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Stenman T, Rönngren Y, Näppä U, Melin-Johansson C. "Unless someone sees and hears you, how do you know you exist?" Meanings of confidential conversations - a hermeneutic study of the experiences of patients with palliative care needs. BMC Nurs 2024; 23:336. [PMID: 38762496 PMCID: PMC11102614 DOI: 10.1186/s12912-024-01988-9] [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: 09/12/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs. METHODS In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations. RESULTS The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life's challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences. CONCLUSIONS Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients' suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients' varying preferences.
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Affiliation(s)
- Tove Stenman
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden.
| | - Ylva Rönngren
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden
| | - Ulla Näppä
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden
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2
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Zwanenburg LC, van der Lee ML, Koldenhof JJ, Suijkerbuijk KPM, Schellekens MPJ. What patients with advanced cancer experience as helpful in navigating their life with a long-term response: a qualitative study. Support Care Cancer 2024; 32:222. [PMID: 38470541 PMCID: PMC10933145 DOI: 10.1007/s00520-024-08398-2] [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: 08/11/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Despite improved survival for people with advanced cancer due to new medical treatments, a growing group of long-term responders (LTRs) has to learn to live with uncertainties that affect several life domains. At the core of their experience, they neither feel like a patient nor feel healthy. Despite growing awareness of LTRs' experiences, learning more about how they cope with their long-term response can provide insight into how to best support them. Our study aimed to gain a deeper understanding what LTRs experience as helpful in navigating life with a long-term response. METHODS We conducted an exploratory qualitative study using thematic data analysis. Semi-structured in-depth interviews were conducted with 17 participants with advanced melanoma or lung cancer with confirmed response or long-term stable disease while on immuno- or targeted therapy. RESULTS LTRs reported several strategies to navigate life with a long-term response, for example, by involving the social environment, seeing uncertainty as an opportunity, and being present in the moment. This helped them to reclaim a sense of control, alter their perspective, and reshape their lives according to their values. CONCLUSION Using different coping strategies enables LTRs to acknowledge both their sick and healthy side. Striking a healthy balance between being oriented on feeling sick or feeling healthy can help LTRs and their close others to navigate life with a long-term response. Healthcare professionals can provide support by recognizing whether LTRs are oriented at feeling sick or healthy, and by actively involving close others during medical appointments.
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Affiliation(s)
- Laura C Zwanenburg
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723MB, Bilthoven, The Netherlands.
- Department of Medical and Clinical Psychology, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands.
| | - Marije L van der Lee
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723MB, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - José J Koldenhof
- Department of Medical Oncology, University Medical Centre in Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre in Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melanie P J Schellekens
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723MB, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands
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Baker KM, Ulrich CM, Meghani SH. An Integrative Review of Measures of Spirituality in Experimental Studies of Psilocybin in Serious Illness Populations. Am J Hosp Palliat Care 2023; 40:1261-1270. [PMID: 36604312 DOI: 10.1177/10499091221147700] [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: 01/07/2023] Open
Abstract
Background: Psilocybin-assisted therapies (PAT) are reemerging as a treatment for complex distress often prompting mystical experiences, enhanced meaning, and spiritual wellbeing. We sought to investigate how measures of spirituality are employed in experimental studies of PAT conducted with seriously ill adults. Methods: We included experimental studies of psilocybin conducted with seriously ill adults, which employed measures that contained spirituality and mysticism concepts within their domains or subdomains. Included studies were peer-reviewed and published in English language (up to December 2021). Results: Seven articles met our inclusion criteria. A total of 12 unique instruments were identified. The most frequently used instruments were the Mystical Experience Questionnaire (MEQ30), the Functional Assessment of Chronic Illness Therapy-Spirituality (FACIT-Sp-12), and the Demoralization Scale (DS-I/II) (used in four studies each), followed by the Persisting Effects Questionnaire (PEQ) (used in three studies). Overall, studies did not consistently define and contextualize spirituality domains and subdomains studied. Conclusions: Despite well-recognized significance of spirituality in PAT, there was considerable heterogeneity in number and types of spirituality measures employed across studies. There also seemed a lack of attention to defining and operationalizing spirituality and its domains and subdomains. This is notable as spirituality and overlapping concepts (eg mystical experiences) contributes substantially to this body of research and patients' therapeutic outcomes. Towards developing more rigorous science of spirituality in PAT research, there is a critical need to evaluate and refine measures of spirituality to enhance their utility and replicability, limit participant burden, and better contextualize spirituality-related findings and outcomes.
