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Taladay-Carter C. Making end-of-life health disparities in the U.S. visible through family bereavement narratives. PEC INNOVATION 2024; 4:100276. [PMID: 38576418 PMCID: PMC10992982 DOI: 10.1016/j.pecinn.2024.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024]
Abstract
Objective End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care. Methods Semi-structured interviews with 25 bereaved individuals were conducted regarding their experiences with the terminal illness and death of an immediate family member. Using a framework of family bereavement narratives, a cross-case data analysis demonstrated qualitative patterns between (in)access to end-of-life care and how participants framed bereavement stories. Results Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond. Innovation This innovative qualitative connection between family members' bereavement stories and end-of-life care emphasizes the importance of employing a health equity lens within hospice and palliative care, especially in addressing the important aim of comprehensively supporting families even when illness ends. This study demonstrates that access to, quality of, and imagining beyond current structures for EOL may be vital factors for facilitating effective sense-making for the dying and their family systems. Conclusion These findings illustrate the potential interconnections between (in)access to end-of-life care, sense-making, and communication for individuals and families experiencing terminal illness and bereavement.
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Affiliation(s)
- Cassidy Taladay-Carter
- Department of Communication Studies, University of Nebraska—Lincoln, 356 Louise Pound Hall, Lincoln, NE 68588, USA
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Tong J, Wang S, Cao J. Do People Prefer Home Palliative Care? A Survey Study and Assessment of Associated Factors in China. J Palliat Care 2024; 39:202-208. [PMID: 38414416 DOI: 10.1177/08258597241235449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Objectives: This study examined people's preference for the location to receive palliative care services and determined the associated factors. Methods: A questionnaire with reference to the Chinese version of the Hospice Attitude Scale and the Death Correspondence Scale was designed, piloted, revised, and distributed online and in person to collect data (N = 762). Binary logistic regression was used to analyze the effects of relevant factors. Results: The average age of the participants was 38.1, with a relatively even gender distribution. Over 90% of the participants were either single/never married (44.9%) or married with children (46.0%). 58.1% of the respondents (N = 428) indicated that they would like to receive palliative care at home, compared to 41.9% who preferred receiving such care in institutions or other places (N = 309). Each time people's attitudes toward death became one point more positive, they were 10.2% more likely to choose to receive palliative care services at home. People with a neutral attitude toward palliative care, single/never married or divorced with children, and having/had an occupation in health and social work had higher odds of preferring receiving palliative care at home. Those who had poor self-rated health or with an educational background of primary school or lower or some college had lower odds of preferring receiving palliative care at home. Conclusions: The research showed that attitudes toward death and other factors were associated with people's preferences for palliative care locations. More accessible and affordable community-based and home-based palliative care services should be further explored and provided.
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Affiliation(s)
- Juncheng Tong
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuaiyan Wang
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiawei Cao
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
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Hauschildt KE. Whose Good Death? Valuation and Standardization as Mechanisms of Inequality in Hospitals. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:221-236. [PMID: 36523154 PMCID: PMC10267289 DOI: 10.1177/00221465221143088] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although most clinicians have come to perceive invasive life-sustaining treatments as overly aggressive at the end of life, some of the public and greater proportions of some socially disadvantaged groups have not. Drawing on 1,500+ hours of observation in four intensive care units and 69 interviews with physicians and patients' family members, I find inequality occurs through two mechanisms complementary to the cultural health capital and fundamental causes explanations prevalent in existing health disparities literature: in valuation, as the attitudes and values of the socially disadvantaged are challenged and ignored, and in standardization, as the outcomes preferred by less advantaged groups are defined as inappropriate and made harder to obtain by the informal and formal practices and policies of racialized organizations. I argue inequality is produced in part because wealthier and White elites shape institutional preferences and practices and, therefore, institutions and clinical standards to reflect their cultural tastes.
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Chen TC, Wang SH, Ho CM, Lin HC, Tung CL, Chang CC, Tsai CF, Chen TH, Fang YC, Lin WT, Lee YT, Chang YS, Lee MY. Effectiveness of early palliative care in patients with head and neck cancer in Taiwan. J Chin Med Assoc 2024; 87:643-652. [PMID: 38838200 DOI: 10.1097/jcma.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Early palliative care (EPC) benefits some cancers, but its clinical outcomes differ depending on patients' racial and ethnic disparities, and customs. To determine whether EPC improves symptoms, emotional distress, and quality of life among Taiwanese patients with early or advanced-stage head and neck cancer (HNC). METHODS Based on participants' pathological stages, they were categorized as having early and advanced-stage HNC. Those willing and unwilling to undergo EPC were assigned to the EPC and standard groups, respectively. Their daily cancer-related symptoms were assessed using the Distress Thermometer (DT) and MD Anderson Symptom Inventory (MDASI), whose scores' concurrent validity was evaluated using the European Organization for Research and Treatment of Core Quality of Life (EORTC-QLQ-C30) and Head and Neck 35 (EORTC-QLQ-H&N35) questionnaires. RESULTS Patients (n = 93) diagnosed with HNC at Taiwan's Chia-Yi Christian Hospital from November 2020 to October 2022 were recruited. The patients voluntarily split into two groups: EPC groups and standard groups (23 and 11 in early-stage; 46 and 13 in advanced-stage, respectively). DT assessment showed significant emotional distress improvements for all patients with HNC who received EPC. The EORTC-QLQ-C30 questionnaire indicated that, compared to standard interventions, EPC groups significantly improved the quality of life and some symptoms for both early and advanced-stage HNC patients. However, the EORTC-QLQ-H&N35 questionnaire found no significant difference between the two groups. Furthermore, advanced-stage patients' anticancer treatment completion rates with EPC and standard interventions were 95.35% and 75%, respectively. CONCLUSION EPC improves symptoms, emotional distress, quality of life, and treatment completion rates in Taiwanese patients with early or advanced-stage HNC. Nonetheless, further extensive clinical studies are required for validation.
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Affiliation(s)
- Tzu-Chun Chen
- Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan, ROC
| | - Shih-Hao Wang
- Department of Otolaryngology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
- Department of otolaryngology, St. Martin De Porres Hospital, Chiayi, Taiwan, ROC
| | - Cho-Ming Ho
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Hwan-Chung Lin
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Chun-Liang Tung
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Chih-Chia Chang
- Department of Radiation Therapy and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yi-Chun Fang
- Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Wei-Ting Lin
- Department of Oral and Maxillofacial Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yu-Ting Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Yu-Sung Chang
- Department of Otolaryngology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Ming-Yang Lee
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan, ROC
- Department of Internal Medicine, Division of Hemato-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
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Harhara T, Buhumaid R, Oyoun Alsoud L, Ibrahim H. Palliative care education: a nationwide qualitative study of emergency medicine residency program directors in the United Arab Emirates. Int J Emerg Med 2024; 17:69. [PMID: 38783214 PMCID: PMC11119274 DOI: 10.1186/s12245-024-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Emergency medicine (EM) physicians routinely care for patients with serious life-limiting illnesses. Educating EM residents to have general skills and competencies in palliative medicine is a global priority. The purpose of this study was to describe the current status of palliative and end-of-life education in EM residency programs in the United Arab Emirates (UAE) and to identify barriers and opportunities to inculcating palliative care (PC) instruction into EM training in a non-Western setting. METHODS Using the American College of Emergency Medicine's milestones for Hospice and Palliative Medicine for Emergency Medicine as a question guide, semi-structured interviews were conducted with program directors of all 7 EM residency programs in the UAE from January through July 2023. Qualitative content analysis was conducted to identify recurring themes. RESULTS All program directors agreed that PC knowledge and skills are essential components of training for EM residents but have had variable success in implementing a structured PC curriculum. Six themes emerged, namely the educational curriculum, PC policies and practices, comprehensive PC services, cultural and religious barriers to PC, EM scope of practice, and supporting residents after patient death. CONCLUSION UAE national EM residency curriculum development is evolving with an emphasis on developing a structured PC curriculum. As EM residencies implement policies and programs to improve care for patients and families dealing with serious illness, future studies are needed to assess the impact of these initiatives on patient quality of life and physician well-being.
