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Siouta E, Farrell C, Chan EA, Walshe C, Molassiotis A. Communicative constructions of person-centred and non-person-centred caring in nurse-led consultations. Eur J Oncol Nurs 2019; 40:10-21. [DOI: 10.1016/j.ejon.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/01/2019] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
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2
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Carlsson E, Pettersson ME. Communicative and pedagogical strategies in nurses' and surgeons' discharge consultations with patients undergoing surgery for colorectal cancer. J Adv Nurs 2018; 74:2840-2850. [PMID: 30019343 DOI: 10.1111/jan.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/21/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To describe the structure, content, and the communicative and pedagogic strategies in discharge consultations between patients and professionals after colorectal cancer surgery. BACKGROUND Both nurses and surgeons play an important role in preparing patients for discharge from hospital following surgery for colorectal cancer (CRC). DESIGN An explorative quantitative and qualitative research based on analysis of transcriptions of 13 audio-taped discharge consultations between patients and nurses and patients and surgeons conducted between January - March 2012. METHODS In the quantitative analysis, the structure of each consultation was described in phases, subtopics, and main topics. The proportion of the main topics in relation to the whole conversation was counted in percentages. The text from the consultations was then analysed qualitatively with the support from Ricoeur's theory of interpretation. RESULTS The language constituted the essence in the consultations regardless of other communicative and pedagogical strategies. The pedagogic strategies used were explanation model, information transfer, task orientation, and dialogue. Topics occurring in the consultations were Operation, Symptoms, Medication, Thromboprophylaxis, Recovery after surgery, Bowel function, Spreading, and Follow-up. The surgeons and nurses used similar topics, but the surgeons used more communicative and pedagogic strategies. CONCLUSION Language was fundamental for communication and independent of the communicative and pedagogical strategies. Using preparedness communication more consistent in discharge consultation can help patients to better understand the recovery process after CRC surgery and regain control over their life. It is important that the consultations build on the patient as an active and learning person.
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Affiliation(s)
- Eva Carlsson
- The Surgical Department, Sahlgrenska University Hospital/Östra, Göteborg, Sweden.,Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Monica E Pettersson
- Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.,The Vascular Department Sahlgrenska University Hospital/Sahlgrenska, Göteborg, Sweden
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3
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Cowley A, Evans C, Bath-Hextall F, Cooper J. Patient, nursing and medical staff experiences and perceptions of the care of people with palliative esophagogastric cancer: a systematic review of the qualitative evidence. ACTA ACUST UNITED AC 2018; 14:134-166. [PMID: 27846123 DOI: 10.11124/jbisrir-2016-003168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Esophagogastric cancer is the fifth most common malignancy and its incidence is increasing. The disease progresses quickly and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence on the most effective service models to support esophagogastric cancer patients. OBJECTIVES The overall objective of this systematic review was to synthesize the best available evidence on the experiences and perceptions of patients and health professionals with regard to the care of people diagnosed with palliative esophagogastric cancer. INCLUSION CRITERIA TYPES OF PARTICIPANTS The review considered studies that included patients diagnosed with palliative esophagogastric cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. PHENOMENA OF INTEREST The review considered studies that investigated the experiences and perceptions of people diagnosed with palliative esophagogastric cancer and staff working with these people. CONTEXT Studies that were carried out in any setting, including in-patient and outpatient areas, specialist cancer and non-specialist palliative care services and those were any patient were in receipt or had experiences of palliative care services were considered. All types of health practitioners delivering palliative care to esophagogastric cancer patients were considered. TYPES OF STUDIES Studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and narrative approaches were considered. Mixed methods studies were considered in the review only if qualitative findings were reported separately. SEARCH STRATEGY A three-step search strategy was utilized. A total 11 databases were searched for studies from 2000 onward, followed by hand searching of reference lists. METHODOLOGICAL QUALITY Methodological quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI). DATA EXTRACTION Qualitative findings were extracted using the JBI-QARI data extraction Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach. RESULTS The review included two publications. There were 46 findings which were aggregated into four categories and one overall synthesized finding: "In addition to support for physical needs, patients need support that takes into account changing life situations to achieve the best quality of life." CONCLUSIONS The review shows that patients value services and support that addresses their complex, fluctuating and highly individual needs. No evidence was uncovered regarding how these services should be designed and delivered.
