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Elkefi S, Asan O. Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients. JMIR Hum Factors 2024; 11:e53053. [PMID: 38656776 PMCID: PMC11079762 DOI: 10.2196/53053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University, New York, NY, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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2
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Arboleda LPA, Pereira TCE, Epstein JB, Migliorati CA, Warnakulasuriya S, Diniz-Freitas M, Lopes MA, Santos-Silva AR. Clinical and Psychosocial Impact of Communication about Oral Potentially Malignant Disorders: A Scoping Review. Dent J (Basel) 2023; 11:209. [PMID: 37754329 PMCID: PMC10530221 DOI: 10.3390/dj11090209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Delivering bad news has been widely studied in cancer, thus, this scoping review aims to identify the available evidence concerning the communication of oral potentially malignant disorders (OPMDs) and their clinical and psychosocial impacts. A search was performed using electronic databases (Medline/PubMed, Scopus, Embase, and Web of Science) and one grey literature database (Google Scholar). Studies focused on communicating the diagnosis of OPMDs and the patients' perceptions were included. Study selection and data extraction were performed by two authors in a two-phase process. Five publications were included in the qualitative analysis. Differences regarding the study design, population, OPMDs assessed, and outcomes of professional-patient communication were found in each study. Protocols for OPMD communication have not yet been reported and there is a need to standardize strategies as communication skills may provide better clinical outcomes for patients diagnosed with potentially malignant disorders. Although future studies are needed, a brief list recommending the aspects that must be communicated is proposed.
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Affiliation(s)
- Lady P. A. Arboleda
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil; (L.P.A.A.); (T.C.E.P.); (M.A.L.)
- Graduate Program, A.C. Camargo Cancer Center, São Paulo 01508-020, SP, Brazil
| | - Thaís C. E. Pereira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil; (L.P.A.A.); (T.C.E.P.); (M.A.L.)
| | - Joel B. Epstein
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Health System, Los Angeles, CA 90048, USA;
- Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Cesar A. Migliorati
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL 32603, USA;
| | - Saman Warnakulasuriya
- WHO Collaborating Centre for Oral Cancer and Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Londos WC2R 2LS, UK;
| | - Márcio Diniz-Freitas
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain;
| | - Marcio A. Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil; (L.P.A.A.); (T.C.E.P.); (M.A.L.)
| | - Alan R. Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil; (L.P.A.A.); (T.C.E.P.); (M.A.L.)
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Cadet F, Sainfort F. Service quality in health care: empathy as a double-edged sword in the physician–patient relationship. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2023. [DOI: 10.1108/ijphm-09-2021-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Purpose
As one of the five major dimensions of service quality, empathy has been and continues to be regarded as a requirement for a successful service encounter. This paper focuses on the highly customer-centric service industry of health care. The purpose of this paper is to shed light on the potential negative effects of empathy on both the physician and the patient.
Design/methodology/approach
Building on an in-depth review of literature and well-established service quality models, the authors propose a new model for understanding the complex role of physician empathy in the physician–patient encounter. The trait, emotional intelligence (EI), is presented as a moderator for physician empathy levels.
Findings
The Health Care Optimal Physician Empathy (HOPE) model enables further characterization and analysis of the tradeoffs between patient satisfaction and physician burnout and determining when empathy optimally works to the benefit of both the physician and the patient to maximize service quality. The HOPE model provides a systematic way to understand and determine the appropriate level of physician empathy that results in optimal outcomes for both physicians and their patients by demonstrating the tradeoffs between physician burnout and patient satisfaction.
Originality/value
The authors highlight the potential detrimental effects on physicians themselves, and, in turn, on service quality. The theoretical and practical implications in this paper provide insights into the development and implementation of empathy-focused interventions and best practices to optimize service quality in the physician–patient interaction. The HOPE model is the first of its kind in shedding light on the manifestation of physician empathy.
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Alves CGB, Ribeiro ACP, Brandão TB, Tonaki JO, Pedroso CM, Rivera C, Epstein JB, Migliorati CA, Kowalski LP, Mak MP, Castro G, Lopes MA, Santos-Silva AR. Patient's perceptions of oral and oropharyngeal cancer diagnosis disclosure: communication aspects based on SPIKES protocol. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:518-529. [PMID: 36740563 DOI: 10.1016/j.oooo.2022.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Breaking bad medical news is a complex task of clinical practice. The manner in which this is done has a significant impact on patients. This study aimed to assess patient's perceptions regarding oral and oropharyngeal cancer diagnosis disclosure according to the "SPIKES" protocol. STUDY DESIGN This cross-sectional study used a questionnaire with 21 SPIKES-based items. The questionnaire was administered to 100 patients with recently diagnosed oral and oropharyngeal squamous cell carcinoma who evaluated each item according to their preference and experience. RESULTS Nineteen items showed a significant difference between patient's preference and recalled experience. Eighteen of these items showed lower experience scores primarily related to the amount of information desired by patients, presence of a companion, time to express feelings, and summary of information. Most patients preferred receiving as much information as possible about the diagnosis. However, only 35% reported that they had obtained sufficient information. Patients who were aware of cancer diagnostic suspicion had better communication experiences. CONCLUSIONS Protocols may be useful to guide health professionals to support patient-centered strategies to disclose oral cancer diagnoses.