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Affiliation(s)
- Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Department of Emergency Medicine, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Leen Oyoun Alsoud
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.
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Madni A. Culturally Responsive Care for Patients With a Serious Illness #478. J Palliat Med 2024; 27:699-701. [PMID: 38728088 DOI: 10.1089/jpm.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
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Anderson K, Marquez SA, Pulley K, Benninghove P, Kurzman J, Harris K, Roberts J, Jones H, May T, Thornton A, Dwyer EJ, Hogue B. A Catalyst for Change: Intensive Care Unit Social Work Practice in the Post-COVID Era. HEALTH & SOCIAL WORK 2024; 49:125-130. [PMID: 38484145 DOI: 10.1093/hsw/hlae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/05/2023] [Indexed: 04/30/2024]
Affiliation(s)
- Kerri Anderson
- LCSW, is clinical social worker, palliative care, Virginia Commonwealth University (VCU) Health, 1250 East Marshall Street, Richmond, VA 23298, USA
| | - Sarah Andes Marquez
- LCSW, is clinical social worker III, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Kasey Pulley
- LCSW, is social work clinician, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Patricia Benninghove
- MSW, is care coordination team lead, inpatient pediatrics, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Judy Kurzman
- MSW, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Katina Harris
- MSW, are clinical social workers, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Joseph Roberts
- MSW, is clinical social worker, pediatric intensive care unit, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Harley Jones
- MSW, is clinical social worker II, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Tammie May
- RN, ACNS-BC, CCN, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Ashena Thornton
- BSN, RN, are care coordination team leads, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Emily J Dwyer
- BSW, RN, ACM, is registered nurse care coordinator and team lead, College of Health Professions, VCU Health, Richmond, VA, USA
| | - Bonita Hogue
- LCSW, C-SWHC, is social work manager, College of Health Professions, VCU Health, Richmond, VA, USA
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Kaplan A, Ladin K, Junna S, Lindenberger E, Ufere NN. Serious Illness Communication in Cirrhosis Care: Tools to Improve Illness Understanding, Prognostic Understanding, and Care Planning. GASTRO HEP ADVANCES 2024; 3:634-645. [PMID: 38873184 PMCID: PMC11175167 DOI: 10.1016/j.gastha.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Patients with cirrhosis frequently experience an unpredictable illness trajectory, with frequent hospitalizations and complications. Along with the uncertain nature of the disease, the possibility of a lifesaving and curative transplant often makes prognostic discussions and future care decisions challenging. Serious illness communication (SIC) refers to supportive communication whereby clinicians assess patients' illness understanding, share prognostic information according to patients' preferences, explore patients' goals, and make recommendations for care that align with these goals. SIC includes 3 key components: (1) illness understanding; (2) prognostic understanding; and (3) care planning. In this piece, we explore current barriers to early implementation of SIC in cirrhosis care and share possible solutions, including adopting a multidisciplinary approach, delivering culturally competent care, and training clinicians in SIC core skills. By use of a case example, we aim to demonstrate SIC in action and to provide clinicians with tools and skills that can be used in practice.
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Affiliation(s)
- Alyson Kaplan
- Department of Gastroenterology, Department of Surgery, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts
| | - Keren Ladin
- Department of Community Health, Tufts University, Boston, Massachusetts
| | - Shilpa Junna
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth Lindenberger
- Department of Geriatrics and Palliative Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Nneka N. Ufere
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
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Black R, Hasson F, Slater P, Beck E, McIlfatrick S. Building public engagement and access to palliative care and advance care planning: a qualitative study. BMC Palliat Care 2024; 23:98. [PMID: 38605315 PMCID: PMC11010379 DOI: 10.1186/s12904-024-01420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. METHODS Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. RESULTS Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. CONCLUSIONS Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society.
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Affiliation(s)
- Rachel Black
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1ED, Northern Ireland
| | - Esther Beck
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1ED, Northern Ireland
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland.
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Sultan L, de Jong N, Alsaywid B, Khan MA, de Nooijer J. Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:281-291. [PMID: 38600963 PMCID: PMC11005846 DOI: 10.2147/amep.s450166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
Background Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care. Aim This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings. Methods We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted. Findings The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants. Conclusion The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.
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Affiliation(s)
- Lama Sultan
- Department of Clinical Nutrition, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, KSA, Saudi Arabia
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Nynke de Jong
- Department of Health Services Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NL, Saudi Arabia
| | - Basim Alsaywid
- Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, KSA, Saudi Arabia
- Education and Research Skills Directory, Saudi National Institute of Health, Riyadh, KSA, Saudi Arabia
| | - Muhammad Anwar Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA, Saudi Arabia
| | - Jascha de Nooijer
- Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Lim GH, Yong C, Breen LJ, Keesing S, Buchanan A. Occupations and occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore: A focus group study. Aust Occup Ther J 2024. [PMID: 38499502 DOI: 10.1111/1440-1630.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/03/2024] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION While Singapore is rapidly ageing and the need for palliative care services is projected to rise, there has been limited exploration of the occupations of Chinese older adults with life-limiting conditions. This study is the third in a series of three studies aimed to address this issue. This study also sought to discuss future directions for occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore. METHOD The study adopted a qualitative exploratory design using focus groups. Participants were recruited using convenience and snowball sampling. Inclusion criteria were occupational therapists who had attained full registration status with the Allied Health Professionals Council in Singapore, had two or more years of practice as an occupational therapist, and had a current or recent palliative care caseload. FINDINGS Three focus groups with 16 participants were conducted, and three themes were constructed from the data through reflexive thematic analysis. Reflections on culture and occupations is about the impact of a collectivist culture on occupations, such as tensions new caregivers experience between keeping clients safe and respecting clients' choices. It also highlights that there will always be individual differences within any cultural group. Challenges of occupational therapy practice in palliative care describe the need for therapists to be comfortable with rest and ethical tensions participants faced with billing for sessions that mainly involved time spent conversing with clients and when clients and caregivers' goals differed. Finally, Moving forward is about the importance of having mentors and the learning needs of occupational therapists in palliative care. CONCLUSION Occupational therapists experienced in providing services to palliative care clients in Singapore emphasised the collectivist nature of Singaporean Chinese families and contributed more information to its possible impact on occupations and occupational therapy practice and made suggestions for future practice.
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Affiliation(s)
- Geck Hoon Lim
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Health & Social Sciences, Singapore Institute of Technology, Singapore
| | | | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Sharon Keesing
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Angus Buchanan
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Heller LD. Palliative Care in Sub-Saharan Africa: A Narrative Review. J Palliat Med 2024. [PMID: 38466990 DOI: 10.1089/jpm.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: As a person nears the end of their life, culture and ethnicity increasingly drive preferences and priorities for care. Understanding these preferences and priorities is fundamental to health care professionals' goals to respect decision making and support the individual throughout this phase of life. Across Africa, several countries are in the initial stages of implementing palliative care services in their burgeoning health care systems. Moving forward, it is imperative to consider cultural similarities and differences when compared with the Western world, where the field of palliative care evolved, to create a tailored palliative care approach that is consistent with African culture. In palliative care, understanding cultural preferences and priorities requires communication between the patient and the provider and is a crucial step toward a successful implementation in Africa. A paternalistic patient-provider relationship is the current leading model in sub-Saharan Africa.1 Aim: This narrative review explores the prevalence of paternalism and explores its appropriateness and necessity in the current application of palliative care in sub-Saharan African countries. Methods: This narrative review was conducted using four databases as well as hand searching of relevant articles sourced from references of already selected articles. A total of 730 articles were identified. Fourteen articles met the inclusion/exclusion criteria set for this narrative review. Results: In sub-Saharan Africa, the leading patient-provider relationship was determined to be paternalistic. Reasons for this were language, education, cultural norms and expectations, lack of time, and benevolence. Conclusions: The implementation of palliative care often relies on communication of patient desires and goals. Consideration is needed to determine how a provider can appropriately know these factors in a paternalistic relationship.