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Affiliation(s)
- Alison Cowley
- 1Nottingham University Hospitals NHS Trust, Nottingham, UK 2School of Health Sciences, University of Nottingham 3The Nottingham Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence, Nottingham, UK
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Lim CT, Tadmor A, Fujisawa D, MacDonald JJ, Gallagher ER, Eusebio J, Jackson VA, Temel JS, Greer JA, Hagan T, Park ER. Qualitative Research in Palliative Care: Applications to Clinical Trials Work. J Palliat Med 2017; 20:857-861. [PMID: 28388341 DOI: 10.1089/jpm.2017.0061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While vast opportunities for using qualitative methods exist within palliative care research, few studies provide practical advice for researchers and clinicians as a roadmap to identify and utilize such opportunities. OBJECTIVE To provide palliative care clinicians and researchers descriptions of qualitative methodology applied to innovative research questions relative to palliative care research and define basic concepts in qualitative research. Body: We describe three qualitative projects as exemplars to describe major concepts in qualitative analysis of early palliative care: (1) a descriptive analysis of clinician documentation in the electronic health record, (2) a thematic content analysis of palliative care clinician focus groups, and (3) a framework analysis of audio-recorded encounters between patients and clinicians as part of a clinical trial. CONCLUSIONS This study provides a foundation for undertaking qualitative research within palliative care and serves as a framework for use by other palliative care researchers interested in qualitative methodologies.
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Affiliation(s)
| | - Avia Tadmor
- 2 Harvard College , Cambridge, Massachusetts
| | - Daisuke Fujisawa
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts.,4 National Cancer Center Hospital East , Kashiwa, Chiba, Japan .,5 Department of Neuropsychiatry, Keio University School of Medicine , Tokyo, Japan
| | - James J MacDonald
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Emily R Gallagher
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Justin Eusebio
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Vicki A Jackson
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Jennifer S Temel
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Joseph A Greer
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | | | - Elyse R Park
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
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5
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Pettersson ME, Öhlén J, Friberg F, Hydén LC, Carlsson E. Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery. Scand J Caring Sci 2016; 31:674-686. [DOI: 10.1111/scs.12378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/30/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Monica E. Pettersson
- Institute of Health and Care Sciences and Centre for Person-Centred Care; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
- Vascular Department; Sahlgrenska University Hospital/Sahlgrenska; Göteborg Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and Centre for Person-Centred Care; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| | - Febe Friberg
- Institute of Health and Care Sciences and Centre for Person-Centred Care; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
- Department of Health studies; Faculty of Social sciences; University of Stavanger; Stavanger Norway
| | - Lars-Christer Hydén
- Department of Health and Medical Sciences; Linköping University; Linköping Sweden
| | - Eva Carlsson
- Institute of Health and Care Sciences and Centre for Person-Centred Care; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
- The Colorectal Unit; Sahlgrenska University Hospital; Göteborg Sweden
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6
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Yoon S, Chan M, Hung WK, Ying M, Or A, Lam WWT. Communicative characteristics of interactions between surgeons and Chinese women with breast cancer in oncology consultation: a conversation analysis. Health Expect 2015; 18:2825-40. [PMID: 25200668 PMCID: PMC5810679 DOI: 10.1111/hex.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk-in-interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent. OBJECTIVE To provide insight into the talk-in-interaction in surgical-oncology consultations in the context of a Chinese medical setting. METHODS Thirty-one consultations involving 31 patients with breast cancer and eight surgeons were videotaped. The recordings were transcribed verbatim and analysed using conversation analysis. RESULTS The manner in which surgeons delivered the diagnostic results was fairly similar across all the consultations. Most surgeons gave the diagnosis in a very straightforward and abrupt manner at the outset of the consultation with no mitigation. While patients in our study conformed to the traditional information giving and receiving roles, how information was presented by surgeons shaped the subsequent sequential organization of surgeon-patient interaction and turn-taking patterns. More importantly, there was a tendency by the surgeons to move from issues of psychosocial nature to clinical matters regardless of the topics taken up in the specific encounter. CONCLUSIONS This study demonstrated the potential of conversation analysis as a context-sensitive method that enabled researchers to gain a more thorough understanding of dynamics of interaction in cancer consultations, thereby informing training interventions for surgeons. Our findings underscore the importance of discursive practices in shaping and encouraging (or discouraging) patient participation in oncology consultation.
