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Rosario-Ramos L, Torres-Marrero S, Rivera T, Navedo ME, Burgos R, Garriga M, del Carmen Pacheco M, Lopez B, Torres Y, Torres-Blasco N. Preparing for Cancer: A Qualitative Study of Hispanic Patient and Caregiver Needs. Healthcare (Basel) 2024; 12:1117. [PMID: 38891192 PMCID: PMC11172160 DOI: 10.3390/healthcare12111117] [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: 05/02/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Cancer disproportionately affects Hispanic populations, yet the preparedness of Hispanic caregiver-patient dyads facing cancer remains understudied. This study aims to identify essential components of preparedness needs and inform future psychosocial interventions for this demographic. METHODS Secondary analyses were conducted utilizing focus groups to develop a communication intervention for Hispanic patients and caregivers. Transcripts were qualitatively analyzed using NVivo v12 (2020). RESULTS Analysis revealed symptom management and treatment comprehension as pivotal aspects of preparation. Additionally, preparedness among our sample emerged by addressing the multifaceted dimensions of preparedness, including psychological, emotional, educational, familial, practical, financial, and spiritual aspects. CONCLUSIONS Tailoring interventions encompassing diverse dimensions of preparedness can foster inclusivity and maximize their impact on supportive measures. This underscores the necessity for culturally sensitive approaches when delivering interventions supporting Hispanic individuals navigating the challenges of cancer.
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Affiliation(s)
- Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Stephanie Torres-Marrero
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Tiffany Rivera
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Maria Elena Navedo
- Department of Medicine, University of Connecticut, Storrs, CT 06269, USA;
| | - Rosael Burgos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Mayra Garriga
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Maria del Carmen Pacheco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Betsy Lopez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Yamilet Torres
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
- Ponce Research Institute, Ponce 00716, Puerto Rico
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van der Padt-Pruijsten A, Leys MB, Oomen-de Hoop E, van der Rijt CCD, van der Heide A. Quality of cancer treatment care before and after a palliative care pathway: bereaved relatives' perspectives. BMJ Support Palliat Care 2023:spcare-2023-004495. [PMID: 37973203 DOI: 10.1136/spcare-2023-004495] [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: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Appropriate communication between healthcare providers and patients and their families is an essential part of good (palliative) care. We investigated whether implementation of a standardised palliative care pathway (PCP) facilitated communication, that is, aspects of shared decision-making (SDM), including advance care planning (ACP) conversations and satisfaction with care as experienced by bereaved relatives of patients with advanced cancer. METHODS We conducted a prospective preintervention and postintervention study in a hospital. Questionnaires were sent to relatives of patients who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). Relatives' perceptions on communication and satisfaction with care were assessed using parts of the Views of Informal Carers-Evaluation of Services and IN-PATSAT32 Questionnaires. RESULTS 195 (46%) and 180 (42%) bereaved relatives completed the questionnaire in the pre-PCP and post-PCP period, respectively. The majority of all patients in both the pre-PCP period and the post-PCP period had been told they had an incurable illness (92% and 89%, respectively, p=0.544), mostly in the presence of a relative (88% and 85%, respectively, p=0.865) and had discussed their preferences for end-of-life (EOL) treatment (82% and 76%, respectively, p=0.426). Bereaved relatives were reasonably satisfied with the received hospital care in both groups. CONCLUSIONS We found no overall effect of the PCP on the communication process and satisfaction with EOL care of bereaved relatives. Before the use of the PCP bereaved relatives already reported favourably about the EOL care provided.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
- Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maria Bl Leys
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Torres Blasco N, Rosario L, Shen MJ. Latino advanced cancer patients' prognostic awareness and familial cultural influences on advance care planning engagement: a qualitative study. Palliat Care Soc Pract 2023; 17:26323524231193038. [PMID: 37662440 PMCID: PMC10472825 DOI: 10.1177/26323524231193038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Advanced cancer patients need an accurate understanding of their prognoses in order to engage in informed end-of-life care treatment decision-making. Latino cancer patients experience disparities around prognostic understanding, in part due to a lack of culturally competent communication around prognosis and advance care planning (ACP). Objective The objective of the present study of Latino patients with advanced, terminally ill cancer is to examine their understanding of prognosis, and how cultural factors may influence this understanding and engagement in ACP. Methods A mixed methods study was conducted, which consisted of surveys and semi-structured interviews. Descriptive statistics were used for sociodemographic information and self-reported prognostic understanding. Interviews around prognostic understanding and cultural influences on this understanding and engagement in ACP were recorded, transcribed, and then coded and analyzed using thematic content analysis. Findings Latino patients with advanced cancer (n = 20) completed a self-reported survey and participated in a semi-structured interview. Results indicate that among terminally ill patients, 50% of the patients inaccurately believed they had early-stage cancer, 85% did not believe their cancer was terminal, and 70% believed their cancer was curable. Moreover, interviews yielded two main themes: varying levels of awareness of the incurability of their cancer and diverse end-of-life care decision-making and treatment preferences based on prognostic understanding. Within these themes, patients expressed denial or acceptance of their prognosis through communication with the oncologist, the importance of family, and incorporating their pre-existing beliefs. Conclusion Findings indicate the importance of communication, family involvement, and incorporation of beliefs for promoting an accurate prognostic understanding among Latino patients. It is imperative to address disparities in Latino advanced cancer patients' prognostic understanding so they can engage in informed treatment decision-making around end-of-life care.
