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Khonsari S, Johnston B, Patterson H, Mayland C. Mechanisms of end-of-life communication contributing to optimal care at the end of life: a review of reviews. BMJ Support Palliat Care 2024:spcare-2024-004904. [PMID: 38955461 DOI: 10.1136/spcare-2024-004904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND End-of-life communication is an essential component of high-quality care, but its potential mechanisms for improving care are not well understood. OBJECTIVES To summarise the potential mechanisms by which end-of-life communication may contribute to enhanced end-of-life care in any setting. DESIGN An overview of systematic reviews, with a narrative synthesis of results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was assessed using the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. DATA SOURCES CINAHL, MEDLINE, Cochrane, SSCI and PsycINFO databases, were searched from inception to January 2024. Manual searches were also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews (published in English) related to end-of-life communication, where the target population was adult patients in their last year of life, relatives, caregivers and/or healthcare professionals involved in communicating with dying patients. RESULTS We reviewed 35 eligible studies. The reviews suggest potential mechanisms of effective end-of-life communication including collaborative decision-making, tailoring communication to individuals, using effective communication strategies and incorporating communication skills into practice. The reviews also highlighted barriers related to patients, professionals and organisations. CONCLUSION This review highlights a nuanced understanding of potential mechanisms of end-of-life communication, emphasising the need for tailored training, policy enhancements and interprofessional collaboration. It calls on healthcare professionals to reflect on their practices, advocating for co-designing a person-centred communication model that addresses patient preferences at the end of life. Importantly, in culturally diverse contexts, there is a need for a communication paradigm that embraces diversity to provide truly empathetic and effective end-of-life care. This concise roadmap may foster compassionate, dignified and effective end-of-life communication. TRIAL REGISTRATION NUMBER Protocol registered with PROSPERO (CRD42022271433, 29 March 2022).
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Affiliation(s)
| | - Bridget Johnston
- University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
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Jia Z, Kurahashi A, Sharma RK, Mahtani R, Zagorski BM, Sanders JJ, Yarnell C, Detsky M, Lindvall C, Teno JM, Bell CM, Quinn KL. A Comparison of Palliative Care Delivery between Ethnically Chinese and Non-Chinese Canadians in the Last Year of Life. J Gen Intern Med 2024:10.1007/s11606-024-08859-8. [PMID: 38926319 DOI: 10.1007/s11606-024-08859-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Ethnically Chinese adults in Canada and the United States face multiple barriers in accessing equitable, culturally respectful care at the end-of-life. Palliative care (PC) is committed to supporting patients and families in achieving goal-concordant, high-quality serious illness care. Yet, current PC delivery may be culturally misaligned. Therefore, understanding ethnically Chinese patients' use of palliative care may uncover modifiable factors to sustained inequities at the end-of-life. OBJECTIVE To compare the use and delivery of PC in the last year of life between ethnically Chinese and non-Chinese adults. DESIGN Population-based cohort study. PARTICIPANTS All Ontario adults who died between January 1st, 2012, and October 31st, 2022, in Ontario, Canada. EXPOSURES Chinese ethnicity. MAIN MEASURES Elements of physician-delivered PC, including model of care (generalist; specialist; mixed), timing and location of initiation, and type of palliative care physician at initial consultation. KEY RESULTS The final study cohort included 527,700 non-Chinese (50.8% female, 77.9 ± 13.0 mean age, 13.0% rural residence) and 13,587 ethnically Chinese (50.8% female, 79.2 ± 13.6 mean age, 0.6% rural residence) adults. Chinese ethnicity was associated with higher likelihoods of using specialist (adjusted odds ratio [aOR] 1.53, 95%CI 1.46-1.60) and mixed (aOR 1.32, 95%CI 1.26-1.38) over generalist models of PC, compared to non-Chinese patients. Chinese ethnicity was also associated with a higher likelihood of PC initiation in the last 30 days of life (aOR 1.07, 95%CI 1.03-1.11), in the hospital setting (aOR 1.24, 95%CI 1.18-1.30), and by specialist PC physicians (aOR 1.33, 95%CI 1.28-1.38). CONCLUSIONS Chinese ethnicity was associated with a higher likelihood of mixed and specialist models of PC delivery in the last year of life compared to adults who were non-Chinese. These observed differences may be due to later initiation of PC in hospital settings, and potential differences in unmeasured needs that suggest opportunities to initiate early, community-based PC to support ethnically Chinese patients with serious illness.