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Affiliation(s)
- Layne DeAnn Heller
- School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
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Beattie JM, Castiello T, Jaarsma T. The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review. Vasc Health Risk Manag 2024; 20:109-123. [PMID: 38495057 PMCID: PMC10944309 DOI: 10.2147/vhrm.s392636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this life-limiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.
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Affiliation(s)
- James M Beattie
- School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Teresa Castiello
- Department of Cardiology, Croydon University Hospital, London, UK
- Department of Cardiovascular Imaging, King’s College London, London, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Qi Y, Reijneveld SA, Almansa J, Brouwer S, Vrooman JC. Diverging death risks: Mortality as a corollary of economic, social, cultural and person capital. SSM Popul Health 2024; 25:101644. [PMID: 38486801 PMCID: PMC10937154 DOI: 10.1016/j.ssmph.2024.101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital. Methods We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. Economic capital was measured through education, income, occupation, home equity, and liquid assets. Social capital was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; cultural capital by lifestyle, digital skills, and mastery of English, and person capital by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression. Results In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex. Conclusion The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.
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Affiliation(s)
- Yuwei Qi
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - Sijmen A. Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - Josué Almansa
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - Sandra Brouwer
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - J. Cok Vrooman
- Utrecht University, Department of Sociology/ICS, Utrecht, the Netherlands
- The Netherlands Institute for Social Research|SCP, the Netherlands
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15
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Forte DN, Stoltenberg M, Ribeiro SCDC, de Almeida IM(MO, Jackson V, Daubman BR. The Hierarchy of Communication Needs: A Novel Communication Strategy for High Mistrust Settings Developed in a Brazilian COVID-ICU. Palliat Med Rep 2024; 5:86-93. [PMID: 38415076 PMCID: PMC10898234 DOI: 10.1089/pmr.2023.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
Context The COVID-19 pandemic presented unique challenges for health care systems. Overcrowded units, extreme illness severity, uncertain prognoses, and mistrust in providers resulted in a "pressure cooker" where traditional communication strategies were often insufficient. Objectives Building on well-studied traditional communication interventions, neurobiology principles were used to create a novel communication strategy designed in the COVID-ICU to respond to the unique communication needs of patients within the context of a high mistrust setting. Methods The hierarchy of communication needs recognizes three specific levels of communication that are essential within high-emotion and low-trust settings. The first level is to establish trust. The second level is to resonate with patients' emotions, helping to reduce arousal and improve empathy. The third level includes the more traditional content of disclosing prognostic information and shared decision-making. When facing communication challenges, clinicians are taught to move back a level and reattune to emotions and/or reestablish trust. Discussion The COVID pandemic revealed the shortcomings of a primarily cognitive communication style. The hierarchy of communication needs emphasizes trust building, and emotional resonance as prerequisites of effective cognitive discussions, resulting in more effective clinician-patient communication that more fully incorporates cultural humility and better meets the needs of diverse patient populations. Additional research is needed to further develop this strategy and evaluate its impact on patient experience and outcomes.
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Affiliation(s)
- Daniel Neves Forte
- Intensive Care Unit, Medical Emergency Department, University of São Paulo Medical School, São Paulo, Brazil
- Teaching and Research Institute, Sírio Libanês Hospital, São Paulo, Brazil
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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16
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Wondimagegnehu A, Assefa M, Teferra S, Kantelhardt EJ, Zebrack B, Addissie A. A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model. QUALITATIVE HEALTH RESEARCH 2024:10497323231219409. [PMID: 38229470 DOI: 10.1177/10497323231219409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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17
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Gerger H, van Dijk-de Vries A, Moser A, Jochem I, Veenstra M, Perry M, van Bokhoven M. Adjusting advance care planning to older people's needs: results from focus groups and interviews. BMC Health Serv Res 2024; 24:51. [PMID: 38200528 PMCID: PMC10782636 DOI: 10.1186/s12913-023-10491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) is becoming increasingly important in medical care. Some suggest standardized approaches to initiate ACP with all older adults. However, the idea of patient-centered care suggests more nuanced approaches tailored to individual older adults' needs. This study investigated how older adults with different views and needs about ACP can be approached in an adequate and most beneficial way by health care professionals. METHODS We used questionnaires, interviews, focus groups and informal conversations with older adults, living in their own homes, who volunteered to take part in our research. The research was participatory as we collaborated closely with practice partners and we used the obtained findings immediately and continuously to inform the next steps of our research throughout the process. RESULTS We identified three subgroups of older adults with differential needs regarding ACP-related activities: The first group avoids talking about their needs and wishes for care towards the end of life. These older people benefit from activities, which aim at motivating them to concern themselves with ACP-related topics. The second group consists of older adults who are in principle open for ACP-conversations but do not initiate these themselves. This group either trusts their next-of-kin or their healthcare professional to act in accordance with their wishes or does not bring up the topic in order to avoid confronting relevant others with possibly unpleasant topics. This group of people benefits from information about ACP and from healthcare professionals initiating the ACP process. The third group of older people initiates the ACP process themselves, gathers information, and takes the necessary steps for ACP. With this group it remains relevant to check carefully whether they have indeed taken all relevant steps and shared the information with all relevant involved care institutions and relatives. CONCLUSIONS We propose a model to simplify adjustments of ACP to individuals' needs. Our suggested approach might contribute to increasing the motivation of older people to engage in ACP conversations if these are more closely related to their own needs. Further, it might also contribute to simplifying the individual shaping of the ACP process for healthcare professionals as our suggested model offers clear guidance for approaching different types of older people in different ways. The suggested approach may in future be used for training health care professionals in the conduct of ACP conversations.
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Affiliation(s)
- Heike Gerger
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Anneke van Dijk-de Vries
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Albine Moser
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | | | | | - Marieke Perry
- Department of Primary Care Medicine and Geriatrics, Radboudumc, Nijmegen, the Netherlands
| | - Marloes van Bokhoven
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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18
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Zapata C, Poore T, O’Riordan D, Pantilat SZ. Hispanic/Latinx and Spanish Language Concordance Among Palliative Care Clinicians and Patients in Hospital Settings in California. Am J Hosp Palliat Care 2024; 41:73-77. [PMID: 37073754 PMCID: PMC10709994 DOI: 10.1177/10499091231171337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Background: Members of racial or ethnic minority groups utilize palliative care (PC) services less than non-Hispanic White patients and multiple factors contribute to this disparity. The impact of racial, ethnic, and language (REL) concordance between patients and clinicians has been demonstrated in general medical populations, but not in PC populations. We characterized the racial and ethnic composition and languages spoken of California PC clinicians and patients to examine clinical impacts of REL concordance. Methods: Using Palliative Care Quality Network data, 15 inpatient teams were identified in California that had collected data on patient race/ethnicity and language. Patient and clinician data were analyzed using means and medians for continuous variables, and chi-squared tests to explore similarities and differences between clinician and patient data. Results: 51 clinicians from nine teams completed the survey. The largest non-White and non-English speaking groups among patients and clinicians identified as Hispanic/Latinx (31.5% of patients, 16.3% of clinicians) and as Spanish speakers (22.6% of patients, 7.5% of clinicians). There was a significantly higher proportion of Hispanic/Latinx patients compared to clinicians (p-value 0.01), with Southern California demonstrating the largest difference (30.4% of patients vs. 10.7 % of clinicians, p-value 0.01). Similar proportions of patients and clinicians reported Spanish fluency (22.6% vs 27.5%, p-value 0.31). Discussion: We found significant differences in the racial/ethnic distributions of Hispanic/Latinx patients and clinicians in California, prompting consideration of whether a lack of representation of Hispanic/Latinx clinicians relative to the patient population may contribute to lower palliative care utilization among Hispanic/Latinx patients.
