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Kodba‐Čeh H, Lunder U, Bulli F, Caswell G, van Delden JJM, Kars MC, Korfage IJ, Miccinesi G, Rietjens JAC, Seymour J, Toccafondi A, Zwakman M, Pollock K. How can advance care planning support hope in patients with advanced cancer and their families: A qualitative study as part of the international ACTION trial. Eur J Cancer Care (Engl) 2022; 31:e13719. [PMID: 36168108 PMCID: PMC9787960 DOI: 10.1111/ecc.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope. METHODS In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question. RESULTS Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties; (II) an action towards an aware and empowered position; (III) an act of mutual care anchored in commitments. CONCLUSION Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.
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Affiliation(s)
- Hana Kodba‐Čeh
- University Clinic of Respiratory and Allergic Diseases GolnikGolnikSlovenia
- Faculty of Arts, Department of PsychologyUniversity of LjubljanaLjubljanaSlovenia
| | - Urška Lunder
- University Clinic of Respiratory and Allergic Diseases GolnikGolnikSlovenia
| | - Francesco Bulli
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Glenys Caswell
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ida J. Korfage
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Guido Miccinesi
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jane Seymour
- Division of Nursing and Midwifery, Health Sciences SchoolUniversity of SheffieldSheffieldUK
| | - Alessandro Toccafondi
- Clinical Epidemiology UnitOncological network research and prevention Institute‐ISPROSienaItaly
| | - Marieke Zwakman
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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2
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Soltis-Jarrett V. Remembering the value of connectedness and solicitude: A call to action for our own health and well-being as psychiatric nurses. Arch Psychiatr Nurs 2022; 39:A3-A4. [PMID: 35688552 DOI: 10.1016/j.apnu.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Laranjeira C, Baptista Peixoto Befecadu F, Da Rocha Rodrigues MG, Larkin P, Pautex S, Dixe MA, Querido A. Exercising Hope in Palliative Care Is Celebrating Spirituality: Lessons and Challenges in Times of Pandemic. Front Psychol 2022; 13:933767. [PMID: 35846675 PMCID: PMC9278349 DOI: 10.3389/fpsyg.2022.933767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Research in Education and Community Intervention (RECI I&D), Piaget Institute, Viseu, Portugal
| | - Filipa Baptista Peixoto Befecadu
- Palliative and Supportive Care Service and Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Maria Goreti Da Rocha Rodrigues
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland.,High School of Health (HEdS), Geneva, Switzerland
| | - Philip Larkin
- Palliative and Supportive Care Service and Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sophie Pautex
- Department of Readaptation and Geriatrics, Palliative Medicine Division, University Hospital Geneva and University of Geneva, Geneva, Switzerland
| | - Maria Anjos Dixe
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
| | - Ana Querido
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, Porto, Portugal
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4
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Qama E, Diviani N, Grignoli N, Rubinelli S. Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:1470-1487. [PMID: 34593262 DOI: 10.1016/j.pec.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.
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Affiliation(s)
- Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, 6850 Mendrisio, Switzerland.
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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5
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Buchanan K, Newnham E, Ireson D, Davison C, Geraghty S. Care ethics framework for midwifery practice: A scoping review. Nurs Ethics 2022; 29:1107-1133. [PMID: 35395917 DOI: 10.1177/09697330221073996] [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: 11/17/2022]
Abstract
Background: As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity.Aim: The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a care ethics framework and definition for midwifery practice.Method: The scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was applied to the databases CINAHL, MEDLINE, PschInfo and Pubmed which were searched in September 2019 and again in July 2021. The inclusion criteria were guided by the mnemonic for search terms: Participants, Concept, and Context (PCC) and included variations of health care professionals, care ethics and utilization. The search was limited to qualitative studies published in English between 2010 and 2021. A data extraction tool was used to extract and synthesize data into categories. The articles were screened for eligibility by title, abstract and full text review, by two independent reviewers.Ethical Considerations: The scoping review was guided by ethical conduct respecting authorship and referencing sources.Results: Twelve of the initially identified 129 studies were included in the scoping review. Data synthesis yielded four categories of care ethics use by health professionals: relationship, context, attention to power and caring practices. In combination, the evidence forms a framework for care ethics use in midwifery practice.Conclusion: Care ethics use by health professionals enhances ethical sensitivity. A framework and definition for care ethics for midwifery practice is proposed. This review will be of interest to midwives and other health practitioners seeking to enhance ethical sensitivity.