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Affiliation(s)
- Kayla M Baker
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
| | - Connie M Ulrich
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA; United States
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4
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Neller SA, Cloyes KG, Edelman LS, Wong B, Baines B, Towsley GL. Preparing for the Future While Living in the Present: Older Adults' Experiences Creating a Legacy of Values. THE GERONTOLOGIST 2023; 63:1488-1496. [PMID: 36842069 PMCID: PMC10581374 DOI: 10.1093/geront/gnad019] [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: 11/28/2022] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A legacy of values (e.g., legacy letter) is a nonlegal way to intentionally communicate intangible assets (e.g., values, life lessons, and emotional and supportive instruction) with others. There is scant research on legacy creation outside of a palliative care context, and no studies have explored the experiences of community-dwelling older adults creating a legacy of values. RESEARCH DESIGN AND METHODS As part of an exploratory sequential mixed methods study, we conducted semistructured interviews with older adults (N = 16) who had previously created a legacy of values. We analyzed transcribed interviews using an interpretive descriptive approach. We iteratively coded interviews deductively with sensitizing concepts identified in the literature (existential well-being, end-of-life preparation and completion, generativity, and resilience), and inductively, based on participants' descriptions. Codes were categorized by patterns of motivations, content, outcomes, and meaning, and thematically summarized. RESULTS We conceptualized the overall experience of creating a legacy of values as Preparing for the Future While Living in the Present and identified 4 themes: Preserving the Intangible for You and for Me, Sharing What I Want You to Know, Obtaining Peace through Reflection and Preparation, and Living into a Continuing Legacy. Participants attained peace, realized their life was not complete, and were challenged to live intentionally through legacy creation. DISCUSSION AND IMPLICATIONS Creating a legacy of values may concurrently prepare older adults for the end of life and the remainder of life. These findings offer insight into a generative act that can promote intentional living among older adults.
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Affiliation(s)
- Sarah A Neller
- College of Nursing, The University of Tennessee, Knoxville, Knoxville, Tennessee, USA
| | - Kristin G Cloyes
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Barry Baines
- Hennepin Health Care Hospice of the Twin Cities, Minneapolis, Minnesota, USA
| | - Gail L Towsley
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Tarbi EC, Broden EG, Rosa WE, Hayden A, Morgan BE. Existential Care in Daily Nursing Practice. Am J Nurs 2023; 123:42-48. [PMID: 37732668 PMCID: PMC10805359 DOI: 10.1097/01.naj.0000979092.39243.d4] [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] [Indexed: 09/22/2023]
Abstract
ABSTRACT Relationship-centered palliative nursing during serious illness requires existential care. Yet, multilevel systemic barriers hinder nurses' ability to provide this care. The authors suggest ways to navigate these barriers, highlighting existential care priorities that nurses can attend to in their daily practice. These include 1) maintaining a strengths-based orientation, 2) taking a life course perspective, 3) grounding care firmly in relationships, and 4) responding moment to moment. They propose that by emphasizing existential care in palliative nursing, we can create a more compassionate and human-centered health system.
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Affiliation(s)
- Elise C Tarbi
- Elise C. Tarbi is an assistant professor in the Department of Nursing at the University of Vermont in Burlington. Elizabeth G. Broden is a fellow in the Yale National Clinician Scholars Program in New Haven, CT, and has received funding from a National Institutes of Health training grant (5T32HS017589) to the Yale School of Public Health. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Adam Hayden is an independent scholar and unaffiliated patient advocate. Brianna E. Morgan is a postdoctoral fellow in the Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Langone Health in New York City. Contact author: Elise C. Tarbi, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Esquives BSN, Walsh EA, Penedo FJ, Thomas JL, Horner FS, Torzewski JB, Gradishar W, Victorson D, Moreno PI. Coping strategies and psychosocial resources among women living with metastatic breast cancer: A qualitative study. J Psychosoc Oncol 2023; 42:381-397. [PMID: 37698184 PMCID: PMC10927610 DOI: 10.1080/07347332.2023.2254754] [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: 09/13/2023]
Abstract
Objective: Despite more women living with metastatic breast cancer (MBC), this population is underrepresented in cancer survivorship research. Few studies have assessed how women with MBC cope with their cancer experience. This qualitative study describes the coping strategies and psychosocial resources utilized by women living with MBC.Methods: Twenty-two women with MBC participated in four focus groups. Transcripts were analyzed using a general inductive approach. Codes derived from participants' responses were subsequently condensed into themes.Results: We identified 12 coping strategies and psychosocial resources and grouped them into five themes: Behavioral Coping Strategies (i.e. stress management, active coping and planning); Cognitive Coping Strategies and Psychological Resources (i.e. cognitive reappraisal, optimism, mindfulness, positive thinking, and religious coping); Existential Approach-Oriented Coping (i.e. acceptance, values-based living, and identity integration); Avoidance (i.e. avoidant coping); and Interpersonal Resources and Seeking Social Support (i.e. social support).Conclusions: Women living with MBC utilize several engagement and disengagement coping strategies, as well as intrapersonal and interpersonal resources. This study provides useful perspectives of women living with MBC that may inform the development of psychosocial interventions. Further research is needed to assess coping strategies and psychosocial resources across different subgroups of MBC patients and determine their impact on cancer outcomes.