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Affiliation(s)
- Carly Zapata
- Division of Palliative Medicine, University of California, San Francisco, CA, US
| | - Timothy Poore
- Division of Palliative Medicine, University of California, San Francisco, CA, US
| | - David O’Riordan
- Division of Palliative Medicine, University of California, San Francisco, CA, US
| | - Steven Z. Pantilat
- Division of Palliative Medicine, University of California, San Francisco, CA, US
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19
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Dolmans RGF, Robertson FC, Eijkholt M, van Vliet P, Broekman MLD. Palliative Care in Severe Neurotrauma Patients in the Intensive Care Unit. Neurocrit Care 2023; 39:557-564. [PMID: 37173560 PMCID: PMC10689547 DOI: 10.1007/s12028-023-01717-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 05/15/2023]
Abstract
Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide and many patients with TBI require intensive care unit (ICU) management. When facing a life-threatening illness, such as TBI, a palliative care approach that focuses on noncurative aspects of care should always be considered in the ICU. Research shows that neurosurgical patients in the ICU receive palliative care less frequently than the medical patients in the ICU, which is a missed opportunity for these patients. However, providing appropriate palliative care to neurotrauma patients in an ICU can be difficult, particularly for young adult patients. The patients' prognoses are often unclear, the likelihood of advance directives is small, and the bereaved families must act as decision-makers. This article highlights the different aspects of the palliative care approach as well as barriers and challenges that accompany the TBI patient population, with a particular focus on young adult patients with TBI and the role of their family members. The article concludes with recommendations for physicians for effective and adequate communication to successfully implement the palliative care approach into standard ICU care and to improve quality of care for patients with TBI and their families.
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Affiliation(s)
- Rianne G F Dolmans
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Marleen Eijkholt
- Department of Ethics and Law in Healthcare, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter van Vliet
- Department of Intensive Care Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Marike L D Broekman
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Centre, The Hague, The Netherlands
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20
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Burke C, Doody O, Lloyd B. Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 2023; 22:182. [PMID: 37978500 PMCID: PMC10655398 DOI: 10.1186/s12904-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.
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Affiliation(s)
- Colette Burke
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Barbara Lloyd
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland.
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21
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Zhang Y, Zhang S, Liu C, Chen X, Ding Y, Guan C, Hu X. Caregiver burden among family caregivers of patients with advanced cancer in a palliative context: A mixed-method study. J Clin Nurs 2023; 32:7751-7764. [PMID: 37706353 DOI: 10.1111/jocn.16872] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023]
Abstract
AIM To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context. DESIGN A sequential, explanatory, mixed-method study was performed. METHODS Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor-Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden. RESULTS The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support). CONCLUSION Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed. IMPLICATIONS FOR THE PROFESSION It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units. IMPACT This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units. REPORTING METHOD The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards. PATIENT OR PUBLIC CONTRIBUTION Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.
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Affiliation(s)
- Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua Liu
- Department of Targeting Therapy & Immunology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yuxin Ding
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Chang Guan
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China school of Nursing, Sichuan University, Chengdu, Sichuan, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, China
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22
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Anandarajah G, Mennillo MR, Wang S, DeFries K, Gottlieb JL. Trust as a Central Factor in Hospice Enrollment Disparities Among Ethnic and Racial Minority Patients: A Qualitative Study of Interrelated and Compounding Factors Impacting Trust. J Palliat Med 2023; 26:1488-1500. [PMID: 37379486 DOI: 10.1089/jpm.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Background: Disparities in end-of-life (EOL) care remain among ethnic/racial minority populations. Choosing hospice care in the United States depends on goals-of-care discussions founded on trust. While studies examine hospice enrollment disparities and others explore trust in hospice settings in general, very few explicitly examine the role of trust in hospice enrollment disparities. Objectives: To explore factors impacting trust and how these might contribute to disparities in hospice enrollment. Design: A qualitative, individual interview study, based on grounded theory. Setting/Subjects: Setting: Rhode Island, USA. Participants: Multiple stakeholders in EOL care, with diverse professional and personal backgrounds. Measurements: In-depth semistructured individual interviews were audio-recorded and transcribed as part of a broader study of hospice enrollment barriers in diverse patients. Analysis: Five researchers did a secondary data analysis, focusing on trust as the central phenomenon of interest. Researchers independently analyzed transcripts, then held iterative group analysis meetings until they reached consensus regarding themes, subthemes, and relationships. Results: Twenty-two participants included five physicians, five nurses, three social workers, two chaplains, one nursing assistant, three administrators, and three patient caregivers/family. Interviews reveal that trust is multidimensional, involving personal- and systems-level trust, and both locus and degree of trust. Factors impacting trust include: fear; communication/relationships; knowledge of hospice; religious/spiritual beliefs; language; and cultural beliefs/experiences. While some are common across groups, several are more prevalent in minority populations. These factors appear to interact in complex ways, unique to individual patients/families, compounding their impact on trust. Conclusions: While gaining patient/family trust regarding EOL decision making is challenging across all groups, minority patients often experience additional compounding factors impacting trust building. More research is needed to mitigate the negative ways these interacting factors impact trust.
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Affiliation(s)
- Gowri Anandarajah
- Department of Family Medicine and Medical Science, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Meera R Mennillo
- Department of English, University of Rhode Island, Kingston, Rhode Island, USA
| | - Sophie Wang
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Kai'olu DeFries
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Jaya L Gottlieb
- Department of Biology, University of Massachusetts-Amherst, Amherst, Massachusetts, USA
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23
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Skedsmo K, Bingen HM, Hofsø K, Steindal SA, Hagelin CL, Hilderson D, Nes AAG, Smis D, Stenseth HV, Olaussen C. Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study. Nurse Educ Pract 2023; 73:103832. [PMID: 37948917 DOI: 10.1016/j.nepr.2023.103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
AIM The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education. BACKGROUND Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education. DESIGN An exploratory descriptive design. METHODS A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation. RESULTS Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery. CONCLUSIONS Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.
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Affiliation(s)
| | | | - Kristin Hofsø
- Lovisenberg Diaconal University College, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo, University Hospital, Oslo, Norway
| | - Simen A Steindal
- Institute of nursing, Faculty of Health Studies, VID Specialized University, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Carina Lundh Hagelin
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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24
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Viana JN, Pilbeam C, Howard M, Scholz B, Ge Z, Fisser C, Mitchell I, Raman S, Leach J. Maintaining High-Touch in High-Tech Digital Health Monitoring and Multi-Omics Prognostication: Ethical, Equity, and Societal Considerations in Precision Health for Palliative Care. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:461-473. [PMID: 37861713 DOI: 10.1089/omi.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Advances in digital health, systems biology, environmental monitoring, and artificial intelligence (AI) continue to revolutionize health care, ushering a precision health future. More than disease treatment and prevention, precision health aims at maintaining good health throughout the lifespan. However, how can precision health impact care for people with a terminal or life-limiting condition? We examine here the ethical, equity, and societal/relational implications of two precision health modalities, (1) integrated systems biology/multi-omics analysis for disease prognostication and (2) digital health technologies for health status monitoring and communication. We focus on three main ethical and societal considerations: benefits and risks associated with integration of these modalities into the palliative care system; inclusion of underrepresented and marginalized groups in technology development and deployment; and the impact of high-tech modalities on palliative care's highly personalized and "high-touch" practice. We conclude with 10 recommendations for ensuring that precision health technologies, such as multi-omics prognostication and digital health monitoring, for palliative care are developed, tested, and implemented ethically, inclusively, and equitably.