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Affiliation(s)
- Sungwon Yoon
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
| | - Miranda Chan
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wai Ka Hung
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Marcus Ying
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Amy Or
- The Breast CentreDepartment of SurgeryKwong Wah HospitalHong Kong
| | - Wendy WT Lam
- Centre for Psycho‐Oncology Research and TrainingSchool of Public HealthThe University of Hong KongHong Kong
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7
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Clarke G, Johnston S, Corrie P, Kuhn I, Barclay S. Withdrawal of anticancer therapy in advanced disease: a systematic literature review. BMC Cancer 2015; 15:892. [PMID: 26559912 PMCID: PMC4641339 DOI: 10.1186/s12885-015-1862-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/27/2015] [Indexed: 01/23/2023] Open
Abstract
Background Current guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop. Methods A systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed. Results Forty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced ‘professional role dissonance’ between their self-perception as ‘treaters’, and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians’ personal experience, values, emotions. Some patients continued treatment to maintain ‘hope’, often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients’ decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction. Conclusions Oncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1862-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G Clarke
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | - S Johnston
- Carroll Lab Cambridge Research Institute, Cancer Research UK Cambridge Research Institute, Cambridge, United Kingdom.
| | - P Corrie
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom.
| | - I Kuhn
- Medical Library, University of Cambridge, Cambridge, United Kingdom.
| | - S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
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Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication. Palliat Support Care 2015; 14:212-24. [PMID: 26235481 DOI: 10.1017/s1478951515000814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication. METHOD A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model. RESULTS The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated. SIGNIFICANCE OF RESULTS The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient's way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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Bélanger E, Rodríguez C, Groleau D, Légaré F, Macdonald ME, Marchand R. Initiating decision-making conversations in palliative care: an ethnographic discourse analysis. BMC Palliat Care 2014; 13:63. [PMID: 25859161 PMCID: PMC4391144 DOI: 10.1186/1472-684x-13-63] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background Conversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service. Methods This qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place. Results The organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients’ complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic. Conclusions Decision-making conversations and the initiation thereof were framed by the organization of care and the referral process prior to initial encounters. While symptom management was taken for granted as part of health care professionals’ expected role, engaging in decisions regarding preparation for death implicitly remained under patients’ control. This work makes important clinical contributions by exposing the rhetorical function of family physicians’ discourse when introducing palliative care decisions.
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Affiliation(s)
- Emmanuelle Bélanger
- Department of Social and Preventive Medicine, Université de Montréal, 7101 Parc Avenue, Montreal, H3N 1X9 Quebec Canada ; Department of Family Medicine, McGill University, Montreal, Canada
| | - Charo Rodríguez
- Department of Family Medicine, McGill University, Montreal, Canada
| | | | - France Légaré
- Department of Emergency and Family Medicine, Université Laval, Quebec City, Canada
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Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations. Palliat Support Care 2014; 13:661-71. [PMID: 24784141 DOI: 10.1017/s1478951514000352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations. METHOD Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001). RESULTS Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people. SIGNIFICANCE OF RESULTS The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.