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Affiliation(s)
| | | | - Frank J. Penedo
- Department of Psychology, University of Miami
- Department of Medicine, University of Miami Miller School of Medicine
| | - Jessica L. Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - Joanna B. Torzewski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - William Gradishar
- Department of Medicine, Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Patricia I. Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine
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Open dialogue about complementary and alternative medicine early in the oncology treatment trajectory. A qualitative study of patients’ lived experiences. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mroz EL, McDarby M, Arnold RM, Bylund CL, Kutner JS, Pollak KI. Empathic Communication in Specialty Palliative Care Encounters: An Analysis of Opportunities and Responses. J Palliat Med 2022; 25:1622-1628. [PMID: 35426742 PMCID: PMC9836699 DOI: 10.1089/jpm.2021.0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Although empathic responding is considered a core competency in specialty palliative care (PC), patterns of empathic communication in PC encounters are not well understood. Objectives: In this secondary analysis, we delineate types and frequency of empathic communication and examine relationships between patient empathic opportunities and clinician responses. Design: We used the Empathic Communication Coding System to analyze empathic opportunities across three types: emotion (i.e., negative affective state), progress (i.e., stated recent positive life event or development), and challenge (i.e., stated problem or recent, negative life-changing event) and clinician responses. Setting/Subjects: Transcripts from a pilot randomized trial of communication coaching in specialty PC encounters (N = 71) audio-recorded by 22 PC clinicians at two sites in the United States: an academic health system and a community-based hospice and PC organization. Results: Empathic opportunities were frequent across encounters; clinicians often responded empathically to those opportunities (e.g., confirming or acknowledging patients' emotions or experiences). Even though challenge empathic opportunities occurred most frequently, clinicians responded empathically more often to progress opportunities (i.e., 93% of the time) than challenge opportunities (i.e., 75% of the time). One in 12 opportunities was impeded by the patient or a family member changing the topic before the clinician could respond. Conclusions: PC patients frequently express emotions, share progress, or divulge challenges as empathic opportunities. Clinicians often convey empathy in response and can differentiate their empathic responses based on the type of empathic opportunity. PC communication research and training should explore which empathic responses promote desired patient outcomes.
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Affiliation(s)
- Emily L. Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Meghan McDarby
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robert M. Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carma L. Bylund
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathryn I. Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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9
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Prado E, Marcon S, Kalinke L, da Silva M, Barreto M, Takemoto A, Birolim M, Laranjeira C. Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12987. [PMID: 36293568 PMCID: PMC9602127 DOI: 10.3390/ijerph192012987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz's theory. The sample consisted of 21 participants. Three inter-related data categories emerged: "Floating between acceptance and resistance: Perceiving the proximity of death", "Analysing the end from other perspectives: it is in the encounter with death that life is understood" and "Accepting the path: between the love of letting go and the love of wanting to stay". The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.
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Affiliation(s)
- Eleandro Prado
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Sonia Marcon
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Luciana Kalinke
- Nursing Department, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Marcelle da Silva
- Anna Nery Nursing School, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Mayckel Barreto
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Angelica Takemoto
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Marcela Birolim
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology, Rua de Santo André 66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention, Piaget Institute, 3515-776 Viseu, Portugal
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10
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Larsen BH, Lundeby T, Gulbrandsen P, Førde R, Gerwing J. Physicians' responses to advanced cancer patients' existential concerns: A video-based analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:3062-3070. [PMID: 35738963 DOI: 10.1016/j.pec.2022.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE In a recent study, we explored what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation and how they communicate such concerns. The current study builds on these results, investigating how the physicians responded to those concerns. METHODS We analyzed video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. RESULTS We identified 185 immediate physician-responses to the 127 patient existential utterances we had previously identified. The responses demonstrated three approaches: giving the patient control over the content, providing support, and taking control over the content. The latter was by far the most common, through which the physicians habitually kept the discussion around biomedical aspects and rarely pursued the patients' existential concerns. CONCLUSIONS Although the physicians, to some extent, allowed the patients to talk freely about their concerns, they systematically failed to acknowledge and address the patients' existential concerns. PRACTICE IMPLICATIONS Physicians should be attentive to their possible habit of steering the agenda towards biomedical topics, hence, avoiding patients' existential concerns. Initiatives cultivating behavior enhancing person-centered and existential communication should be implemented in clinical practice and medical training.
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Affiliation(s)
- Berit Hofset Larsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Tonje Lundeby
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pål Gulbrandsen
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.