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Affiliation(s)
- Kate Buchanan
- School of Nursing and Midwifery, 2498Edith Cowan University, Joondalup, WA, Australia; 3431The University of Notre Dame Australia, Fremantle, WA, Australia
| | | | - Deborah Ireson
- School of Nursing and Midwifery, 2498Edith Cowan University, Joondalup, WA, Australia
| | | | - Sadie Geraghty
- 3431The University of Notre Dame Australia, Fremantle, WA, Australia
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:896-911. [PMID: 35050706 DOI: 10.1044/2021_ajslp-21-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Knowing what to expect poststroke is important for many significant others of people with aphasia, yet an understanding of their perceptions and preferences in receiving prognostic information is limited. This knowledge is needed to inform the formulation and delivery of aphasia prognoses as conversations about prognosis can be harmful or helpful depending on their alignment with key stakeholder perspectives. Our preliminary study sought insight into the perspectives of significant others of people with aphasia on receiving prognostic information, with an aim toward informing evidence-based practice in aphasia prognostication. METHOD We interviewed seven significant others of people with aphasia, 3-12 months poststroke. The interviews were semistructured, conducted one-to-one, and analyzed qualitatively using reflexive thematic analysis. RESULTS Five themes were drawn from the interviews: (a) You don't know what you don't know. (b) Having them alive is the best you can ask for. (c) Recovery in the eye of the beholder. (d) Outcomes don't matter unless they help me help them. (e) It's my prognosis too if I'm living with aphasia. CONCLUSIONS A significant other's prognosis-related perceptions and preferences are products of their poststroke reality and may inadvertently shape that of the person with aphasia. In order to facilitate recovery, prognostication practices need to consider the needs of significant others both as providers of care and as requiring care themselves for their first-hand experiences of third-party disability.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
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7
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Nikoloudi M, Tsilika E, Parpa E, Kostopoulou S, Tentolouris A, Psarros C, Alexandra M, Mystakidou K. Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer. Indian J Palliat Care 2021; 27:367-374. [PMID: 34898931 PMCID: PMC8655662 DOI: 10.25259/ijpc_364_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design. Materials and Methods: The HHI was translated into Greek (HHI-Gr) using the ‘forward-backward’ procedure. It was administered to 130 eligible cancer patients, while for the stability of patients’ responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach’s a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status. Results: The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001). Conclusion: These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.
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Affiliation(s)
- Maria Nikoloudi
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Eleni Tsilika
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Efi Parpa
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Sotiria Kostopoulou
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Aigaleo, Greece
| | - Constantin Psarros
- Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Aigaleo, Greece
| | | | - Kyriaki Mystakidou
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Aigaleo, Greece
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Grignoli N, Wullschleger R, Di Bernardo V, Amati M, Zanini C, Malacrida R, Rubinelli S. Hope and therapeutic privilege: time for shared prognosis communication. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106157. [PMID: 33055136 DOI: 10.1136/medethics-2020-106157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs' perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from different positions and experience, including doctors and nurses in four different departments (intensive care, oncology, palliative care, rehabilitation), were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient's timing and sharing the patient's wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs' emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation.