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Affiliation(s)
- Normarie Torres Blasco
- School of Behavioral and Brain Science Ponce Health Science University, 388 Zona Industrial Reparada 2, Ponce, 00732-7004, USA
| | - Lianel Rosario
- Ponce Health Science University, School of Behavioral and Brain Science, Ponce, Puerto Rico
| | - Megan J. Shen
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
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Janett-Pellegri C, Eychmüller AS. 'I Don't Have a Crystal Ball' - Why Do Doctors Tend to Avoid Prognostication? PRAXIS 2021; 110:914-924. [PMID: 34814721 DOI: 10.1024/1661-8157/a003785] [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: 06/13/2023]
Abstract
Uncertainty, fear to harm the patient, discomfort handling the discussion and lack of time are the most cited barriers to prognostic disclosure. Physicians can be reassured that patients desire the truth about prognosis and can manage the discussion without harm, including the uncertainty of the information, if approached in a sensitive manner. Conversational guides could provide support in preparing such difficult conversations. Communicating 'with realism and hope' is possible, and anxiety is normal for both patients and clinicians during prognostic disclosure. As a clinician pointed out: 'I had asked a mentor once if it ever got easier. - No. But you get better at it.'
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Affiliation(s)
- Camilla Janett-Pellegri
- Service de Médicine Interne, Hôpital Cantonal Fribourg, Fribourg
- Universitäres Zentrum für Palliative Care, Inselspital, Universitätsspital Bern, Bern
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Landry-Hould F, Mondésert B, Day AG, Ross HJ, Brouillette J, Clarke B, Zieroth S, Toma M, Parent MC, Fowler RA, You JJ, Ducharme A. Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study. CJC Open 2021; 3:994-1001. [PMID: 34505038 PMCID: PMC8413241 DOI: 10.1016/j.cjco.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical or constitutes physician-assisted suicide. We investigated whether individuals’ characteristics are associated with these beliefs. Methods The Decision-Making About Goals of Care for Hospitalized Patients With Heart Failure (DECIDE-HF) survey was given to healthcare providers at 9 hospitals to assess their perceived barriers to goals-of-care discussions. The association between respondent characteristics and their beliefs was examined using 2 adjusted logistic regression models. Results We included 760 clinicians (459 nurses, 94 fellows, and 207 cardiologists). The responses varied among professions, with the belief that ICDD is unethical considered to be important barrier by nurses (24%), fellows (10%), and staff (7%); P < 0.001). After adjusting for site, spirituality being more important in life (odds ratio [OR]: 2.21; 95% confidence interval [CI]:1.37-3.56; P = 0.001, compared to less important), region of training (Asia [OR: 5.88; 95% CI: 2.12-16.31; P = 0.001] and Middle East [OR: 5.55; 95% CI:1.57-19.63; P = 0.008] compared to Canada), and years in practice (OR: 1.32; 95% CI: 1.07-1.63; P = 0.01 per decade) influenced beliefs about ICDD being unethical, with similar results for the belief that ICDD represents physician-assisted suicide. Conclusions Sociocultural factors, region of training, and profession influence clinicians’ beliefs about ICDD being unethical and representing physician-assisted suicide. These factors and beliefs must be acknowledged when facing the delicate issue of end-of-life discussion.