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Pokpalagon P, Chaiviboontham S, Phinitkhajorndech N. Spiritual needs, spiritual well-being, and Buddhist practices of patients with terminal illness, Thailand. Palliat Support Care 2022:1-8. [PMID: 36177659 DOI: 10.1017/s1478951522001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purposes of this study were to describe and compare the spiritual needs and spiritual well-being among terminally ill patients receiving care in different palliative care settings and to investigate the differences in spiritual well-being in relation to the level of Buddhist practices. METHODS A cross-sectional multicenter study was carried out that included community/home-based care (Home), a faith-based organization for patients with AIDS (FB_AIDS), a faith-based organization for patients with cancer (FB_CA), and a hospice ward (Hospice). Descriptive statistics were used to analyze the participants' demographics, Buddhist practices, spiritual needs, and spiritual well-being. The analysis was performed using analysis of variance and Kruskal-Wallis tests to compare the spiritual needs and the spiritual well-being in the different settings. The Kruskal-Wallis test was used to investigate the differences in spiritual well-being in relation to the level of Buddhist practices. RESULTS A total of 170 patients with a terminal illness (30 Home, 33 FB_AIDS, 64 FB_CA, and 43 Hospice) participated. Patients with a terminal illness receiving care at the FB_CA and Home had significantly higher mean scores for spiritual needs than those in the other settings. Patients with a terminal illness receiving care at the FB_CA had a significantly higher mean score for spiritual well-being than those receiving care in the other settings. Participants having a higher frequency of Buddhist practice had significantly higher mean scores for spiritual well-being. SIGNIFICANCE OF RESULTS Spiritual needs and spiritual well-being differed significantly among participants in different palliative care settings. The more the patients engaged in Buddhist practices, the higher their scores were for spiritual well-being. Thus, religious-based strategies should be integrated into palliative care and should be more emphasized.
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Affiliation(s)
- Piyawan Pokpalagon
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchira Chaiviboontham
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noppawan Phinitkhajorndech
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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12
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Schüttengruber G, Halfens RJ, Lohrmann C. 'End of life': a concept analysis. Int J Palliat Nurs 2022; 28:314-321. [PMID: 35861440 DOI: 10.12968/ijpn.2022.28.7.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The concept of end of life (EOL), as in the term end-of-life care, is used synonymously in both palliative and terminal care. Practitioners and researchers both require a clearer specification of the end-of-life concept to be able to provide appropriate care in this phase of life and to conduct robust research on a well-described theoretical basis. AIMS The aim of this study was to critically analyse the end-of-life concept and its associated terminology. METHOD A concept analysis was performed by applying Rodgers' evolutionary concept analysis method. FINDINGS Time remaining, clinical status/physical symptoms, psychosocial symptoms and dignity were identified as the main attributes of the concept. Transition into the end-of-life phase and its recognition were identified as antecedents. This study demonstrates that end-of-life care emerged following the application of the 'end-of-life concept' to clinical practice. CONCLUSION The early recognition of the end-of-life phase seems to be crucial to ensuring an individual has well-managed symptoms and a dignified death.
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Affiliation(s)
| | - Ruud J Halfens
- Associate Professor, Health Service Research, Maastricht University, The Netherlands
| | - Christa Lohrmann
- Professor, Institute of Nursing Science, Medical University of Graz, Austria
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13
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Hayden L, Byrne E, Deegan A, Dunne S, Gallagher P. A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer. Health Psychol Open 2022; 9:20551029221121526. [PMID: 36105766 PMCID: PMC9465615 DOI: 10.1177/20551029221121526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.
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Affiliation(s)
- Lucy Hayden
- School of Psychology, Dublin City University, Ireland
| | - Emma Byrne
- School of Psychology, Dublin City University, Ireland
| | - Avril Deegan
- School of Psychology, Dublin City University, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Ireland
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14
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Tarbi EC, Blanch-Hartigan D, van Vliet LM, Gramling R, Tulsky JA, Sanders JJ. Toward a basic science of communication in serious illness. PATIENT EDUCATION AND COUNSELING 2022; 105:1963-1969. [PMID: 35410737 DOI: 10.1016/j.pec.2022.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
High-quality communication can mitigate suffering during serious illness. Innovations in theory and technology present the opportunity to advance serious illness communication research, moving beyond inquiry that links broad communication constructs to health outcomes toward operationalizing and understanding the impact of discrete communication functions on human experience. Given the high stakes of communication during serious illness, we see a critical need to develop a basic science approach to serious illness communication research. Such an approach seeks to link "what actually happens during a conversation" - the lexical and non-lexical communication content elements, as well as contextual factors - with the emotional and cognitive experiences of patients, caregivers, and clinicians. This paper defines and justifies a basic science approach to serious illness communication research and outlines investigative and methodological opportunities in this area. A systematic understanding of the building blocks of serious illness communication can help identify evidence-informed communication strategies that promote positive patient outcomes, shape more targeted communication skills training for clinicians, and lead to more tailored and meaningful serious illness care.
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Affiliation(s)
- Elise C Tarbi
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA.
| | | | | | - Robert Gramling
- University of Vermont. Department of Family Medicine, Burlington, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA; Brigham and Women's Hospital, Division of Palliative Medicine, Department of Medicine, Boston, USA.
| | - Justin J Sanders
- McGill University, Division of Palliative Care, Department of Family Medicine, Montreal, Canada.