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Affiliation(s)
- Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Valentina Di Bernardo
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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9
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Olsman E. Witnesses of hope in times of despair: chaplains in palliative care. A qualitative study. J Health Care Chaplain 2020; 28:29-40. [PMID: 32090710 DOI: 10.1080/08854726.2020.1727602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hope is an important topic in spiritual care in palliative care but the experiences of chaplains with hope have hardly been explored. The objective of this study was to explore Dutch chaplains' experiences with hope in palliative care. Semi-structured interviews were conducted, which were thematically analyzed. The 10 chaplains had a variety of ordinations: Muslim, Protestant, Roman Catholic, Humanistic, or otherwise. Participants spoke about changes in patients' hope, often implying despair and surrender, in which patients' self-reflection was pivotal. Participants felt witnesses of hope, not by offering hope, but by acknowledging patients' hope and despair while being with their patients. They criticized other professionals who, not bearing witness to these experiences, tried to offer hope to patients. We conclude that chaplains may become witnesses of hope in times of despair, which includes the (ideological) critical function of spiritual care.
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Affiliation(s)
- Erik Olsman
- Section of Medical Ethics & Health Law, Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Spiritual Care, Hospice Bardo, Hoofddorp, The Netherlands
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10
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Möllerberg ML, Årestedt K, Swahnberg K, Benzein E, Sandgren A. Family sense of coherence and its associations with hope, anxiety and symptoms of depression in persons with cancer in palliative phase and their family members: A cross-sectional study. Palliat Med 2019; 33:1310-1318. [PMID: 31368844 DOI: 10.1177/0269216319866653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is evidence indicating that family sense of coherence predicts quality of family life and promotes family well-being. In families living with the palliative phase of cancer, low hope, anxiety and symptoms of depression are common in both persons with cancer and their family members. AIM To determine whether family sense of coherence was associated with hope, anxiety and symptoms of depression, respectively, in persons with cancer in the palliative phase and their family members. DESIGN An observational, cross-sectional, multicentre study was conducted. Nested linear regression analyses were performed in two blocks to determine whether family sense of coherence was associated with hope, anxiety and symptoms of depression. SETTING/PARTICIPANTS Persons with cancer (n = 179) and their family members (n = 165) were recruited from two oncology clinics and two palliative centres in three regions in Sweden. RESULTS The main findings showed that family sense of coherence was significantly and independently associated with hope, anxiety and symptoms of depression. Stronger family sense of coherence was associated with higher hope and lower anxiety and symptoms of depression levels in both persons with cancer and their family members. CONCLUSION Health care providers should strive to identify families with weak family sense of coherence, because of its associations with hope, anxiety and symptoms of depression, in order to offer them professional support and thereby achieve increased well-being during the palliative phase of cancer. Future studies should expand our knowledge of family sense of coherence and how to identify families at risk of lower levels of well-being.
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Affiliation(s)
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden.,The Research Section, Kalmar County Council, Kalmar, Sweden
| | - Katarina Swahnberg
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Eva Benzein
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden.,Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
| | - Anna Sandgren
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden.,Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
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Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication. PLoS One 2019; 14:e0224394. [PMID: 31661529 PMCID: PMC6818780 DOI: 10.1371/journal.pone.0224394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.
