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Miller EM, Porter JE, Barbagallo MS. The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:146-158. [PMID: 37265375 PMCID: PMC10621022 DOI: 10.1177/19375867231177299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. BACKGROUND In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. METHOD Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. RESULTS Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." CONCLUSIONS A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.
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Affiliation(s)
- Elizabeth M. Miller
- Collaborative Evaluation and Research Group (CERG), Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E. Porter
- Collaborative Evaluation and Research Group (CERG), Federation University Australia, Churchill, Victoria, Australia
| | - Michael S. Barbagallo
- Institute of Health and Wellbeing, Federation University Australia, Churchill, Victoria, Australia
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Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. PATIENT EDUCATION AND COUNSELING 2023; 114:107811. [PMID: 37244131 PMCID: PMC10526983 DOI: 10.1016/j.pec.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. METHODS We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US. RESULTS Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses. CONCLUSION The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present. PRACTICE IMPLICATIONS Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, United States.
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, United States
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, United States; Department of Population Health Sciences, Duke University School of Medicine, United States
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Vendetta L, Vig E, Kross E, Merel SE. The Role of the Palliative Medicine Clinician in the Family Conference. Am J Hosp Palliat Care 2023; 40:5-9. [PMID: 35465731 DOI: 10.1177/10499091221093560] [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: 12/16/2022] Open
Abstract
Facilitating a family conference is a core skill for a palliative medicine clinician, yet the role of the palliative medicine consultant in a family conference has not been clearly defined in the literature. Most educational articles describe a structured approach to a family conference that focuses on the role of the person leading the conference, who may be a palliative medicine specialist or a member of the primary team caring for the patient. For the palliative medicine clinician, balancing the roles of communication facilitator and palliative consultant is nuanced and requires a specific framework and set of skills. In this article, we review the literature on family conferences focusing on facilitation and communication by the palliative care consultant during the conferences, and outline specific ways the palliative medicine clinician can contribute to family conferences. Our hope is that this framework helps guide palliative medicine clinicians and others seeking more specialized training in palliative medicine to be more intentional with their contributions to family conferences in the future. We also hope that this framework will help palliative medicine educators training future specialists.
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Affiliation(s)
- Lindsay Vendetta
- 601956VA Puget Sound Geriatric Research Education and Clinical Center, Seattle, WA, USA.,205280University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, WA, USA
| | - Elizabeth Vig
- 205280University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, WA, USA.,UW Geriatrics and Extended Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Erin Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Seattle, WA, USA.,Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | - Susan E Merel
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA.,205280University of Washington Department of Medicine, Division of General Internal Medicine, Seattle, WA, USA
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Abstract
Specialists in palliative care view the family meeting as a means to engage patients and their families in a serious illness discussion that may clarify the values of patients and caregivers, provide information, determine care preferences, and identify sources of illness-related distress and burden. The family meeting is considered the best practice for achieving patient- and family-centered care in palliative care. Although studies of the family meeting are limited, those extant suggest that these interventions may reduce caregiver distress, mitigate the perception of unmet needs, prepare family members for caregiving, and improve bereavement outcomes. The experience of palliative care specialists further suggests that the family meeting may reinforce the therapeutic alliance with families, promote consensus, and reduce the need for ad hoc meetings. Physician satisfaction may be enhanced when the treatment plan includes the opportunity to show empathy and see the family’s perspective—core elements of the clinical approach to the family meeting. In the oncology setting, the potential to achieve these positive outcomes supports the integration of the family meeting into practice. Clinical skills for the planning and running of family meetings should be promoted with consideration of a standardized protocol for routine family meetings at critical points during the illness and its treatment using an interdisciplinary team. Further research is needed to refine understanding of the indications for the family meeting and determine the optimal timing, structure, and staffing models. Outcome studies employing validated measures are needed to better characterize the impact of family meetings on patient and family distress and on treatment outcomes. Although better evidence is needed to guide the future integration of the family meeting into oncology practice, current best practices can be recommended based on available data and the extensive observations of palliative care specialists.
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Ikander T, Dieperink KB, Hansen O, Raunkiær M. Patient, Family Caregiver, and Nurse Involvement in End-of-Life Discussions During Palliative Chemotherapy: A Phenomenological Hermeneutic Study. JOURNAL OF FAMILY NURSING 2022; 28:31-42. [PMID: 34551643 DOI: 10.1177/10748407211046308] [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
The aim of this study was to investigate current nursing practice related to end-of-life discussions with incurable lung cancer patients and their family caregivers from the perspectives of patients, family caregivers, and nurses in an oncology outpatient clinic. This phenomenological hermeneutic study included nine patients, eight family caregivers, and 11 nurses. Data were collected using participant observation, informal and semi-structured individual or joint interviews with patients and family caregivers, and focus group interviews with nurses. A Ricoeur-inspired approach was used to analyze the data. Three themes were identified: (a) content of end-of-life discussions, (b) timing of end-of-life discussions, and (c) challenges in end-of-life discussions. End-of-life discussions were seldom initiated; when they were, it was often too late. Discussions addressed treatment, place of care, practical/economic concerns, and existential matters. The physical environment at the outpatient clinic, lack of continuity, and nurses' instrumental task workloads and time pressure posed challenges to initiating end-of-life discussions.