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15
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Larsen BH, Lundeby T, Gerwing J, Gulbrandsen P, Førde R. "Eh - What type of cells are these - flourishing in the liver?" Cancer patients' disclosure of existential concerns in routine hospital consultations. PATIENT EDUCATION AND COUNSELING 2022; 105:2019-2026. [PMID: 34839995 DOI: 10.1016/j.pec.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Advanced cancer poses a threat to all aspects of being, potentially causing existential suffering. We explore what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation, and how they communicate such concerns. METHODS We analyzed thirteen video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. RESULTS Nearly all patients disclosed how the illness experience included losses and threats of loss that are strongly associated with existential suffering, displaying uncertainty about future and insecurity about self and coping. Patients usually disclosed existential concerns uninvited, but they did so indirectly and subtly, typically hiding concerns in biomedical terms or conveying them with hesitation and very little emotion. CONCLUSIONS Patients may have existential concerns they want to address, but they may be uncertain whether these are issues they can discuss with the physician. PRACTICE IMPLICATIONS Health professionals should be attentive to underlying existential messages embedded in the patient's questions and concerns. Acknowledging these existential concerns provides an opportunity to briefly explore the patient's needs and may direct how the physician tailors information and support to promote coping, autonomy, and existential health.
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Affiliation(s)
- Berit Hofset Larsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Tonje Lundeby
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.
| | - Pål Gulbrandsen
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.
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16
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Kukla H, Herrler A, Strupp J, Voltz R. "My life became more meaningful": confronting one's own end of life and its effects on well-being-a qualitative study. Palliat Care 2022; 21:58. [PMID: 35484588 PMCID: PMC9050349 DOI: 10.1186/s12904-022-00950-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress. To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts. Methods Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach. Results While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted. Conclusions There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action. Trial registration www.germanctr.de, DRKS-ID: DRKS00020577. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00950-3.
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Affiliation(s)
- Helena Kukla
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Albertus-Magnus-Platz, 50931, Cologne, Germany. .,Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.
| | - Angélique Herrler
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Albertus-Magnus-Platz, 50931, Cologne, Germany
| | - Julia Strupp
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
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17
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Rosa WE, Chochinov HM, Coyle N, Hadler RA, Breitbart WS. Attending to the Existential Experience in Oncology: Dignity and Meaning Amid Awareness of Death. JCO Glob Oncol 2022; 8:e2200038. [PMID: 35286135 PMCID: PMC8932479 DOI: 10.1200/go.22.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey M Chochinov
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada.,CancerCare Manitoba Research Institute, Manitoba, Canada
| | - Nessa Coyle
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel A Hadler
- Department of Anesthesiology, University of Iowa Hospitals and Health Clinics, Iowa City, IA, USA
| | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
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18
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Transitional self-disappear: the journey of cancer survivors to self re-coherence in a Middle East society. Support Care Cancer 2022; 30:4231-4241. [PMID: 35083542 PMCID: PMC8791693 DOI: 10.1007/s00520-021-06783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022]
Abstract
Purpose People who experience cancer often face serious and unpleasant challenges in understanding their past, present, and future. They think they have lost their lifetime, agency, and interpersonal relationships, and no longer know their bodies. These experiences can change survivors’ perceptions of themselves. Therefore, the present study aimed to develop a deep theoretical understanding of the change of self in cancer survivors. Methods Semi-structured interviews were used to collect data. Interviews were conducted with 17 cancer survivors, 2 oncologists, and 2 family members of survivors. In this study, grounded theory methodology was used to explore the process of understanding and experiencing “self” in cancer survivors. Results The present study generated a model about the change of self, with the main concept called “transitional self-disappear,” which is understandable based on the concepts of self-disruption (temporal disruption, highlighted body, interference in the agency, individual-self disruption, over-differentiation, relational self-disruption, and painful emotional experiences), self-reconstruction strategy, and quality of self-coherence, and occurs in the context of the cancer-based socio-cultural experiences and individual-environmental preparedness. Conclusion This model illuminated the complex paths and roads of the survivors’ journey from self-disappear to self reconstruction/re-coherence. A healthier experience of this journey can be facilitated by the transcendence of the “self” conceptualized in the past, and the promotion of specific (cancer-based socio-cultural experiences) and general (individual-environmental preparedness) conditions.
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19
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Tarbi EC, Morgan B. Opportunities for Poetic Analysis in Qualitative Nursing Research. Nurs Res 2022; 71:322-327. [PMID: 35067647 PMCID: PMC9246822 DOI: 10.1097/nnr.0000000000000580] [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: 01/26/2023]
Abstract
BACKGROUND The voices of people living with serious, life-limiting illnesses are often underrepresented in research. Furthermore, a biomedical bias toward treatment and stigma associated with illness prevents healthcare providers from engaging with topics critical for people living with serious illness, such as existential communication and inner strength. Poetry is an established method of analysis and dissemination in qualitative research but is underutilized by nursing researchers. OBJECTIVES The purpose of this article is to demonstrate the inherent opportunities in using poetry in nursing research to highlight the voices and issues of people whose experiences are outside the assumed norms of the biomedical paradigm. METHODS We apply methods of poetic analysis to qualitative data sets that highlight the voice of people living with serious illness-in naturally occurring palliative care conversations and dyadic interviews of people with dementia and their care partners. Methods of poetic analysis include poetic transcription and voice poems. RESULTS Methods of poetic analysis allowed us to engage with the data reflexively to intensify and evoke the deeper meaning of narratives. Poetic analysis served to center the participant's voices by using their own words to demonstrate themes. Poems are a uniquely accessible method of disseminating complex findings, as poems relay layered cognitive and emotional meaning resonant of universal human experiences in a concise and relatable format. DISCUSSION Especially in circumstances where participant's voices are underrepresented, poetic analysis enables nurse researchers to challenge normative assumptions and reimagine a difference-centered society. Our findings offer opportunities to incorporate poetry into clinical and research nursing training to better meet the needs of the populations we serve.
