spanish version of the "Scale for End-of Life Caregiving Appraisal" (SEOLCAS). METHOD Observational cross-sectional study. Convenience sample of 201 informal end-of-life caregivers recruited in a southern Spanish hospital. The reliability of the questionnaire was assessed through its internal consistency (Cronbach's α) and temporal stability (Pearson's correlation coefficient [r] between test-retest). The content validity index of the items and the scale was calculated. Criterion validity was explored through performing a linear regression analysis to evaluate the SEOLCAS' predictive validity. Exploratory factor analysis was used to examine its construct validity. RESULTS The SEOLCAS' reliability was very high (Cronbach's α = 0.92). Its content validity was excellent (all items' content validity index = 0.8-1; scale's validity index = 0.88). Evidence of the SEOLCAS' criterion validity showed that the participants' scores on the SEOLCAS explained approximately 79.3% of the between-subject variation of their results on the Zarit Burden Interview. Exploratory factor analysis provided evidence of the SEOLCAS' construct validity. This analysis revealed that two factors ("internal contingencies" and "external contingencies") explained 53.77% of the total variance found and reflected the stoic Hispanic attitude toward adversity.Significance of resultsThe Spanish version of the SEOLCAS has shown to be an easily applicable, valid, reliable, and culturally appropriate tool to measure the impact of end-of-life care provision on Hispanic informal caregivers. This tool offers healthcare professionals the opportunity to easily explore Hispanic informal end-of-life caregivers' experiences and discover the type of support they may need (instrumental or emotional) even when there are communicational and organizational constraints.
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Johnston B, Patterson A, Bird L, Wilson E, Almack K, Mathews G, Seymour J. Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites. BMC Palliat Care 2018; 17:36. [PMID: 29475452 PMCID: PMC6389143 DOI: 10.1186/s12904-018-0281-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. METHODS The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014-2016) included: Quantitative outcome measures - Palliative Performance Scale [PPS] and Palliative Prognostic Index [PPI] (n = 2711); Integrated Palliative Outcome Scales [IPOS] (n = 1157); Carers Support Needs Assessment Tool [CSNAT] (n = 241); Views of Informal Carers -Evaluation of Services [VOICES-SF] (n = 102); a custom-designed Service Data Tool [SDT] that gathered prospective data from each site (n = 88). Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. RESULTS Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. CONCLUSIONS Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.
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Affiliation(s)
- Bridget Johnston
- Florence Nightingale Foundation Professor of Clinical Nursing Practice Research, School of Medicine, Dentistry and Nursing, University of Glasgow, 57-61 Oakfield Avenue, Room 61/504, Glasgow, G12 8LL UK
| | - Anne Patterson
- School of Sociology and Social Policy, University Park, University of Nottingham, Nottingham, NG7 2RD UK
| | - Lydia Bird
- Present address: Division of Primary Care, University of Nottingham, Queens Medical Centre, Derby Road, Nottingham, NG7 2HA UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Derby Road, Nottingham, NG7 2HA UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB UK
| | - Gillian Mathews
- School of Medicine, Dentistry and Nursing, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL UK
| | - Jane Seymour
- School of Nursing and Midwifery, The University of Sheffield, Barber House Annex, 3a Clarkehouse Road, Sheffield, S10 2LA UK
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