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Affiliation(s)
- Tine Ikander
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark
- Family-focused healthcare research Centre (FaCe). Department of Clinical Research, University of Southern Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Karin B Dieperink
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Family-focused healthcare research Centre (FaCe). Department of Clinical Research, University of Southern Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Olfred Hansen
- Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark
| | - Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark
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The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158081. [PMID: 34360374 PMCID: PMC8345580 DOI: 10.3390/ijerph18158081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
The possibility of coming to a “good death” is a challenging issue that crosses ethical and religious beliefs, cultural assumptions, as well as medical expertise. The provision of palliative care for relieving patients’ pain is a practice that reshapes the path to the event of death and gives form to a particular context of awareness, recalling the notion proposed by Glaser and Strauss. This decision redesigns the relationships between patients, practitioners and caregivers and introduces a new pattern of collaboration between them. Our study focuses on the implications of the collaboration between practitioners and caregivers, starting from the assumption that the latter may provide support to their loved ones and to the practitioners, but need to be supported too. We provide a qualitative analysis of this collaboration based on an empirical research that took place in four different settings of provision of palliative care, reporting the contrast between the affective engagement of caregivers and the professional approach of practitioners. We claim that this ambivalent collaboration, while embedded in contingent and incommensurable experiences, brings to the fore the broader understanding of the path to a “good death,” outlining its societal representation as a collective challenge.
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Agne JL, Bertino EM, Grogan M, Benedict J, Janse S, Naughton M, Eastep C, Callahan M, Presley CJ. Too Many Appointments: Assessing Provider and Nursing Perception of Barriers to Referral for Outpatient Palliative Care. Palliat Med Rep 2021; 2:137-145. [PMID: 34223513 PMCID: PMC8241388 DOI: 10.1089/pmr.2020.0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Integration of early outpatient palliative care for patients with advanced cancer requires overcoming logistical constraints as well as attitudinal barriers of referring providers. This pilot study assessed provider perception of logistical and attitudinal barriers to outpatient palliative care referral as well as provider acceptability of an embedded onco-palliative clinic model. Methods: This was a cross-sectional survey-based study of medical oncologists, palliative care physicians, advanced practice providers (APP), and oncology nurses at a large U.S. academic center. Participants were invited to participate through anonymous online survey. Participants rank ordered logistical barriers influencing referral to an outpatient palliative clinic. Respondents indicated level of agreement with attitudinal perception of palliative care and acceptability of an embedded palliative clinic model through five-item Likert-like scales. Results: There were a total of 54 study participants (28 oncology physicians/APPs, 15 palliative physicians/APPs, and 11 oncology nurses). Across the three cohorts, most survey respondents ranked "time burden to patients" as the primary logistical barrier to outpatient palliative care referral. Both oncology and palliative providers indicated comfort with primary palliative care skills although palliative providers were more comfortable with symptom management compared with oncology providers (93.3% vs. 32.2%). A majority of participants (94.9%) were willing to refer to a palliative care provider embedded within an oncology clinic. Conclusion: Additional health care time cost to patients is a major barrier to outpatient palliative care referral. Embedding a palliative care provider in an oncology clinic may be an acceptable model to increase patient access to outpatient palliative care while supporting the oncology team.
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Affiliation(s)
- Julia L Agne
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Erin M Bertino
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jason Benedict
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sarah Janse
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle Naughton
- Cancer Control and Prevention, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Christine Eastep
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael Callahan
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
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Fliedner M, Halfens RJG, King CR, Eychmueller S, Lohrmann C, Schols JMGA. Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting: A Scoping Review. J Hosp Palliat Nurs 2021; 23:59-68. [PMID: 33284145 DOI: 10.1097/njh.0000000000000715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what skills are needed in the ACP process. The themes that staff nurses and advanced practice registered nurses (APRNs) discuss in relationship to ACP are manifold. This scoping review demonstrates that staff nurses' core role is advocating for the wishes and values of patients with any life-limiting disease. Staff nurses also serve as facilitators, educators, and advocates to help start ACP conversations and ease patients' transitions between settings based on well-discussed decisions. To be able to engage in ACP discussions, APRNs must have excellent communication skills. Continuous training to improve these skills is mandatory. In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.