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Affiliation(s)
- Florence Landry-Hould
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Heather J Ross
- Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Judith Brouillette
- Departments of Psychiatry and Addictology, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Brian Clarke
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelley Zieroth
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mustafa Toma
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Claude Parent
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Robert A Fowler
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John J You
- Department of Medicine, Division of General Internal and Hospitalist Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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Suurmond J, Lanting K, de Voogd X, Oueslati R, Boland G, van den Muijsenbergh M. Twelve tips to teach culturally sensitive palliative care. MEDICAL TEACHER 2021; 43:845-850. [PMID: 33070696 DOI: 10.1080/0142159x.2020.1832650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
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Affiliation(s)
- Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Katja Lanting
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Academy of Health (AGZ), Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Xanthe de Voogd
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gudule Boland
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
- Department of Primary Care and Community Health, Radboud University Nijmegen, Nijmegen, The Netherlands
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Lazcano-Ponce E, Angeles-Llerenas A, Rodríguez-Valentín R, Salvador-Carulla L, Domínguez-Esponda R, Astudillo-García CI, Madrigal-de León E, Katz G. Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico. BMC Med Ethics 2020; 21:125. [PMID: 33302932 PMCID: PMC7731770 DOI: 10.1186/s12910-020-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Angelica Angeles-Llerenas
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. .,Research Ethics Committee, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Rocío Rodríguez-Valentín
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | | | | | - Eduardo Madrigal-de León
- Hospital Director at the National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Gregorio Katz
- Department of Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Messerotti A, Banchelli F, Ferrari S, Barbieri E, Bettelli F, Bandieri E, Giusti D, Catellani H, Borelli E, Colaci E, Pioli V, Morselli M, Forghieri F, Galeazzi GM, Marasca R, Bigi S, D'Amico R, Martin P, Efficace F, Luppi M, Potenza L. Investigating the association between physicians self-efficacy regarding communication skills and risk of "burnout". Health Qual Life Outcomes 2020; 18:271. [PMID: 32762755 PMCID: PMC7409639 DOI: 10.1186/s12955-020-01504-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians’ self-efficacy regarding communication to patients and risk of burnout. Methods We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models. Results Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout. Conclusions Our findings suggest that some physicians’ BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.
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Affiliation(s)
- Andrea Messerotti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Emiliano Barbieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bettelli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Local Health Agency, Carpi (Modena), Italy
| | - Davide Giusti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Hillary Catellani
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Borelli
- Department of Biomedic and Metabolic Science and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Colaci
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Pioli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Morselli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Forghieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Marasca
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Roberto D'Amico
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Faculty of Health, Deakin University, Melbourne, Australia
| | - Fabio Efficace
- Italian Group for Adult Hematologic Disease (GIMEMA), Health Outcomes Research Unit, Rome, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Patient and Professional Factors That Impact the Perceived Likelihood and Confidence of Healthcare Professionals to Discuss Implantable Cardioverter Defibrillator Deactivation in Advanced Heart Failure: Results From an International Factorial Survey. J Cardiovasc Nurs 2019; 33:527-535. [PMID: 29727378 PMCID: PMC6200367 DOI: 10.1097/jcn.0000000000000500] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Supplemental digital content is available in the text. Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. Methods and Results: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. Conclusions: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.