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Affiliation(s)
- Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
- Program in Global Palliative Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Allison Kurahashi
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Rashmi K Sharma
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ramona Mahtani
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Justin J Sanders
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Ariadne Labs, Boston, MA, USA
| | - Christopher Yarnell
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine and Research Institute, Scarborough Health Network, Toronto, Canada
| | - Michael Detsky
- Interdepartmental Division of Critical Care Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Charlotta Lindvall
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joan M Teno
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Chaim M Bell
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto and Sinai Health, Toronto, Ontario, Canada
| | - Kieran L Quinn
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto and Sinai Health, Toronto, Ontario, Canada
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Chen Z, Li Y, Xie Z, Tang S, Xiao J. Psychometric validation of the Chinese versions of the quality of communication questionnaires for cancer patients and their family caregivers. BMC Nurs 2024; 23:413. [PMID: 38898521 PMCID: PMC11188171 DOI: 10.1186/s12912-024-02071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Given the lack of valid and reliable instruments for evaluating the quality of communication between physicians and cancer patients and their family caregivers in China, this study translated and culturally adapted the Quality of Communication questionnaires for cancer patients (QOC-P) and their family caregivers (QOC-F) for use in the Chinese context and evaluated their psychometric properties. METHODS The QOC-P and QOC-F were translated following an adapted version of Brislin's translation model and culturally adapted according to a Delphi expert panel. We pretested and refined the Chinese versions of the QOC-P and QOC-F among 16 dyads of patients and their family caregivers. Subsequently, we administered the questionnaires to 228 dyads of patients and their family caregivers who were recruited from six tertiary hospitals. The content validity, construct validity, convergent validity, and reliability of the QOC-P and QOC-F were examined. RESULTS Through exploratory factor analysis, The QOC-P and QOC-F were divided into two dimensions: general communication and end-of-life communication. The Cronbach's coefficients ranged from 0.905 to 0.907 for the two subscales of the QOC-P and from 0.908 to 0.953 for the two subscales of the QOC-F. The two-week test-retest reliability was acceptable for both the QOC-P and QOC-F, with intraclass correlation coefficients of 0.993 and 0.991, respectively. The scale content validity index (QOC-P: 0.857, QOC-F: 1.0) and split-half reliability (QOC-P: 0.833, QOC-F: 0.935) were satisfactory. There was a negative correlation with anxiety and depression for both the QOC-P (r = -0.233 & -0.241, p < 0.001) and QOC-F (r = -0.464 & -0.420, p<0.001). The QOC-P showed a negative correlation with decision regret (r = -0.445, p<0.001) and a positive correlation with shared decision-making (r = 0.525, p<0.001), as hypothesized. CONCLUSION The QOC-P and QOC-F show acceptable psychometric properties for evaluating the quality of communication between physicians and cancer patients and their family caregivers in both clinical and research contexts. Future studies should use more diverse and inclusive samples to test the structure of the Chinese version of the QOC-P and QOC-F with confirmatory factor analysis.
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Affiliation(s)
- Zhihan Chen
- Xiangya School of Nursing, Central South University, NO. 172 Rd, Changsha, 410013, China
| | - Yanjia Li
- Xiangya School of Nursing, Central South University, NO. 172 Rd, Changsha, 410013, China
| | - Zhishan Xie
- Xiangya School of Nursing, Central South University, NO. 172 Rd, Changsha, 410013, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, NO. 172 Rd, Changsha, 410013, China.
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, NO. 172 Rd, Changsha, 410013, China.
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Chen W, Chung JOK, Lam KKW, Molassiotis A. Patients', families' and healthcare providers' perspectives on end-of-life communication in Chinese hospital settings: A qualitative study protocol. PLoS One 2023; 18:e0296342. [PMID: 38150444 PMCID: PMC10752523 DOI: 10.1371/journal.pone.0296342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Perspectives of key stakeholders should be fully considered to enhance culturally appropriate strategies in end-of-life communication and strengthen healthcare service delivery. So far, little research evidence is available on Chinese patients', families', and healthcare professionals' experiences with and perspectives of end-of-life communication in hospital settings. AIM The current study aims to explore experiences, perceptions and suggestions of end-of-life communication among Chinese terminally ill patients, their families and healthcare providers. METHODS The phenomenology qualitative approach will be adopted. Semi-structured in-depth interviews and focus group discussions will be used to collect relevant data. Eligible terminally ill patients, family caregivers and healthcare providers will be recruited in two hospitals in Mainland China via purposive sampling. Thematic analysis will be performed to analyse data. The Standards for Reporting Qualitative Research (SRQR) checklist will be followed for reporting. This study has been registered at ClinicalTrials.gov (NCT05734781). DISCUSSION This qualitative study is, as far as we are aware, the first to specifically address patient/family-provider end-of-life communication in the Chinese social-cultural context. The results hold the potential to enrich current knowledge of end-of-life communication, navigate culturally appropriate communication strategies, and inform the development of related training programs for healthcare providers in hospital settings.
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Affiliation(s)
- Weilin Chen
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China
| | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China
| | - Katherine Ka Wai Lam
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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