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Affiliation(s)
- John Noel Viana
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Caitlin Pilbeam
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mark Howard
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Philosophy, School of Philosophical, Historical and International Studies, Monash University, Clayton, Australia
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Zongyuan Ge
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Data Science & AI, Monash University, Clayton, Australia
| | - Carys Fisser
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Sujatha Raman
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
| | - Joan Leach
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
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Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact On Acute Pain and Pain Services. Curr Pain Headache Rep 2023; 27:429-436. [PMID: 37405553 PMCID: PMC10462520 DOI: 10.1007/s11916-023-01125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.
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Affiliation(s)
- Rahel Rogger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S. Romero
- Anesthesia, Critical Care and Pain Department, Hospital General Universitario de Valencia, Universitad Europea de Valencia, Valencia, Spain
| | - Richard D. Urman
- Department of Anaesthesiology, The Ohio State University, Columbus, OH USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Mark G. Filipovic
- Department of Anaesthesiology and Pain Medicine, Pain Center, Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Bulle S, Arya A, Dosani N. From Cultural Safety to Anti-Racism: Reflections on Addressing Inequities in Palliative Care. Curr Oncol 2023; 30:7920-7925. [PMID: 37754490 PMCID: PMC10527891 DOI: 10.3390/curroncol30090575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights.
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Affiliation(s)
- Seana Bulle
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada;
| | - Amit Arya
- Palliative Care Physician, Freeman Centre for the Advancement of Palliative Care, North York General Hospital, 4001 Leslie Street Ontario, North York, ON M2K 1E1, Canada;
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Health, 25 Brunswick Avenue, Toronto, ON M5S 2L9, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON L8P 1H6, Canada
| | - Naheed Dosani
- Department of Family & Community Medicine, St. Michael’s Hospital, Unity Health Toronto, 36 Queen Street East, Toronto, ON M5B 1W6, Canada
- PEACH (Palliative Education And Care for the Homeless) Program, Inner City Health Associates, 145 Front Street East, Toronto, ON M5A 1E3, Canada
- Kensington Hospice, Kensington Health, 45 Brunswick Avenue, Toronto, ON M5A 3M3, Canada
- Canadian Partnership against Cancer, 145 King Street West, Toronto, ON M5H 1J8, Canada
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Ben-Moshe S, Curseen KA. Advance Care Planning in the Geriatrics Clinic. Clin Geriatr Med 2023; 39:407-416. [PMID: 37385692 DOI: 10.1016/j.cger.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Advance care planning (ACP) is a process that allows individuals to express their health-care preferences and make decisions about their future medical care. Clinicians practicing in a Geriatrics clinic or with many patients who are aged 65 years or older have a unique opportunity to discuss patients' goals of care. ACP is particularly important for older adults, who may be facing serious health issues and/or end-of-life decisions. This review article will provide an overview of the importance of ACP in the geriatrics clinic, discuss the barriers to implementation, and explore strategies for successful integration..
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Affiliation(s)
- Sivan Ben-Moshe
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Geriatrics Clinic, Emory Healthcare, 1525 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Kimberly A Curseen
- Division of Palliative Medicine, Emory Palliative Care Center, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30322, USA.
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Hooper M, Perrine BL, Carroll RL. The Vocal Priorities of College Students With and Without Self-Reported Voice Problems. J Voice 2023:S0892-1997(23)00175-3. [PMID: 37423796 DOI: 10.1016/j.jvoice.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine if the Vocal Priorities Questionnaire (VPQ) could be used in people who were not seeking treatment for a voice problem. To determine if the VPQ could be used to compare groups based on self-reported voice problems. To determine if vocal priorities (loudness, clarity, pitch, pitch range) vary based on self-reported voice problems. STUDY DESIGN Prospective cross-sectional study. METHODS An online survey that contained demographic questions, questions about self-reported voice problems, and the VPQ was distributed to undergraduate university students. Confirmatory factor analyses (CFA) and exploratory factor analysis (EFA) were completed to determine if the VPQ was appropriate for use in this population. Invariance testing determined if the VPQ could be used to compare groups. Cronbach's alpha determined internal consistency. An analysis of variance was conducted to compare the scores for each vocal priority across three self-reported voice problem categories: never, current, and past. RESULTS Responses from 285 participants were analyzed. An initial CFA found that the four-priority VPQ originally proposed did not have adequate fit indices. An EFA and modified CFA revealed that four priorities were still present, but "not having a gravelly voice" fit better with the priority of pitch, not clarity. With this model, invariance was verified and Cronbach's alpha indicated internal consistency. Loudness was the top vocal priority for 34.8%. In those with a past voice problem, clarity was scored higher compared to those with a current voice problem, F(2, 284) = 5.298, P = 0.006, and pitch range was scored higher compared to those who had never experienced a voice problem, F(2, 284) = 5.431, P = 0.005. CONCLUSIONS A modified four-priority version of the VPQ presented with acceptable dimensionality and invariance for college students with and without self-reported voice problems. Scores for clarity and pitch range were influenced by experiences with voice problems.
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Affiliation(s)
- McKenna Hooper
- Olympic View Elementary School, North Thurston Public Schools, Lacey, Washington
| | - Brittany L Perrine
- Department of Communication Sciences and Disorders, Baylor University, Waco, Texas.
| | - Rachel L Carroll
- Department of Communication Sciences and Disorders, Baylor University, Waco, Texas
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Kasimovskaya N, Geraskina N, Fomina E, Ivleva S, Krivetskaya M, Ulianova N, Zhosan M. Russian nurses' readiness for transcultural care of palliative patients. BMC Palliat Care 2023; 22:87. [PMID: 37407991 DOI: 10.1186/s12904-023-01198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Palliative care involves an approach aimed at improving the quality of life of patients and their families, who are forced to cope with the problems associated with life-threatening diseases. This definition includes a growing group of patients around the world. It requires an extension of the definition of patients in need of palliative care in countries such as Russia and a significant improvement in the work of nursing personnel with these patients. This study aims to determine the level of preparedness of nursing personnel for specialized care (transcultural care) and the quality of care provided to palliative patients. The presented findings of the study demonstrate the relevance of developing transcultural competence, which enables significant improvement in the quality of life of palliative patients. The analysis of medical workers' assessment of the level of specific training and their intercultural preparedness was conducted based on hospices (Moscow). A survey was conducted among 113 medical workers of the middle level of education aged between 28 and 56 (average of 44.2 years) and experience in palliative care ranged from 3 to 18 years (average of 9.5 years). The Intercultural Readiness Check (IRC) test, widely used to assess nursing staff worldwide, was used for the survey to determine the level of readiness for transcultural care. A strong correlation was found between a number of the test scales and measures of participants' age and experience. The presented material demonstrates the realization of an interdisciplinary approach to the issues of specific training of nursing personnel in the field of "transcultural care" in providing palliative care to incurable patients.
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Affiliation(s)
- Nataliya Kasimovskaya
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Natalia Geraskina
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
| | - Elena Fomina
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Svetlana Ivleva
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Maria Krivetskaya
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nina Ulianova
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Marina Zhosan
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Dixon KC, Conci R, Bowers B, Duschinsky R, Spathis A, Barclay S. Traveller end of life care experiences and needs: thematic analysis. BMJ Support Palliat Care 2023:spcare-2023-004284. [PMID: 37402538 DOI: 10.1136/spcare-2023-004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Travelling communities are a significant, but poorly understood, group of ethnic minorities known to experience inequalities in many aspects of healthcare, including at the end of life. This study explored the end of life care experiences and needs of Travellers, along with the perspectives of healthcare professionals. METHODS Secondary thematic analysis of data from two focus groups and 16 interviews. Eighteen UK-based members of Travelling communities and three healthcare professionals took part in two focus groups. Sixteen hospice staff were interviewed. Data were collected by UK charity One Voice 4 Travellers in 2018. RESULTS Tensions permeated the healthcare experience of Travellers. The perceived need for concealment of ethnic identity in the healthcare setting conflicted with participants' desire for personalised care and tailored services. Healthcare professionals' limited awareness of Travellers' cultural rituals around death led to difficulties, including misunderstandings relating to the large numbers of family gathered at the bedside of dying relatives in hospital and hospice settings. Approaches that could increase the acceptability of healthcare included Travellers working in liaison roles, increased provision of space for visiting family and cultural competency training for staff. However, challenges remain in converting ideal solutions into feasible changes. CONCLUSIONS Improved communication and understanding between Travelling communities and healthcare professionals is needed to relieve the multilevel tensions experienced at the end of life. At an individual level, this would enable personalised care; at a systems level, cocreation of end of life care services with Travellers would help ensure that their cultural needs are met.