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Araujo Hernández M, García Navarro S, García-Navarro EB. Approaching grief and death in family members of patients with COVID-19: Narrative review. ENFERMERIA CLINICA 2020; 31:S112-S116. [PMID: 34629857 PMCID: PMC7236700 DOI: 10.1016/j.enfcli.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
Objetivo Realizar una síntesis de la evidencia disponible para establecer recomendaciones sobre el abordaje del duelo y la muerte en familiares de pacientes con COVID-19, así como ofrecer recursos sustitutivos de los rituales y procedimientos necesarios con el fin de favorecer duelos funcionales y prevenir duelos complicados. Método Se realizó búsqueda bibliográfica en bases de datos MEDLINE, EMBASE, SCIENCEDIRECT, WOS, CINAHL y CUIDEN, utilizando términos MeSH (family, patient, isolation hospitals, grief, death, ceremonial behavior, self care, affects y social networking) con su ecuación booleana correspondiente. Los artículos seleccionados se sometieron a una lectura crítica a través del Critical Apraisal Skill Programme en español. Resultados Se encontraron 560 artículos atingentes; tras aplicar los criterios de selección 13 estudios se incluyeron en el análisis, de los cuales 8 eran revisiones sistemáticas, 3 estudios cualitativos, un estudio piloto prospectivo transversal y una guía clínica, que permitieron identificar estrategias para el abordaje del duelo y la muerte atendiendo a este momento de excepcionalidad de la COVID-19, incidiendo en el manejo competencial de los profesionales sanitarios en apoyo emocional y en el acompañamiento, así como en el seguimiento durante todo el proceso y en la comunicación con la familia. Conclusión En el proceso final de la vida en tiempos de la COVID-19 los profesionales sanitarios deben trabajar despedidas, los ritos fúnebres alternativos, la atención espiritual y el afrontamiento precoz que permitirán a su vez la prevención del duelo complicado.
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Affiliation(s)
- Miriam Araujo Hernández
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Huelva, España; Grupo de Investigación Afrontamiento al final de la vida (AFLV), Huelva, España
| | - Sonia García Navarro
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Huelva, España; Grupo de Investigación Afrontamiento al final de la vida (AFLV), Huelva, España; Unidad de Gestión Clínica Los Rosales, Distrito Huelva-Costa-Condado-Campiña, Huelva, España.
| | - E Begoña García-Navarro
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Huelva, España; Grupo de Investigación Afrontamiento al final de la vida (AFLV), Huelva, España
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Carter K. The Role of the Veterinary Technician in End-of-Life Care. Vet Clin North Am Small Anim Pract 2020; 50:639-645. [PMID: 32127223 DOI: 10.1016/j.cvsm.2019.12.012] [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: 10/24/2022]
Abstract
In addressing end-of-life care in veterinary medicine, the role of the veterinary technician can have a profound impact on quality of life during the final days in a pet's life. The role of the veterinary technician in end-of-life care is multifaceted, as duties range from nursing care to social and emotional support for pet caregivers. Human hospice care is helpful as a a model to better understand the importance of palliative care in animals. The skills of the veterinary technician are well suited for caring for hospice and palliative care patients. This article demonstrates and reviews how a technician's expertise is used in end-of-life care including assistance in the euthanasia process.
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Affiliation(s)
- Kelly Carter
- 4 Paws Farewell: Mobile Pet Hospice, Palliative Care and Home Euthanasia, Asheville, NC, USA.
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Ibañez-Masero O, Carmona-Rega IM, Ruiz-Fernández MD, Ortiz-Amo R, Cabrera-Troya J, Ortega-Galán ÁM. Communicating Health Information at the End of Life: The Caregivers' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2469. [PMID: 31336698 PMCID: PMC6678674 DOI: 10.3390/ijerph16142469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/02/2022]
Abstract
Health information and communication are key elements that allow patients and family members to make decisions about end-of-life care and guarantee a death with dignity. Objective: To understand caregivers' experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were caregivers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and five discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyze the discourses. A comprehensive reading was carried out along with a second reading. The most relevant units of meaning were identified, and the categories were extracted. The categories were then grouped in dimensions and, finally, the contents of each dimension were interpreted and described given the appropriate clarifications. Results: Four dimensions of the dying process emerged: differences in caregivers' perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life increased the suffering and discomfort of patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.
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Affiliation(s)
| | | | | | - Rocío Ortiz-Amo
- Department of Nursing, Physiotherapy, and Medicine, University of Almería, 04120 Almería, Spain
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Mitchell SA. Palliative care during and following allogeneic hematopoietic stem cell transplantation. Curr Opin Support Palliat Care 2018; 12:58-64. [PMID: 29303840 PMCID: PMC5803752 DOI: 10.1097/spc.0000000000000327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize recent literature regarding the provision of palliative care to patients during and following allogeneic hematopoietic stem cell transplantation (HSCT), highlighting factors which mediate impairments in health-related quality of life in this patient population, and the intervention approaches and models of care delivery that clinicians can consider to address unmet needs for palliative care and to strengthen patient and family resiliency. RECENT FINDINGS Provision of palliative care simultaneous with the delivery of treatment directed at the underlying malignancy has emerged as a recommended practice for patients with advanced cancer and high-symptom burden, and a recent randomized trial demonstrates the effectiveness of early palliative care in reducing some of the symptom burden and mood disturbances associated with HSCT. Although more research is needed, there is an expanding body of research-tested interventions to ameliorate the physical and psychological morbidity of HSCT across the transplant trajectory. SUMMARY Palliative care interventions delivered by an interdisciplinary team that includes transplant clinicians and palliative care across the HSCT trajectory can alleviate physical and psychological morbidity, thereby improving the patient and family experience of HSCT.
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Affiliation(s)
- Sandra A Mitchell
- Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, Rockville, Maryland, USA
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