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Affiliation(s)
- Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Rehabilitation Clinic, Ente Ospedaliero Cantonale, Novaggio, Switzerland
- Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Julia Amann
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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12
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De Panfilis L, Di Leo S, Peruselli C, Ghirotto L, Tanzi S. "I go into crisis when …": ethics of care and moral dilemmas in palliative care. BMC Palliat Care 2019; 18:70. [PMID: 31399094 PMCID: PMC6689155 DOI: 10.1186/s12904-019-0453-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/31/2019] [Indexed: 11/21/2022] Open
Abstract
Background Recognising and knowing how to manage ethical issues and moral dilemmas can be considered an ethical skill. In this study, ethics of care is used as a theoretical framework and as a regulatory criterion in the relationship among healthcare professionals, patients with palliative care needs and family members. This study is a part of a larger project aimed at developing and implementing a training programme on “ethical communication” addressed to professionals caring for patients with palliative care needs. The aim of this study was comprehending whether and how the ethics of care informs the way healthcare professionals make sense of and handle ethical issues in palliative care. Methods Qualitative study employing a theoretically driven thematic analysis performed on semi-structured interviews. The research was conducted in a clinical cancer centre in northern Italy. Eligible participants were physicians and nurses from eleven hospital wards who assisted patients with chronic advanced disease daily and had previously attended a 4-h training on palliative care held by the hospital Palliative Care Unit. Results The researchers identified five themes: morality is providing global care; morality is knowing how to have a relationship with patients; morality is recognizing moral principles; moral dimension and communication; and moral dilemmas are individual conflicts. Conclusions Ethics of care seems to emerge as a theoretical framework that includes the belief systems of healthcare professionals, especially those assisting patients with palliative care needs; moreover, it allows the values of both the patients and professionals to come to light through the relationship of care. Ethics of care is also appropriate as a framework for ethical training.
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Affiliation(s)
- Ludovica De Panfilis
- Unit of Bioethics, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Peruselli
- Past President Italian Society of Palliative Care, Milano, Italy
| | - Luca Ghirotto
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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13
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Rytterström P, Borgestig M, Hemmingsson H. Hope and Technology: Other-Oriented Hope Related to Eye Gaze Technology for Children with Severe Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101667. [PMID: 31091645 PMCID: PMC6571960 DOI: 10.3390/ijerph16101667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/14/2022]
Abstract
Introducing advanced assistive technology such as eye gaze controlled computers can improve a person's quality of life and awaken hope for a child's future inclusion and opportunities in society. This article explores the meanings of parents' and teachers' other-oriented hope related to eye gaze technology for children with severe disabilities. A secondary analysis of six parents' and five teachers' interview transcripts was conducted in accordance with a phenomenological-hermeneutic research method. The eye gaze controlled computer creates new imaginations of a brighter future for the child, but also becomes a source for motivation and action in the present. The other-oriented hope occurs not just in the future; it is already there in the present and opens up new alternatives and possibilities to overcome the difficulties the child is encountering today. Both the present situation and the hope for the future influence each other, and both affect the motivation for using the technology. This emphasises the importance of clinicians giving people opportunities to express how they see the future and how technology could realise this hope.
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Affiliation(s)
- Patrik Rytterström
- Division of Nursing Science, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, 601 74 Norrköping, Sweden.
| | - Maria Borgestig
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 702 81 Örebro, Sweden.
| | - Helena Hemmingsson
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden.
- Division of Occupational Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, 601 74 Norrköping, Sweden.
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14
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Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature. Med Sci (Basel) 2019; 7:medsci7020025. [PMID: 30736416 PMCID: PMC6409788 DOI: 10.3390/medsci7020025] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 12/28/2022] Open
Abstract
Many studies on spiritual care in palliative care are performed in the US, leaving other continents unexplored. The objective of this systematic review is to map the recent studies on spiritual care in palliative care in Europe. PubMed, CINAHL, ATLA, PsycINFO, ERIC, IBSS, Web of Science, EMBASE, and other databases were searched. Included were European studies published in a peer-reviewed journal in 2015, 2016, or 2017. The characteristics of the included studies were analyzed and a narrative synthesis of the extracted data was performed. 53 articles were included. Spiritual care was seen as attention for spirituality, presence, empowerment, and bringing peace. It implied creative, narrative, and ritual work. Though several studies reported positive effects of spiritual care, like the easing of discomfort, the evidence for spiritual care is low. Requirements for implementation of spiritual care in (palliative) care were: Developing spiritual competency, including self-reflection, and visibility of spirituality and spiritual care, which are required from spiritual counselors that they participated in existing organizational structures. This study has provided insight into spiritual care in palliative care in Europe. Future studies are necessary to develop appropriate patient outcomes and to investigate the effects of spiritual care more fully.