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van Gurp J, Hasselaar J, van Leeuwen E, Hoek P, Vissers K, van Selm M. Connecting with patients and instilling realism in an era of emerging communication possibilities: a review on palliative care communication heading to telecare practice. PATIENT EDUCATION AND COUNSELING 2013; 93:504-514. [PMID: 23906650 DOI: 10.1016/j.pec.2013.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Appropriate palliative care communication is pivotal to optimizing the quality of life in dying patients and their families. This review aims at describing communication patterns in palliative care and discussing potential relations between communication patterns and upcoming telecare in the practice of palliative care. METHODS This review builds on a systematic five-step qualitative analysis of the selected articles: 1. Development of a 'descriptive table of studies reviewed' based on the concept of genre, 2. Open coding of table content and first broad clustering of codes, 3. Intracluster categorization of inductive codes into substantive categories, 4. Constant inter- and intracluster comparison results in identification of genres, and 5. Labeling of genres. RESULTS This review includes 71 articles. In the analysis, two communication genres in palliative care proved to be dominant: the conversation to connect, about creating and maintaining a professional-patient/family relationship, and the conversation to instill realism, about telling a clinical truth without diminishing hope. CONCLUSION The abovementioned two genres clarify a logical intertwinement between communicative purposes, the socio-ethical background underlying palliative care practice and elements of form. PRACTICE IMPLICATIONS Our study supports understanding of current communication in palliative care and anticipates future communicative actions in an era of new communication technologies.
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Affiliation(s)
- Jelle van Gurp
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
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13
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Structure and content in consultations with patients undergoing surgery for colorectal cancer. Eur J Oncol Nurs 2013; 17:820-6. [PMID: 24012188 DOI: 10.1016/j.ejon.2013.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/11/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE To explore the structure and content of pre-planned consultations as part of the care and treatment of patients undergoing surgery for colorectal cancer. METHODS The study was based on 50 transcripts of audio-recorded pre-planned consultations between seven patients and 36 healthcare professionals from the time of diagnosis, pre-operative consultation, discharge consultation and pathology report in a colorectal unit. RESULTS The spread of consultation time between professions was considerable. Total mean consultation time for patients during the care process (7 consultations/patient) was 111 min (range 83-191). The mean consultation time for surgeons was 18 min (7-40), anaesthesiologists 12 min (5-18) and nurses 14 min (5-49). Patients took up 40% of the word space, healthcare professionals used 59% and significant others 1%. Word space changed in such a way that the patient became more active towards the final consultation. Neither during the diagnosis consultation nor during the pre-operative consultation did the patients meet the operating surgeon. Six major subjects emerged: general health, diagnosis, surgical procedure, pre-operative preparations, recovery and treatment and follow-up. CONCLUSIONS There is a need for clearer structure in the consultations. Most consultations lacked a clear introduction to the subject of the conversation. The study makes it possible to develop methods and structure for supporting conversations in which the patient is given space to help with the difficult issues present after undergoing surgery for colorectal cancer. The study also contributes to providing knowledge of how to organise surgical consultations in order to optimise person-centeredness, teamwork and clinical efficiency.
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van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
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Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Korfage IJ, Audrey S, Hak T, Blazeby JM, Abel J, Campbell R. Recognising the importance of 'family time-out' in consultations: an exploratory qualitative study. BMJ Open 2013; 3:bmjopen-2012-002144. [PMID: 23328310 PMCID: PMC3549218 DOI: 10.1136/bmjopen-2012-002144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Patients are often accompanied by family or companions during consultations, but little is known about how this might influence the process. We explored how the presence of a companion in a consultation contributes to communication and the decision-making process. DESIGN Observational study. SETTING A teaching hospital and a district general hospital in south-west England. PARTICIPANTS 31 patients and their physicians were observed during consultations in which decisions to undergo palliative chemotherapy were made. Each patient was accompanied by at least one companion. OUTCOME MEASURES Communication patterns between physicians, patients and companions. RESULTS In addition to standard patient/physician interactions, patients and companions were often found to discuss medical information and exchange opinions between themselves without the physician actively participating. We called these instances 'family time-out'. On the occasion of disagreement between patients and companions about preferred treatment options, physicians and patients were able to agree the decision while acknowledging the differences in opinion. CONCLUSIONS Instances of 'family time-out' may contribute to better consultation outcomes because they are understood and supported by the patient's social system. This study highlights the potentially important role of exchanges between patients and companions during consultations and how physicians may benefit from observation of such exchanges. We recommend testing the value of making space for family time-out during consultations. Also, we recommend further study into the medical ethics of family time-out. While the focus here is on palliative chemotherapy, this finding has implications for other consultations, particularly those involving difficult treatment decisions.