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Affiliation(s)
- Elise C. Tarbi
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA
| | - Brianna Morgan
- University of Pennsylvania School of Nursing, Philadelphia,
PA,Leonard Davis Institute, University of Pennsylvania,
Philadelphia, PA
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20
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Tarbi EC, Gramling R, Bradway C, Meghani SH. "If it's the time, it's the time": Existential communication in naturally-occurring palliative care conversations with individuals with advanced cancer, their families, and clinicians. PATIENT EDUCATION AND COUNSELING 2021; 104:2963-2968. [PMID: 33992483 PMCID: PMC8578593 DOI: 10.1016/j.pec.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To explore how patients with advanced cancer, their families, and palliative care clinicians communicate about existential experience during palliative care conversations. METHODS We analyzed data from the Palliative Care Communication Research Initiative (PCCRI) - a multisite cohort study conducted between 2014 and 2016 involving hospitalized adults with advanced cancer who were referred for inpatient palliative care consultations at two academic medical centers. We used a qualitative descriptive approach paired with inductive content analysis to analyze a random subsample of 30 patients from the PCCRI study (contributing to 38 palliative care conversations). RESULTS We found existential communication to be woven throughout palliative care conversations, with key themes related to: 1) time as a pressing boundary; 2) maintaining a coherent self; and 3) connecting with others. CONCLUSION Communication about existential experience is omnipresent and varied in palliative care conversations between individuals with advanced cancer, their families, and clinicians. PRACTICE IMPLICATIONS Clinicians can recognize that discussion of time, routines of daily life, and relationships in the clinical context may hold profound existential relevance in palliative care conversations. Understanding how patients and families talk about existential experience in conversation can create opportunities for clinicians to better meet these needs.
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Affiliation(s)
- Elise C Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA; NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA.
| | - Robert Gramling
- Department of Family Medicine, University of Vermont College of Medicine, Burlington, USA
| | - Christine Bradway
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
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21
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Kukla H, Herrler A, Strupp J, Voltz R. The effects of confronting one's own end of life on older individuals and those with a life-threatening disease: A systematic literature review. Palliat Med 2021; 35:1793-1814. [PMID: 34486450 DOI: 10.1177/02692163211042528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Awareness of the impending end of one's life can pose profound existential challenges, thereby impairing well-being. Confronting one's own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches). AIM To synthesize the existing knowledge on the effects of different approaches of confronting one's own end of life on older individuals and those with a life-threatening disease. DESIGN A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso. DATA SOURCES Medline, PsycINFO, and Web of Science were searched from inception to 12/2020. RESULTS N = 49 studies reported on different approaches of confronting one's own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being). CONCLUSION Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.
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Affiliation(s)
- Helena Kukla
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Angélique Herrler
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
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22
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Gramling R, Javed A, Durieux BN, Clarfeld LA, Matt JE, Rizzo DM, Wong A, Braddish T, Gramling CJ, Wills J, Arnoldy F, Straton J, Cheney N, Eppstein MJ, Gramling D. Conversational stories & self organizing maps: Innovations for the scalable study of uncertainty in healthcare communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2616-2621. [PMID: 34353689 DOI: 10.1016/j.pec.2021.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding uncertainty in participatory decision-making requires scientific attention to interaction between what actually happens when patients, families and clinicians engage one another in conversation and the multi-level contexts in which these occur. Achieving this understanding will require conceptually grounded and scalable methods for use in large samples of people representing diversity in cultures, speaking and decision-making norms, and clinical situations. DISCUSSION Here, we focus on serious illness and describe Conversational Stories as a scalable and conceptually grounded framework for characterizing uncertainty expression in these clinical contexts. Using actual conversations from a large direct-observation cohort study, we demonstrate how natural language processing and unsupervised machine learning methods can reveal underlying types of uncertainty stories in serious illness conversations. CONCLUSIONS Conversational Storytelling offers a meaningful analytic framework for scalable computational methods to study uncertainty in healthcare conversations.