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Variables Related to Communication About Prognosis Between Nurses and Patients at Heart Failure Clinics in Sweden and the Netherlands. J Cardiovasc Nurs 2019; 33:E1-E6. [PMID: 28481827 DOI: 10.1097/jcn.0000000000000416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In contrast to recommendations in recent guidelines, prognosis is not optimally discussed with patients with heart failure (HF). Reasons for not doing so can be related to both patient and provider characteristics. PURPOSE The purpose of the study was to explore which patient- and nurse-related variables influence discussing prognosis with patients at an HF clinic. METHOD Data from a previous survey on attitudes and clinical practice of HF nurses on discussing prognosis that was conducted in Sweden and the Netherlands were combined with data from a registration on topics that nurses discussed with their patients during a prespecified week at the HF clinic. Multivariable logistic regression analysis was performed to assess which variables are related to discussing prognosis. RESULTS A total of 275 HF nurses (mean age, 49 years) and data of 1633 patients with HF (mean age, 71 years) were included in the study. Prognosis was discussed with 42% of all patients during the visit at the HF clinic. Patients with whom prognosis was discussed were more often in New York Heart Association classes III to IV (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.44-2.26). Nurses discussing prognosis reported more knowledge on the topic (OR, 1.71; 95% CI, 1.36-2.16) and discussed more topics with the patient (OR, 1.27; 95% CI, 1.21-1.32). Dutch HF nurses were more likely to discuss prognosis compared with their Swedish colleagues (OR, 1.83; 95% CI, 1.43-2.33). CONCLUSIONS Discussing prognosis with patients with HF by nurses at the HF clinic is related to the characteristics of patients and HF nurses. Future interventions to improve communications about prognosis therefore should have a broad approach.
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Velan B, Ziv A, Kaplan G, Rubin C, Connelly Y, Karni T, Tal O. Truth-telling and doctor-assisted death as perceived by Israeli physicians. BMC Med Ethics 2019; 20:13. [PMID: 30777058 PMCID: PMC6380017 DOI: 10.1186/s12910-019-0350-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients about a poor medical prognosis, and assisting terminally ill patients in ending their lives. Methods Attitudes towards medico-ethical dilemmas were examined through a nationwide online survey conducted among members of the Israeli Medical Association, yielding 2926 responses. Results Close to 60% of the respondents supported doctor-assisted death, while one third rejected it. Half of the respondents opposed disclosure of the full truth about a poor medical prognosis, and the others supported it. Support for truth-telling was higher among younger physicians, and support for doctor-assisted death was higher among females and among physicians practicing in hospitals. One quarter of respondents supported both truth-telling and assisted death, thereby exhibiting respect for patients’ autonomy. This approach characterizes younger doctors and is less frequent among general practitioners. Another quarter of the respondents rejected truth-telling, yet supported assisted death, thereby manifesting compassionate pragmatism. This was associated with medical education, being more frequent among doctors educated in Israel, than those educated abroad. All this suggests that both personal attributes and professional experience affect attitudes of physicians to ethical questions. Conclusions Examination of attitudes to two debatable medical dilemmas allowed portrayal of the multi-faceted medico-ethical scene in Israel. Moreover, this study, demonstrates that one can probe the ethical atmosphere of a given medical community, at various time points by using a few carefully selected questions. Electronic supplementary material The online version of this article (10.1186/s12910-019-0350-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Baruch Velan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. .,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
| | - Arnona Ziv
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Giora Kaplan
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.,Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Carmit Rubin
- TheGertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Yaron Connelly
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Tami Karni
- Comprehensive Breast Care Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Orna Tal
- Israeli Center for Emerging Technologies, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
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ten Koppel M, Onwuteaka-Philipsen BD, Pasman HR, Bernabei R, Carpenter I, Denkinger MD, Onder G, van der Roest HG, Topinkova E, van Hout HPJ. Are older long term care residents accurately prognosticated and consequently informed about their prognosis? Results from SHELTER study data in 5 European countries. PLoS One 2018; 13:e0200590. [PMID: 30020976 PMCID: PMC6051611 DOI: 10.1371/journal.pone.0200590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Informing residents in long term care facilities (LTCFs) about their prognosis can help them prepare for the end of life. This study aimed to examine which proportion of European LTCF residents, close to death, are accurately prognosticated and consequently informed about their prognosis; and to examine factors related to accurate prognostication and discussion of prognosis. METHODS A subsample of SHELTER study data was used, consisting of: 500 residents from 5 European countries, who died within 6 months after their last assessment, and had a valid answer on the item 'End stage disease, 6 or fewer months to live'. This item was used to indicate whether an accurate prognosis was established and discussed with residents. Generalized estimating equations were used to examine factors related to establishment and discussion of accurate prognosis. RESULTS 86.4% of residents close to death did not receive an accurate prognosis. Residents with cancer; fatigue; dehydration; and normal mode of nutritional intake were more likely to have an accurate prognosis established and discussed. Accurate prognostication and prognosis discussion was less likely for residents who: had a diagnosis under 'other'; initiated interactions; and residents from Germany, Italy and the Netherlands. CONCLUSIONS The great majority of residents close to death did not receive an accurate prognosis. Prognostication tools might help clinicians to increase their prognostic accuracy and communication training might help to discuss prognosis with residents.