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Affiliation(s)
- Kathryn Charlotte Dixon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Riccardo Conci
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ben Bowers
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Landstad BJ, Kvangarsnes M. Physicians' narratives of communication with patients and their relatives in different phases of the palliative pathway. BMJ Open 2023; 13:e065681. [PMID: 37328175 PMCID: PMC10277073 DOI: 10.1136/bmjopen-2022-065681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To explore physicians' experiences of the communication with patients and their relatives in the different phases of the palliative pathway. METHODS Purposeful sampling was employed to recruit a total of 13 oncologists and general practitioners who engaged in palliative care. A qualitative study with a narrative approach was conducted. Interviews with physicians working in primary and specialist healthcare were conducted via Skype Business in the spring of 2020. The interview guide had open-ended questions with each interview lasting between 35 and 60 min. RESULTS Communication between the physicians, their patients and their relatives was contextual and changed depending on the phase in the palliative pathway. In the first phase, physicians told us that patients and their relatives experienced an emotional shock. Transitioning from the curative to palliative phase was difficult, which emphasised the need for trust through communication. In the middle phase, they revealed that communication about the death process became the priority: what was probably going to happen, the family's role in what was going to happen and perhaps, depending on the illness, any medical decisions that needed to be made. It was important for the physicians to communicate information about the palliative pathway while providing the relatives with knowledge that facilitated any decision making. In the terminal phase, physicians employed a compassionate approach, as bereaved family members needed to process their feelings of guilt and grief. CONCLUSIONS The study gives new insight into communication with patients and their relatives during different phases of the palliative pathway, from the physician's perspective. The findings may help physicians improve the quality of communication with patients and their relatives over these vulnerable pathways. The findings also have practical implications in training contexts. The study reveals ethical dilemmas in physicians' communication with patients and their relatives during a palliative pathway.
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Affiliation(s)
- Bodil J Landstad
- Faculty of Human Science, Mid Sweden University, Ostersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Ostersund, Sweden
| | - Marit Kvangarsnes
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
- Unit of Research, Møre og Romsdal Hospital Trust, Alesund, Norway
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Salas Moreira AP, Baceiredo BG, Centeno C, Reigada C. Educational innovation as a communication strategy in palliative care: A study protocol and preliminary results. PLoS One 2023; 18:e0286343. [PMID: 37294774 PMCID: PMC10256175 DOI: 10.1371/journal.pone.0286343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/02/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Society associates palliative care with "death" or "end of life", which cause them fear and anxiety. In Spain, the media worsens the misunderstanding by depicting a wrong picture of palliative care. Educational innovation for university students may serve as an alternative communication strategy. Care and Society is a university course designed by and for students from non-health degrees to help disseminate the palliative care message. The first year of the Teach-Inn Pal project aims to evaluate the effects of the course and to identify areas of improvement. OBJECTIVE To present an evaluation to determine if the course can work as a campaign to refocus the public opinion on palliative care and share the preliminary results of the pilot study. METHODOLOGY A prospective Participatory Action Research study. University students enrolled in the course (n = 29) are invited to test and redesign the palliative care message. Knowledge and empathy will be measured throughout the learning process. Afterwards, qualitative, thematic, inductive analysis of the course material will be carried out. This study is registered on the ISRCTN Registry under the name "Can a university course help communicate palliative care?" (Registration number: ISRCTN10236642). DISCUSSION This study is part of a doctoral thesis. Education is used as a creative outlet, allowing rapid testing of multiple tools to create ambassadors of palliative care that may reframe the public opinion. CONCLUSION The understanding of students about palliative care changed, the overall impression of the experience was positive, and students were also able to explain palliative care to people with little or no experience in the topic. However, to determine if they became ambassadors the results of the mid-term assessment are required.
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Affiliation(s)
- Ana Paula Salas Moreira
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
| | - Beatriz Gómez Baceiredo
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
- Journalism Department, School of Communication of the University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
| | - Carla Reigada
- ATLANTES Global Observatory of Palliative Care, Culture and Society Institute, University of Navarra, Pamplona, Spain
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Boyden JY, Bogetz JF, Johnston EE, Thienprayoon R, Williams CSP, McNeil MJ, Patneaude A, Widger KA, Rosenberg AR, Ananth P. Measuring Pediatric Palliative Care Quality: Challenges and Opportunities. J Pain Symptom Manage 2023; 65:e483-e495. [PMID: 36736860 PMCID: PMC10106436 DOI: 10.1016/j.jpainsymman.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Pediatric palliative care (PPC) programs vary widely in structure, staffing, funding, and patient census, resulting in inconsistency in service provision. Improving the quality of palliative care for children living with serious illness and their families requires measuring care quality, ensuring that quality measurement is embedded into day-to-day clinical practice, and aligning quality measurement with healthcare policy priorities. Yet, numerous challenges exist in measuring PPC quality. This paper provides an overview of PPC quality measurement, including challenges, current initiatives, and future opportunities. While important strides toward addressing quality measurement challenges in PPC have been made, including ongoing quality measurement initiatives like the Cambia Metrics Project, the PPC What Matters Most study, and collaborative learning networks, more work remains. Providing high-quality PPC to all children and families will require a multi-pronged approach. In this paper, we suggest several strategies for advancing high-quality PPC, which includes 1) considering how and by whom success is defined, 2) evaluating, adapting, and developing PPC measures, including those that address care disparities within PPC for historically marginalized and excluded communities, 3) improving the infrastructure with which to routinely and prospectively measure, monitor, and report clinical and administrative quality measures, 4) increasing endorsement of PPC quality measures by prominent quality organizations to facilitate accountability and possible reimbursement, and 5) integrating PPC-specific quality measures into the administrative, funding, and policy landscape of pediatric healthcare.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing (J.Y.B.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jori F Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care (J.F.B.), University of Washington School of Medicine, Seattle, Washington, USA; Center for Clinical and Translational Research (J.F.B.), Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily E Johnston
- Department of Pediatrics, Division of Hematology and Oncology (E.E.J.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (E.E.J.), Birmingham, Alabama, USA
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics (C.S.P.W.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J McNeil
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine (M.J.M.), Memphis, Tennessee, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology (M.J.M.), Memphis, Tennessee, USA
| | - Arika Patneaude
- Bioethics and Palliative Care, Seattle Children's Hospital (A.P.), Seattle, Washington, USA; University of Washington School of Social Work (A.P.), Seattle, Washington, USA; Treuman Katz Center for Pediatric Bioethics (A.P.), Seattle, Washington, USA
| | - Kimberley A Widger
- Lawrence S. Bloomberg Faculty of Nursing (K.A.W.), University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children (K.A.W.), Toronto, Ontario, Canada
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care (A.R.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School (A.R.S.), Boston, Massachusetts, USA
| | - Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine (P.A.), New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center (P.A.), New Haven, Connecticut, USA
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Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
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Childers JW, Bulls H, Arnold R. Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations. J Pain Symptom Manage 2023; 65:e375-e379. [PMID: 36521764 PMCID: PMC10883350 DOI: 10.1016/j.jpainsymman.2022.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Julie W Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA.