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15
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Wakefield D, Bayly J, Selman LE, Firth AM, Higginson IJ, Murtagh FE. Patient empowerment, what does it mean for adults in the advanced stages of a life-limiting illness: A systematic review using critical interpretive synthesis. Palliat Med 2018; 32:1288-1304. [PMID: 29956568 PMCID: PMC6088522 DOI: 10.1177/0269216318783919] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient empowerment, defined as 'a process through which people gain greater control over decisions and actions affecting their health' (World Health Organization) is a key theme within global health and social care strategies. The benefits of incorporating empowerment strategies in care are well documented, but little is known about their application or impact for patients with advanced, life-limiting illness(s). AIM To identify and synthesise the international evidence on patient empowerment for adults with advanced, life-limiting illness(s). DESIGN Systematic review (PROSPERO no. 46113) with critical interpretive synthesis methodology. DATA SOURCES Five databases (MEDLINE, Embase, CINHAL, PsycINFO and Cochrane) were searched from inception to March 2018. Grey literature and reference list/citation searches of included papers were undertaken. INCLUSION CRITERIA empirical research involving patients with advanced life-limiting illness including descriptions of, or references to, patient empowerment within the study results. RESULTS In all, 13 papers met inclusion criteria. Two qualitative studies explored patient empowerment as a study objective. Six papers evaluated interventions, referencing patient empowerment as an incidental outcome. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses. CONCLUSION There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research.
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Affiliation(s)
- Dominique Wakefield
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Jo Bayly
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Lucy Ellen Selman
- 2 Bristol Randomised Trials Collaboration (BRTC), School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Alice M Firth
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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16
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Wolf A, Garlid CF, Hyrkas K. Physicians’ Perceptions of Hope and How Hope Informs Interactions With Patients: A Qualitative, Exploratory Study. Am J Hosp Palliat Care 2018; 35:993-999. [DOI: 10.1177/1049909117751877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Today some studies of physicians’ perceptions of hope are available, but not studies of how hope informs patient care. The objectives of this qualitative study were to describe the ways physicians conceptualize hope and how these may inform interactions with their patients. Methods: Ten physicians working in a large tertiary care teaching hospital were interviewed. They represented palliative care, oncology, and 7 other specialties. Minimal amount of background information was collected. In-depth interviews were conducted during spring of 2016. Open coding and the constant comparison method were used to identify emerging themes from the transcribed data. Validation method included member checking. Results: Hope was defined as an abstract, evolving concept characterized by future-oriented wishes; offering possibilities for reframing and shaping new meaning; an attitude of positivity or optimism; an attribute of the human condition with emotional and relational roots; and as a response to the existential inevitability of suffering and death. Three themes describing hope emerged: “assessing hope,” “fostering and sustaining hope,” and “attributes and outcomes of hope.” Conclusions: The findings show how physicians conceptualize hope and how these conceptions differ in the empirical light of the study. Physicians’ perceptions of “hope” may evolve when entering into a therapeutic relationship exploring the needs and desires of patients. Physicians’ perspectives about “hope” may at times not be solely their own but are those of their patients and thus resulting in an amalgamation, or a rebuilding/rekindling of hope amidst hopelessness, that suits a particular relationship.
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Affiliation(s)
- Airin Wolf
- Clinical Pastoral Education Program, Maine Medical Center, Portland, ME, USA
| | | | - Kristiina Hyrkas
- Center for Nursing Research and Quality, Maine Medical Center, Portland, ME, USA
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17
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van der Biessen DA, van der Helm PG, Klein D, van der Burg S, Mathijssen RH, Lolkema MP, de Jonge MJ. Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation. Psychooncology 2017; 27:163-170. [PMID: 28665008 DOI: 10.1002/pon.4487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/31/2017] [Accepted: 06/22/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well-being as measured by the quality of life (QoL). METHODS An exploratory cross-sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data. RESULTS Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi-square (8) = 9.30, P = .32. CONCLUSIONS Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients' social context and values before proposing a phase I trial.