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Affiliation(s)
- Maud ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Iain Carpenter
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Michael D. Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Graziano Onder
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Henriëtte G. van der Roest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hein P. J. van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Hjelmfors L, Sandgren A, Strömberg A, Mårtensson J, Jaarsma T, Friedrichsen M. “I was told that I would not die from heart failure”: Patient perceptions of prognosis communication. Appl Nurs Res 2018; 41:41-45. [DOI: 10.1016/j.apnr.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 11/29/2022]
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Luttik MLA, Goossens E, Ågren S, Jaarsma T, Mårtensson J, Thompson DR, Moons P, Strömberg A. Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases. Eur J Cardiovasc Nurs 2016; 16:299-308. [DOI: 10.1177/1474515116663143] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- MLA Luttik
- Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, The Netherlands
- Linköping University, Division of Nursing Science, Department of Medicine and Health Sciences, Linköping, Sweden
| | - E Goossens
- KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - S Ågren
- Linköping University, Department of Medicine and Health Sciences and Department of Cardiothoracic Surgery, Linköping, Sweden
| | - T Jaarsma
- Linköping University, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping, Sweden
| | - J Mårtensson
- Jönköping University, School of Health and Welfare, Department of Nursing, Jönköping, Sweden
| | - DR Thompson
- Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia
| | - P Moons
- KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - A Strömberg
- Linköping University, Division of Nursing Science, Department of Medicine and Health Sciences, Linköping, Sweden
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15
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De Vleminck A, Pardon K, Houttekier D, Van den Block L, Vander Stichele R, Deliens L. The prevalence in the general population of advance directives on euthanasia and discussion of end-of-life wishes: a nationwide survey. BMC Palliat Care 2015; 14:71. [PMID: 26643482 PMCID: PMC4671216 DOI: 10.1186/s12904-015-0068-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 11/27/2015] [Indexed: 11/26/2022] Open
Abstract
Background To determine the extent to which members of the general population have talked to their physician about their wishes regarding medical treatment at the end of life, to describe the prevalence of advance directives on euthanasia, and to identify associated factors. Method This study used data from the cross-sectional Health Interview Study (HIS) 2008 that collected data from a representative sample (N = 9651) of the Belgian population. Results Of all respondents, 4.4 % had spoken to their physician about their wishes regarding medical treatment at the end of life, while 1.8 % had an advance directive on euthanasia. Factors positively associated with discussions regarding wishes for medical treatment at the end of life were being female, being older in age, having poorer health status and having more GP contacts. People older than 55 years and living in Flanders or Brussels were more likely than the youngest age categories to have an advance directive on euthanasia. Conclusion Younger people, men, people living in the Walloon region of Belgium, people without a longstanding illness, chronic condition or disability and people with few GP contacts could represent a target group for education regarding advance care planning. Public information campaigns and education of physicians may help to enable the public and physicians to engage more in advance care planning.
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Affiliation(s)
- Aline De Vleminck
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Koen Pardon
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Dirk Houttekier
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Lieve Van den Block
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Robert Vander Stichele
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. .,Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
| | - Luc Deliens
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. .,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
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16
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Morphet J, Decker K, Crawford K, Innes K, Williams AF, Griffiths D. Aged care residents in the emergency department: the experiences of relatives. J Clin Nurs 2015; 24:3647-53. [DOI: 10.1111/jocn.12954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Morphet
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | - Kelly Decker
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | | | - Kelli Innes
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
| | | | - Debra Griffiths
- School of Nursing & Midwifery Monash University Frankston Vic. Australia
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17
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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18
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Fisher K, Seow H, Cohen J, Declercq A, Freeman S, Guthrie DM. Patient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument. J Pain Symptom Manage 2015; 49:716-25. [PMID: 25220047 DOI: 10.1016/j.jpainsymman.2014.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Abstract
CONTEXT Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it. OBJECTIVES To identify patient characteristics associated with PA in a PC population. METHODS The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis. RESULTS The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis. CONCLUSION Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.