| | - Hailey Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA
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Coats H, Shive N, Adrian B, Boyd AD, Doorenbos AZ, Schmiege SJ. An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e41787. [PMID: 36943346 PMCID: PMC10131928 DOI: 10.2196/41787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In the health care setting, electronic health records (EHRs) are one of the primary modes of communication about patients, but most of this information is clinician centered. There is a need to consider the patient as a person and integrate their perspectives into their health record. Incorporating a patient's narrative into the EHR provides an opportunity to communicate patients' cultural values and beliefs to the health care team and has the potential to improve patient-clinician communication. This paper describes the protocol to evaluate the integration of an adapted person-centered narrative intervention (PCNI). This adaptation builds on our previous research centered on the implementation of PCNIs. The adaptation for this study includes an all-electronic delivery of a PCNI in an outpatient clinical setting. OBJECTIVE This research protocol aims to evaluate the feasibility, usability, and effects of the all-electronic delivery of a PCNI in an outpatient setting on patient-reported outcomes. The first objective of this study is to identify the barriers and facilitators of an internet-based-delivered PCNI from the perspectives of persons living with serious illness and their clinicians. The second objective is to conduct acceptability, usability, and intervention fidelity testing to determine the essential requirements for the EHR integration of an internet-based-delivered PCNI. The third objective is to test the feasibility of the PCNI in an outpatient clinic setting. METHODS Using a mixed method design, this single-arm intervention feasibility study was delivered over approximately 3 to 4 weeks. Patient participant recruitment was conducted via screening outpatient palliative care clinic schedules weekly for upcoming new palliative care patient visits and then emailing potential patient participants to notify them about the study. The PCNI was delivered via email and Zoom app. Patient-reported outcome measures were completed by patient participants at baseline, 24 to 48 hours after PCNI, and after the initial palliative care clinic visit, approximately 1 month after baseline. Inclusion criteria included having the capacity to give consent and having an upcoming initial outpatient palliative care clinic visit. RESULTS The recruitment of participants began in April 2021. A total of 189 potential patient participants were approached via email, and 20 patient participants were enrolled, with data having been collected from May 2021 to September 2022. A total of 7 clinician participants were enrolled, with a total of 3 clinician exit interviews and 1 focus group (n=5), which was conducted in October 2022. Data analysis is expected to be completed by the end of June 2023. CONCLUSIONS The findings from this study, combined with those from other PCNI studies conducted in acute care settings, have the potential to influence clinical practices and policies and provide innovative avenues to integrate more person-centered care delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41787.
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Affiliation(s)
- Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nadia Shive
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Andrew D Boyd
- University of Illinois, Chicago, IL, United States
- UI Health, Chicago, IL, United States
| | - Ardith Z Doorenbos
- University of Illinois, Chicago, IL, United States
- University of Illinois Cancer Center, Chicago, IL, United States
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Higuita-Gutiérrez LF, Salas-Zapata WA, Cardona-Arias JA. Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia. Behav Sci (Basel) 2023; 13:bs13030236. [PMID: 36975261 PMCID: PMC10044741 DOI: 10.3390/bs13030236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people’s health or even put them at risk of dying from this disease has garnered a considerable degree of attention. Methods: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. Results: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (β coefficient, −0.12), and brings them closer to psychogenic (β coefficient, 0.22) and alternative treatments (β coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (β coefficient, 0.40) over biomedical treatments (β coefficient, 0.24). Conclusions: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.
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Affiliation(s)
- Luis Felipe Higuita-Gutiérrez
- School of Medicine, Universidad Cooperativa de Colombia, Medellín 050010, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín 050010, Colombia
- Correspondence:
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Forster-Holt N, DeSanto-Madeya S, Davis J. The Mortality of Family Business Leaders: Using a Palliative Care Model to Re-imagine Letting Go. JOURNAL OF MANAGEMENT INQUIRY 2023. [DOI: 10.1177/10564926231159331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The succession literature frames a leader's reluctance to let go as the single largest deterrent to succession planning, and early literature pointed to the stronghold that mortality can have on letting go. The notion has not captured our continued curiosity, preventing a full understanding of the tensions and antecedents of family business succession. Most scholarship on letting go describes a quest for immortality and in this sense, ‘mortality’ has been misapplied and one dimensional. In an interdisciplinary boost to family business, we turn to palliative care, where it is believed that the acknowledgment of one's mortality will facilitate letting go. We develop four typologies of letting go by combining elements of mortality awareness and planning that offers nuance and insights into long-held beliefs about this most vital and finite ‘soft issue’. We discuss emotion governance tools that help change the mortality awareness trajectory and support family business succession.
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Affiliation(s)
- Nancy Forster-Holt
- College of Business Administration, University of Rhode Island, Kingston, RI, USA
| | | | - James Davis
- Huntsman School of Business, Utah State University, Logan, UT, USA
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Six S, Bilsen J, Deschepper R. Dealing with cultural diversity in palliative care. BMJ Support Palliat Care 2023; 13:65-69. [PMID: 32826261 DOI: 10.1136/bmjspcare-2020-002511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/29/2023]
Abstract
Palliative care is increasingly confronted with cultural diversity. This can lead to various problems in practice. In this perspective article, the authors discuss in more detail which issues play a role in culture-sensitive palliative care, why naive culturalism will not solve such problems and in which direction research into this aspect of care can be further elaborated.
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Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
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Gergis M, Bekhet A, Kozlowski-Gibson M, Hovland C, Dahlin C, Ent M, Thoman J. Resourcefulness and stress among hospice and palliative nurses: the role of positive thinking. Int J Palliat Nurs 2023; 29:91-99. [PMID: 36822614 DOI: 10.12968/ijpn.2023.29.2.91] [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: 02/25/2023]
Abstract
Background: Among healthcare professionals, hospice and palliative nurses have a high risk of experiencing work stress. However, little attention has been paid to protective factors that could mitigate the impact of daily stressors on hospice and palliative nurses. Aim: This study aimed to determine whether resourcefulness and positive thinking have a negative association with perceived stress among hospice and palliative nurses, and whether positive thinking moderates or mediates the link between resourcefulness and stress among hospice and palliative nurses. Method: A cross-sectional, correlational design was used to address these two aims. Results: A convenience sample of 86 hospice and palliative nurses (95% female) in the US completed an online survey. The results demonstrated that positive thinking and resourcefulness are useful predictors of stress reduction and help mitigate the effects of stress. Positive thinking did not mediate the relationship between resourcefulness and stress. Conclusion: Moderation analysis suggests that social resourcefulness may be especially helpful in reducing stress among hospice and palliative nurses with a low level of positive thinking.
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Affiliation(s)
- Mary Gergis
- Assistant Professor, School of Nursing, College of Health, Cleveland State University, USA
| | - Abir Bekhet
- Professor, Marquette University, College of Nursing, USA
| | - Maria Kozlowski-Gibson
- Associate Professor, School of Nursing, College of Health, Cleveland State University, USA
| | - Cynthia Hovland
- Associate Professor, School of Social Work, College of Health, Cleveland State University, USA
| | - Constance Dahlin
- Palliative Care Specialist and Consultant, Center to Advance Palliative Care, USA
| | - Michael Ent
- Assistant Professor, Towson University, Department of Psychology, USA
| | - Joan Thoman
- Associate Professor, School of Nursing, College of Health, Cleveland State University, USA
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Mofidi A, Khan Kermanshahi SM, Jaseb K. Effect of a partnership care programme on quality of life in school-age children with leukaemia: a controlled clinical trial. Int J Palliat Nurs 2023; 29:66-74. [PMID: 36822617 DOI: 10.12968/ijpn.2023.29.2.66] [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: 02/25/2023]
Abstract
Background: Despite the low quality of life (QoL) of children with leukaemia, there is a lack of well-designed and culture-oriented care programmes to improve it. The Partnership Care Model (PCM), which was developed based on the Iranian culture, seems to be effective in improving the QoL in children living with chronic diseases. Aim: This study aimed to evaluate the effect of a care programme based on the PCM on the QoL of children with leukaemia. Methods: This controlled clinical trial encompassed 60 school-age children with leukaemia and their mothers. In the experimental group (n=30), a 2-month care programme was implemented based on the PCM, including the four stages of motivation, preparation, involvement and evaluation. Only standard care was provided to the control group (n=30). Children's QoL was assessed using the Paediatric Quality of Life Inventory 3.0 Cancer Module in the pre-test phase and 2 months after the intervention. Findings: The total score of QoL and all its subscales were significantly higher in the experimental group than the control group in the post-test phase (p<0.001). Moreover, a significant difference was observed between pre-test and post-test scores in all domains in the experimental group (p<0.001); however, no significant difference was noticed between the scores in the control group. Conclusion: The partnership care programme seems to improve the QoL in children with leukaemia. Future investigations are recommended to shed further light on the findings of this study.