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Affiliation(s)
- Robert Gramling
- University of Vermont, Department of Family Medicine, Burlington, VT, USA.
| | - Ali Javed
- University of Vermont, Department of Computer Science, Burlington, VT, USA
| | | | | | - Jeremy E Matt
- University of Vermont, Complex Systems & Data Science, USA
| | - Donna M Rizzo
- University of Vermont, Department of Civil & Environmental Engineering, Burlington, VT, USA
| | - Ann Wong
- University of Vermont, Burlington, VT, USA
| | - Tess Braddish
- University of Vermont, Department of Family Medicine, Burlington, VT, USA
| | | | | | - Francesca Arnoldy
- University of Vermont, Continuing and Distance Education, Burlington, VT, USA
| | | | - Nicholas Cheney
- University of Vermont, Department of Computer Science, Burlington, VT, USA
| | | | - David Gramling
- University of British Columbia, Department of Central, Eastern and Northern European Studies, Vancouver, BC, Canada
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23
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Interventions to boost enrollment in nursing doctor of philosophy (PhD) programs. Nurs Outlook 2021; 70:166-192. [PMID: 34689993 DOI: 10.1016/j.outlook.2021.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nursing Doctor of Philosophy (PhD) enrollments are languishing, and little is known about PhD enrollment strategies that may lessen nursing's PhD shortage. PURPOSE This study examined strategies for bolstering PhD enrollments or enrollment intentions among college students and graduates. METHODS An integrative review was undertaken using Whittemore and Knafl's methodology and Garrard's Matrix Method. Nine databases were searched, and a hand search was conducted. FINDINGS Strategies were predominantly situated in science, technology, engineering, and mathematics (STEM) disciplines. Features of successful strategies contained core components of faculty mentoring, hands-on research, funding and compensation, undergraduate participation, summer timeframe, informational sessions, and social support. DISCUSSION Less rigorous study designs and mostly STEM samples inhibit the transferability of these strategies to nursing. Qualitative research is needed to better understand nursing students' perspectives about the PhD. Additionally, current PhD enrollment strategies within nursing schools need to be systematically evaluated and the findings disseminated.
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24
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Tarbi EC, Gramling R, Bradway C, Broden EG, Meghani SH. "I Had a Lot More Planned": The Existential Dimensions of Prognosis Communication with Adults with Advanced Cancer. J Palliat Med 2021; 24:1443-1454. [PMID: 33534644 DOI: 10.1089/jpm.2020.0696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Communication about prognosis is a key ingredient of effective palliative care. When patients with advanced cancer develop increased prognostic understanding, there is potential for existential distress to occur. However, the existential dimensions of prognosis communication are underexplored. Objective: To describe the existential dimensions of prognosis communication in naturally-occurring palliative care conversations. Methods: This study was an explanatory sequential mixed methods design. We analyzed a random subset of patients from the Palliative Care Communication Research Initiative (PCCRI) parent study (n = 34, contributing to 45 palliative care conversations). Data were based on audio-recorded and transcribed inpatient palliative care conversations between adults with advanced cancer, their families, and palliative care clinicians. We stratified the study sample by levels of prognosis communication, and qualitatively examined patterns of existential communication, comparing the intensity, frequency, and content, within and across levels. Results: Existential communication was more common, and of stronger intensity, within conversations with higher levels of prognosis communication. Conversations with more prognosis communication appeared to exhibit a shift toward the existential and away from the more physical nature of the serious illness experience. Conclusion: Existential and prognosis communication are intimately linked within palliative care conversations. Results highlight the multiplicity and mutuality of concerns that arise when contemplating mortality, drawing attention to areas of palliative care communication that warrant future research.
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Affiliation(s)
- Elise C Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Robert Gramling
- Department of Family Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Christine Bradway
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Elizabeth G Broden
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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25
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Gramling R, Straton J, Ingersoll LT, Clarfeld LA, Hirsch L, Gramling CJ, Durieux BN, Rizzo DM, Eppstein MJ, Alexander SC. Epidemiology of Fear, Sadness, and Anger Expression in Palliative Care Conversations. J Pain Symptom Manage 2021; 61:246-253.e1. [PMID: 32822753 DOI: 10.1016/j.jpainsymman.2020.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Advancing the science of serious illness communication requires methods for measuring characteristics of conversations in large studies. Understanding which characteristics predict clinically important outcomes can help prioritize attention to scalable measure development. OBJECTIVES To understand whether audibly recognizable expressions of distressing emotion during palliative care serious illness conversations are associated with ratings of patient experience or six-month enrollment in hospice. METHODS We audiorecorded initial palliative care consultations involving 231 hospitalized people with advanced cancer at two large academic medical centers. We coded conversations for expressions of fear, anger, and sadness. We examined the distribution of these expressions and their association with pre/post ratings of feeling heard and understood and six-month hospice enrollment after the consultation. RESULTS Nearly six in 10 conversations included at least one audible expression of distressing emotion (59%; 137 of 231). Among conversations with such an expression, fear was the most prevalent (72%; 98 of 137) followed by sadness (50%; 69 of 137) and anger (45%; 62 of 137). Anger expression was associated with more disease-focused end-of-life treatment preferences, pre/post consultation improvement in feeling heard and understood and lower six-month hospice enrollment. Fear was strongly associated with preconsultation patient ratings of shorter survival expectations. Sadness did not exhibit strong association with patient descriptors or outcomes. CONCLUSION Fear, anger, and sadness are commonly expressed in hospital-based palliative care consultations with people who have advanced cancer. Anger is an epidemiologically useful predictor of important clinical outcomes.