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Affiliation(s)
- Kathryn Fisher
- Aging and Community Health Research Unit, McMaster University, Hamilton, Ontario, Canada.
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Anja Declercq
- LUCAS & Faculty of Social Sciences, University of Leuven, Leuven, Belgium
| | - Shannon Freeman
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
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19
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Nakajima N, Kusumoto K, Onishi H, Ishida M. Does the Approach of Disclosing More Detailed Information of Cancer for the Terminally Ill Patients Improve the Quality of Communication Involving Patients, Families, and Medical Professionals? Am J Hosp Palliat Care 2014; 32:776-82. [DOI: 10.1177/1049909114548718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Effective and faithful communication between patients and medical professionals could improve patients' quality of life and is an essential and fundamental factor in cancer treatment. The purpose of this study was to examine whether disclosing more detailed information about disease progression toterminally ill patients could improve the quality of communication. Methods: This was a before/after study of 91 consecutive terminal cancer patients. Based on the previous studies, we categorized cancer disclosure into 4 groups: A;“non-disclosure”, B;“disclosure of cancer diagnosis”, C;“disclosureof life-threatening disease”, and D;“disclosure of poor prognosis”. We disclosed more detailed information based on the SPIKES protocol and compared the scores of 3 communication items of Support Team Assessment Schedule (Japanese version) measured between at admission and one-week after this approach. Results: A, B, C and D groups included 8, 25, 40, and 18 cases, respectively. This approach to cancer disclosure was implemented in 37.5% of group A, 60% of group B, and 40% of group C. In group B, all 3 communications were significantly improved (2.40 ± 0.51 vs 1.53 ± 0.83, 1.93 ± 0.96 vs 1.00 ± 0.38, 2.13 ± 0.64 vs 1.13 ± 0.64; p = 0.0035, 0.0062, 0.0013). In group C, all 3 communications were significantly improved (1.25 ± 0.58 vs 0.81 ± 0.66, 1.13 ± 0.34 vs 0.69 ± 0.48, 1.31±0.60 vs 0.56 ± 0.63; p = 0.020, 0.0082, 0.0057). Conclusions: This study revealed that disclosing more detailed information of cancer for terminally ill cancer patients contributed to improving the quality of communication, irrespective of the stage of disclosure.
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Affiliation(s)
- Nobuhisa Nakajima
- Department of Palliative Care, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | | | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University, Hidaka, Japan
| | - Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University, Hidaka, Japan
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20
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Venter M, Venter C, Botha K. Cancer Treatment in South Africa: A Narrative Literature Review. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2012.10820555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Chang A, Datta-Barua I, McLaughlin B, Daly B. A survey of prognosis discussions held by health-care providers who request palliative care consultation. Palliat Med 2014; 28:312-7. [PMID: 24327660 DOI: 10.1177/0269216313514126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient misunderstandings about prognosis may be related to lack of communication. AIM This study aimed to examine prognosis discussions held with hospitalized patients for whom palliative care consultations were requested, and if prognosis discussions did not occur, to explore why not. DESIGN This was a survey conducted over the telephone from a convenience sample of health-care providers who requested palliative care consultations. Respondents were asked about whether prognosis had been discussed with the patient and the topics addressed. PARTICIPANTS A total of 65 health-care providers who called to request a consultation from the palliative care team in a large academic medical center in the United States. RESULTS Of the 65 responses, 45 (69.2%) subjects reported that a prognosis discussion had occurred, while 15 (23.1%) reported that a prognosis discussion had not taken place. Among the surveys reporting a prognosis discussion, a majority of providers responded that most aspects of prognosis were discussed, with the exceptions of life expectancy, survival rates/statistics, and psychosocial concerns. When the prognosis discussion had not occurred, the most common reasons for omitting the prognosis discussion included difficulty in determining prognosis, the perception that the patient already knew his or her prognosis, and the belief that the prognosis discussion was better suited for a different specialty. CONCLUSIONS The results of this study highlight the uncertainty that primary team providers in the academic hospital environment have with prognostication, which is a complex process for which this set of providers, composed primarily of medical trainees and nurses, may not have had sufficient training.