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Affiliation(s)
- Ida J Korfage
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tony Hak
- Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julian Abel
- Department of Palliative Medicine, Weston Area Healthcare Trust, Weston-super-Mare, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Siouta E, Broström A, Hedberg B. Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals. Eur J Cardiovasc Nurs 2012; 12:47-55. [DOI: 10.1177/1474515111430894] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eleni Siouta
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Anders Broström
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Sweden
| | - Berith Hedberg
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Ryhov County Hospital, 55185 Jönköping, Sweden
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Fine E, Reid MC, Shengelia R, Adelman RD. Directly observed patient-physician discussions in palliative and end-of-life care: a systematic review of the literature. J Palliat Med 2010; 13:595-603. [PMID: 20491550 DOI: 10.1089/jpm.2009.0388] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review studies that used direct observation (i.e., videotaping or audiotaping) methods in palliative/end-of-life care communication research. DESIGN Descriptive thematic analysis. SETTING Multinational studies were conducted in both the outpatient and inpatient setting. MEASUREMENTS Extensive bibliographic searches (January 1, 1998 to July 31, 2009) of English-language literature involving physician-patient (or physician-family) interactions were conducted and augmented by reviews of reference listings. Three investigators independently abstracted key information from each article. RESULTS Of the 20 retained articles, most enrolled young-old participants (mean age, 60 years) who were white and had a cancer diagnosis. Patient/family participation rates ranged from 68% to 89% demonstrating feasibility of this approach when studying palliative/end-of-life care communication issues. Four common themes were identified: (1) physicians focus on medical/technical and avoid emotional/quality of life issues; (2) sensitive topics are perceived by physicians to take longer to discuss and often do take longer to discuss; (3) physicians dominate discussions; and (4) patient/family satisfaction is associated with supportive physician behaviors. CONCLUSIONS This study demonstrates that direct observation methods can be feasibly used when studying physician-patient/physician-family communication in palliative/end-of-life care, but few investigations have utilized this approach. This article highlights areas that need improvement, including physicians' ability to address patient/family emotional issues and provide what patients and families find most satisfying (participation and support). A particular focus on older patients and patients with end-stage or late-stage chronic (noncancer) illness, the adaptation/application of existing communication measurement tools to capture palliative care communication issues, and development of corresponding outcome measures to assess impact is now needed.
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Affiliation(s)
- Elizabeth Fine
- Department of Geriatrics, Center for Geriatrics, University Hospitals, Case Medical Center, Cleveland, Ohio 44106, USA.
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Friberg F, Ohlén J. Reflective exploration of Beekman's participant experience. QUALITATIVE HEALTH RESEARCH 2010; 20:273-280. [PMID: 20065310 DOI: 10.1177/1049732309354988] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this study we explored the researcher as an instrument in phenomenological research.To contribute to the discussion on phenomenological research methods for use in fieldwork, we explored Ton Beekman's participant experience (1986) as a way of enhancing the rigor and quality of data construction in phenomenological fieldwork. Beekman's approach is characterized by dialogue, bodily presence, being there, time and space dimensions, social and personal meaning, and interpretations that are close to life. An example from fieldwork in palliative cancer care is presented, in which we used reflective analysis to discern the cocreating aspect of participant experience. We recommend further investigation of cocreating participant experience as part of phenomenological fieldwork.
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Lidén E, Öhlén J, Hydén LC, Friberg F. Ways of talking about illness and prognosis in palliative cancer care consultations—two interactional frames. Support Care Cancer 2009; 18:399-408. [DOI: 10.1007/s00520-009-0673-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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