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Affiliation(s)
- Afsaneh Mofidi
- MSc Student of Nursing, Department of Nursing, Tarbiat Modares University, Iran
| | | | - Kaveh Jaseb
- Assistant Professor, Department of Pediatric Hematology and Oncology, Ahvaz Jundishapur University of Medical Sciences, Iran
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Ufere NN, El-Jawahri A, Ritchie C, Lai JC, Schwarze ML. Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using "Best Case/Worst Case". Gastroenterology 2023; 164:171-176. [PMID: 36702571 DOI: 10.1053/j.gastro.2022.12.005] [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: 01/28/2023]
Affiliation(s)
- Nneka N Ufere
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, and, Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts, and, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine Ritchie
- Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts, and, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Margaret L Schwarze
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using "Best Case/Worst Case". Clin Gastroenterol Hepatol 2023; 21:250-255. [PMID: 36697145 DOI: 10.1016/j.cgh.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 01/27/2023]
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Agustina R, Ispriantari A, Konlan KD, Lin MF. Impact of early palliative care on the quality of life in caregivers of cancer patients: A systematic review. Worldviews Evid Based Nurs 2023. [PMID: 36637053 DOI: 10.1111/wvn.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Maintaining caregivers' quality of life (QoL) is critical to sustaining the care needed for cancer patients. One of the interventions applied to cancer patients' caregivers is early palliative care (EPC). AIMS This systematic review synthesized the implementation of EPC on the QoL of caregivers of cancer patients. METHODS The search was undertaken using seven electronic databases: Medline, Embase, CINAHL, CENTRAL, Web of Science, Scopus, and ProQuest Dissertation & Theses (PQDT). The search strategy integrated relevant terms of early palliative care, caregivers, cancer, and quality of life and was conducted until March 14, 2022. The thematic data analysis approach was used to integrate the results. RESULTS Using advanced search features, 4193 studies were obtained on the initial search. After screening and quality assessment, eight studies were included. Eight studies depicted that EPC interventions were delivered for caregivers of patients with advanced cancer, that is, those with a life expectancy of at least 4-24 months or considered intermediate to poor prognosis. One study provided the intervention for caregivers of patients newly diagnosed with cancer. None of the studies had the same protocol or content in delivering EPC for caregivers. Four studies gave similar details on addressing the strategies for caregivers in several aspects, including physical, psychological, social, and spiritual. There was no difference in the QoL between caregivers with cancer patients who received EPC compared with usual care. EPC was noted to influence other factors, such as caregivers' psychological distress and burden. LINKING EVIDENCE TO ACTION The data on EPC interventions portray no beneficial effects on the QoL of caregivers with cancer patients. Further studies on developing standard protocols of EPC, multidisciplinary team, and how early it should be given to caregivers are strongly recommended.
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Affiliation(s)
- Rismia Agustina
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Nursing, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru, Indonesia
| | - Aloysia Ispriantari
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.,Department of Nursing, Institute of Technology and Health Science RS dr Soepraoen, Malang, Indonesia
| | - Kennedy Diema Konlan
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.,Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Mei-Feng Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Phiri GG, Muge-Sugutt J, Porock D. Palliative and End-of-Life Care Access for Immigrants Living in High-income Countries: A Scoping Review. Gerontol Geriatr Med 2023; 9:23337214231213172. [PMID: 38026093 PMCID: PMC10666706 DOI: 10.1177/23337214231213172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients' family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in high-income countries, requires identifying and addressing barriers to care access, especially by immigrants with CaLD background. Five-stage methodological framework by Arksey and O'Malley was used to undertake the review. Immigrants in OECD countries experience challenges in accessing palliative and EOL care services. The review also identified limited literature on the subject and establishes need for more research on the subject.
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HarnEnz Z, Vermilion P, Foster-Barber A, Treat L. Pediatric neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:157-184. [PMID: 36599507 DOI: 10.1016/b978-0-12-824535-4.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pediatric palliative care seeks to support quality of life for children and families affected by serious illness. Children with neurological disease are among the most frequent recipients of pediatric palliative care. Several important elements distinguish pediatric palliative care from adult practice, including a longer illness duration, longitudinal relationships over the span of years, diseases characterized by chronic fragility rather than progressive pathology, and the reliance on parents as proxy decision makers. This chapter will provide an overview of pediatric neuropalliative care, with emphasis on the types of disease trajectories, symptom management, and communication principles for supporting shared decision making with families. The role of neurology expertise is highlighted throughout, with special attention toward incorporating palliative care into pediatric neurology practice.
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Affiliation(s)
- Zoe HarnEnz
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Paul Vermilion
- Department of Medicine, University of Rochester, Rochester, NY, United States
| | - Audrey Foster-Barber
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Lauren Treat
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States.
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Elbaum A, Kinsey L, Mariano J. Decision-Making Across Cultures. Cancer Treat Res 2023; 187:85-104. [PMID: 37851221 DOI: 10.1007/978-3-031-29923-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
This chapter surveys the range of different orientations toward decision-making, common clinical scenarios, and considerations to bear in mind when caring for culturally diverse patients at the end of life. While this chapter draws on the cultural competency literature, its primary goal is to articulate an approach to end-of-life care that is rooted in cultural humility and structural competency. Medical providers, as representatives of the social institution of medicine, have their own cultural values that often come into conflict with patients' cultural values, especially when patients and providers have different unspoken visions of the "good death," or when patients wish to receive interventions that their providers deem futile. In the final section of the chapter, we seek to move away from this confrontational paradigm by analyzing two case studies of decision-making across cultures in order to empower providers to engage in value-based shared decision-making and thereby achieve goal-concordant care.
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Affiliation(s)
- Alan Elbaum
- University of California San Francisco, San Francisco, USA.
| | | | - Jeffrey Mariano
- Department of Geriatrics, Palliative Medicine and Continuing Care, Kaiser Permanente Bernard J. Tyson School of Medicine, Southern California Permanente Medical Group, Kaiser Permanente West Los Angeles, Pasadena, USA
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Alshehri HH, Wolf A, Öhlén J, Olausson S. Healthcare Professionals' Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study. Glob Qual Nurs Res 2022; 9:23333936221138077. [PMID: 36507302 PMCID: PMC9729985 DOI: 10.1177/23333936221138077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
There is a growing need to integrate palliative care into intensive care units and to develop appropriate knowledge translation strategies. However, multiple challenges persist in attempts to achieve this objective. In this study, we aimed to explore intensive care professionals' perspectives on providing palliative and end-of-life care within an intensive care context. We used an interpretive description approach and interviewed 36 intensive care professionals at four hospitals in Saudi Arabia. Our findings reflect a discourse about end-of-life care driven by a do-not-resuscitate classification and challenges associated with family involvement in care goals. We provide key insights of importance for the development of strategies for the integration and knowledge translation of palliative care into intensive care contexts.
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Affiliation(s)
- Hanan Hamdan Alshehri
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Hanan Hamdan Alshehri, University of Gothenburg Sahlgrenska Academy, Box 457 405 30 Göteborg, Goteborg 405 30, Sweden. Emails: ;
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital/Östra, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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