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Affiliation(s)
- Amy Chang
- 1Previously at School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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22
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Evans N, Costantini M, Pasman HR, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage 2014; 47:604-619.e3. [PMID: 23932176 DOI: 10.1016/j.jpainsymman.2013.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Effective communication is central to high-quality end-of-life care. OBJECTIVES This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. METHODS This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. RESULTS In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. CONCLUSION The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Massimo Costantini
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H R Pasman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Gé A Donker
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Milagros Gil
- Public Health Directorate, Ministry of Health, Castille and León, Spain
| | - Nicole Boffin
- Scientific Institute of Public Health, Brussels, Belgium
| | - Oscar Zurriaga
- Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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Evans N, Pasman HRW, Payne SA, Seymour J, Pleschberger S, Deschepper R, Onwuteaka-Philipsen BD. Older patients' attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients. BMC Palliat Care 2012; 11:24. [PMID: 23186392 PMCID: PMC3583811 DOI: 10.1186/1472-684x-11-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 11/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients' communication with physicians. This study examines older patients' attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries. METHODS A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach. RESULTS Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians' availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment. CONCLUSIONS A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the 'informed' and the 'shared' patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients' experiences.
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Affiliation(s)
- Natalie Evans
- VU University Medical Center, EMGO+ Insitute, Van der Boechorststraat 7, 1081, Amsterdam, BT, The Netherlands
| | - H Roeline W Pasman
- VU University Medical Center, EMGO+ Insitute, Van der Boechorststraat 7, 1081, Amsterdam, BT, The Netherlands
| | | | | | - Sabine Pleschberger
- UMIT-The Health and Life Sciences University, Hall & Vienna, Vienna, Austria
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Current knowledge and future directions about the disclosure of dementia: A systematic review of the first decade of the 21st century. Alzheimers Dement 2012; 9:e74-88. [PMID: 23098912 DOI: 10.1016/j.jalz.2012.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/16/2012] [Accepted: 02/29/2012] [Indexed: 11/22/2022]
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Laguna J, Enguídanos S, Siciliano M, Coulourides-Kogan A. Racial/ethnic minority access to end-of-life care: a conceptual framework. Home Health Care Serv Q 2012; 31:60-83. [PMID: 22424307 DOI: 10.1080/01621424.2011.641922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Minority underutilization of hospice care has been well-documented; however, explanations addressing disparities have failed to examine the scope of factors in operation. Drawing from previous health care access models, a framework is proposed in which access to end-of-life care results from an interaction between patient-level, system-level, and societal-level barriers with provider-level mediators. The proposed framework introduces an innovative mediating factor missing in previous models, provider personal characteristics, to better explain care access disparities. This article offers a synthesis of previous research and proposes a framework that is useful to researchers and clinicians working with minorities at end of life.
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Affiliation(s)
- Jeff Laguna
- University of Southern California, Davis School of Gerontology, Los Angeles, California 90089-0191, USA.
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26
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Abarshi E, Echteld M, Donker G, Van den Block L, Onwuteaka-Philipsen B, Deliens L. Discussing End-of-Life Issues in the Last Months of Life: A Nationwide Study among General Practitioners. J Palliat Med 2011; 14:323-30. [DOI: 10.1089/jpm.2010.0312] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ebun Abarshi
- The EMGO Institute for Health & Care Research (EMGO+), Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Palliative Care Center of Expertise, Amsterdam, The Netherlands
| | - Michael Echteld
- The EMGO Institute for Health & Care Research (EMGO+), Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Palliative Care Center of Expertise, Amsterdam, The Netherlands
| | - Gé Donker
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of General Practice, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- The EMGO Institute for Health & Care Research (EMGO+), Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Palliative Care Center of Expertise, Amsterdam, The Netherlands
| | - Luc Deliens
- The EMGO Institute for Health & Care Research (EMGO+), Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Palliative Care Center of Expertise, Amsterdam, The Netherlands
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Arora NK, Street RL, Epstein RM, Butow PN. Facilitating patient-centered cancer communication: a road map. PATIENT EDUCATION AND COUNSELING 2009; 77:319-321. [PMID: 19948297 DOI: 10.1016/j.pec.2009.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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