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Affiliation(s)
- Robert Gramling
- Department of Family Medicine, University of Vermont, Burlington, VT, USA.
| | | | - Lukas T Ingersoll
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | | | | | | | | | - Donna M Rizzo
- Department of Civil & Environmental Engineering, University of Vermont, Burlington, VT, USA
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26
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Understanding Existential Anxiety and the Soothing Nature of Nostalgia in Life With Incurable Esophageal Cancer: A Phenomenological Hermeneutical Investigation of Patient Narratives. Cancer Nurs 2021; 45:E291-E298. [PMID: 33443956 DOI: 10.1097/ncc.0000000000000916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research has identified how people living with incurable esophageal cancer experience existential concerns. OBJECTIVE The aim of this study was to examine the phenomenon of existential anxiety when living with esophageal cancer in the context of receiving general palliative care in a hospital setting. METHODS This qualitative study is inspired by phenomenological and hermeneutical aspects of the philosophies of Ricoeur and Heidegger. Applying Heidegger's theory of existential anxiety and nostalgia, we interpreted the narratives of 18 patients receiving palliative care due to incurable esophageal cancer. RESULTS The patients experienced existential anxiety at the loss of a future and homeliness when receiving palliative care. Their existence was reduced to the present, with a break in temporal continuity. An anxious mood permeated their entire being-in-the-world in an unhomelike way. Despite this, patients initiated a restoration of home and meaning expressed as a soothing sense of nostalgia that served as an atmospheric, safe space allowing them to inhabit the borderline between past, present, and future. CONCLUSIONS The study suggests an empirical interpretation of the existential anxiety patients experience when receiving palliation for incurable esophageal cancer. It sheds light on how these patients would benefit from healthcare professionals inviting them to narrate significant aspects of their life stories in which the soothing presence of nostalgia can be supported. IMPLICATION FOR PRACTICE Providing care conditions for a life heading toward death, where the patient can live alongside anxiety, involves focusing on "being with" the patient and on incorporating a nostalgic dimension to facilitate soothing restoration of home for patients.
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27
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Perceptions of time spent pursuing cancer care among patients, caregivers, and oncology professionals. Support Care Cancer 2020; 29:2493-2500. [PMID: 32935204 DOI: 10.1007/s00520-020-05763-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with cancer spend significant time receiving treatment and recovering from side effects. Little is known about how patients and their caregivers perceive time spent receiving cancer treatment and how this impacts health-related quality of life (HRQoL). Our study aims to characterize perceptions of time invested in receiving cancer therapy as experienced by patients, caregivers, and oncology professionals. METHODS We conducted semi-structured interviews with patients undergoing treatment for advanced lung cancer and melanoma, their informal caregivers, and oncology professionals (physicians, nurses, social workers, and chaplains). Participants received and provided care at a tertiary cancer center. Interviews were audiorecorded and transcribed verbatim. Transcripts were analyzed qualitatively using predominantly inductive coding to identify themes relating to time perception and cancer care. RESULTS We interviewed 29 participants (11 patients, 7 informal caregivers, and 11 oncology professionals) and found they consistently differentiated between time remaining in life ("existential time") and time required to manage cancer treatment and symptoms ("chronological time"). Patients and caregivers reported distress around the mechanics of oncologic care that interrupted their daily lives (hobbies, activities). Participants described the impact of time invested in cancer care on dimensions of quality of life, ranging from minimal to substantial negative impact. CONCLUSIONS We found that the time spent undergoing cancer treatment affects well-being and often prevents patients and caregivers from participating in meaningful activities. The investment of personal time undergoing cancer therapy for patients with advanced solid tumors merits further study and can enhance communication between patients, caregivers, and their oncologists.
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van Tilburg TG. Social, Emotional, and Existential Loneliness: A Test of the Multidimensional Concept. THE GERONTOLOGIST 2020; 61:e335-e344. [PMID: 32604416 PMCID: PMC8437504 DOI: 10.1093/geront/gnaa082] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Since the 1980s, most researchers have agreed on the concept of social and emotional loneliness as an unacceptable and negatively experienced discrepancy between realized and desired interpersonal relationships. For other researchers, existential loneliness stems from the realization that a human being is fundamentally alone, with the accompanying emptiness, sadness, and longing. This article examines whether instruments to measure these conceptualizations indicate a multidimensional concept. Research Design and Methods The 2019 observation of the Longitudinal Aging Study Amsterdam (N = 1,316; aged 61–101 years; 52% women) included five direct questions about loneliness, the 11-item de Jong Gierveld social and emotional loneliness scale, and 14 items from the translated Existential Loneliness Questionnaire. Confirmatory factor analysis was conducted in Mplus. Results Five factors were observed: direct questions, social and emotional loneliness, and loneliness in relationships and meaninglessness in life. The intercorrelations among all five factors were positive. Emotional loneliness correlated most strongly with direct questions. Discussion and Implications Loneliness is multifaceted and means that one is not embedded in a personal network, misses closeness and intimacy, and lacks meaning in life. The emotional loneliness items most closely represent what people mean when they report loneliness.
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