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Affiliation(s)
| | | | - Dennis Klein
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Simone van der Burg
- Scientific Institute for Quality of Healthcare, Radboud UMC, Nijmegen, the Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maja J de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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18
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Olsman E, Veneberg B, van Alfen C, Touwen D. The value of metaphorical reasoning in bioethics: An empirical-ethical study. Nurs Ethics 2017; 26:50-60. [PMID: 28438074 PMCID: PMC7324142 DOI: 10.1177/0969733017703695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Metaphors are often used within the context of ethics and healthcare but have hardly been explored in relation to moral reasoning. Objective: To describe a central set of metaphors in one case and to explore their contribution to moral reasoning. Method: Semi-structured interviews were conducted with 16 parents of a child suffering from the neurodegenerative disease CLN3. The interviews were recorded, transcribed, and metaphors were analyzed. The researchers wrote memos and discussed about their analyses until they reached consensus. Ethical considerations: Participants gave oral and written consent and their confidentiality and anonymity were respected. Findings: A central set of metaphors referred to the semantic field of the hands and arms and consisted of two central metaphors that existed in a dialectical relationship: grasping versus letting go. Participants used these metaphors to describe their child’s experiences, who had to “let go” of abilities, while “clinging” to structures and the relationship with their parent(s). They also used it to describe their own experiences: participants tried to “grab” the good moments with their child and had to “let go” of their child when (s)he approached death. Participants, in addition, “held” onto caring for their child while being confronted with the necessity to “let go” of this care, leaving it to professional caregivers. Discussion: The ethical analysis of the findings shows that thinking in terms of the dialectical relationship between “grasping” and “letting go” helps professional caregivers to critically think about images of good care for children with CLN3. It also helps them to bear witness to the vulnerable, dependent, and embodied nature of the moral self of children with CLN3 and their parents. Conclusion: Metaphorical reasoning may support the inclusion of marginalized perspectives in moral reasoning. Future studies should further explore the contribution of metaphorical reasoning to moral reasoning in other cases.
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Affiliation(s)
- Erik Olsman
- Leiden University Medical Center, The Netherlands; Academic Medical Center, The Netherlands; Hospice Bardo, The Netherlands
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How should realism and hope be combined in physician–patient communication at the end of life? An online focus-group study among participants with and without a Muslim background. Palliat Support Care 2016; 15:359-368. [DOI: 10.1017/s1478951516000833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:Maintaining false hope may result in prolonged curative aggressive treatments until the very last stage of life. In this study, we sought to explore how people think that realistic and hopeful information should best be combined in physician–patient communications at the end of life.Method:During a period of 15 days, participants of five online focus groups (OFGs) could log in onto a closed discussion site and offer responses to several topics. A variety of people participated: patients, older people, relatives, and healthcare professionals with and without a Muslim background. Participants with a Muslim background constituted a separate group, because previous research indicated that they might have distinct views on good end-of-life care and communication. Transcripts were analyzed following the principles of thematic analysis.Results:Participants from all focus groups preferred that physicians provide realistic information in an empathic way, stating that the patient would never be left on his own and that withholding curative treatment was not equal to withholding care, explicitly asking how the patient could be helped during the time remaining, and involving other professionals in the care process and communications. As such, physicians could support patients' transition from “hope for a cure” to “hope for a good death.” Muslims specified the way they wished to receive realistic information: first from a relative, and not by using the term “incurable illness,” but rather by informing the patient that they had no remaining curative treatments available.Significance of results:Realism and hope are not necessarily mutually exclusive and can be combined when providing realistic information in a delicate and culturally sensitive way. This study provides suggestions on how physicians can do so. Communication skills training as well as anchoring knowledge of the diversity of cultural and religious views into physicians' education could improve end-of-life communication.
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