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Affiliation(s)
- Carolina G B Alves
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Ana Carolina Prado Ribeiro
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Juliana O Tonaki
- Psychology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Caique Mariano Pedroso
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - César Rivera
- Oral Medicine and Pathology Research Group, Faculty of Health Sciences, University of Talca (UTALCA), Talca, Maule Region, Chile
| | - Joel B Epstein
- Cedars-Sinai Health System, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Milena Perez Mak
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Gilberto Castro
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Autonomy in Japan: What does it Look Like? Asian Bioeth Rev 2022; 14:317-336. [PMID: 36203709 PMCID: PMC9530074 DOI: 10.1007/s41649-022-00213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese word Jiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress’s individual autonomy, relational autonomy, and O’Neill’s principled autonomy as the three major ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term ‘a form of autonomy’ first used by Edmund Pellegrino in 1992 and examine the nature of ‘a form of autonomy.’ We finally conclude that the crux of what Pellegrino calls ‘something close to autonomy,’ or ‘a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term ‘Bioethics across the Globe’ instead of ‘Global Bioethics’, calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader’s understanding of Japan and will contribute to the progress of bioethics worldwide.
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Dunand A, Saraga M. Le choc de la nouvelle : perspective psycho-oncologique sur la communication médecin–malade. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les communications des médecins à leurs patients sont souvent rapportées en consultation psychologique lorsqu’elles ont un impact fort. Trois cas cliniques illustrent le fait que cette communication est complexe, dépend des acteurs en présence et de la situation, et qu’une approche standardisée est difficilement applicable. Le rôle du psychologue envers le patient est de l’aider à intégrer l’effet de cette communication. Envers le médecin, il est de lui permettre de communiquer de façon nuancée avec ses patients.
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7
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Norman RJ. Truth telling in reproductive medicine. Fertil Steril 2021; 116:1464-1465. [PMID: 34674829 DOI: 10.1016/j.fertnstert.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Robert J Norman
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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Hori H, Ohta A, Matsui H, Yano K, Morita-Tominaka M, Linn Z, Masumoto D, Okumura Y, Okamura S, Kurihara K, Hayakawa A, Rikiishi T, Kobayashi K. Changes of cancer diagnosis disclosure to children in Japan in the last 20 years. Int J Clin Oncol 2021; 27:245-252. [PMID: 34599412 DOI: 10.1007/s10147-021-02038-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The practice of cancer diagnosis disclosure to children has been changed with the times. The regulations of clinical trials in the 2000s might change the practice in Japan. However, the perspective of this topic among children and adults has not been investigated in detail. METHODS We studied changes in the practice of information sharing with children with cancer at pediatric cancer centers and the perspective of cancer diagnosis disclosure to children among school children, their parents and pediatric oncologists in the last 20 years by comparing the results of questionnaire surveys conducted in 1998, 2008 and 2018. RESULTS This study revealed that the performing rate has increased with the times, but the institutions actively performing for children aged 7-9 years were 36.4% even in the 2018 survey. More than 70% of children wished diagnosis disclosure if they suffer from cancer in the series of surveys, while the ratio of parents who tell cancer diagnosis to their children hovered at 34.5 to 53.7% (p < 0.001 in all surveys). The ratio of pediatric oncologists having the policy to perform diagnosis disclosure proactively increased from 9.3 to 60.0%, while that of parents having the same policy stayed at 5.3% even in 2018. CONCLUSIONS The performing rate of information sharing with children with cancer was significantly changed in the last 20 years. The opinion gaps were observed between parents and children and between parents and pediatric oncologists.
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Affiliation(s)
- Hiroki Hori
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
- Department of Pediatrics, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Asuka Ohta
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Honami Matsui
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kanako Yano
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Miyuki Morita-Tominaka
- Department of Pediatrics, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Zayar Linn
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Daisuke Masumoto
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yosuke Okumura
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Satoshi Okamura
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kosuke Kurihara
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akira Hayakawa
- Department of Palliative Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashi-Yodogawa-ku, Osaka, 533-0024, Japan
| | - Takeshi Rikiishi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, St. Luke's International University Graduate School of Nursing Science, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care 2021; 11:128-132. [PMID: 33762267 DOI: 10.1136/bmjspcare-2020-002700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/04/2022]
Abstract
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed. METHODOLOGY In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation. RESULTS Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution. CONCLUSION Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
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Affiliation(s)
| | - Jan Illing
- Royal College of Surgeons in Ireland, Dublin, Ireland
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10
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Villalobos M, Kreuter M. Inadequate Palliative Care in Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Grignoli N, Wullschleger R, Di Bernardo V, Amati M, Zanini C, Malacrida R, Rubinelli S. Hope and therapeutic privilege: time for shared prognosis communication. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106157. [PMID: 33055136 DOI: 10.1136/medethics-2020-106157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs' perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from different positions and experience, including doctors and nurses in four different departments (intensive care, oncology, palliative care, rehabilitation), were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient's timing and sharing the patient's wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs' emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation.
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Affiliation(s)
- Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Valentina Di Bernardo
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Xiao J, Chow KM, Chan CWH, Li M, Deng Y. Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China. Support Care Cancer 2019; 28:2921-2929. [DOI: 10.1007/s00520-019-05123-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/06/2019] [Indexed: 12/01/2022]
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Dealing with death in cancer care: should the oncologist be an amicus mortis? Support Care Cancer 2019; 28:2753-2759. [PMID: 31712952 DOI: 10.1007/s00520-019-05137-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
The way death is (not) dealt with is one of the main determinants of the current crisis of cancer care. The tendency to avoid discussions about terminal prognoses and to create unrealistic expectations of fighting death is seriously harming patients, families and healthcare professionals, and the delivery of high-quality and equitable care. Drawing on different literature sources, we explore key dimensions of the taboo of death: medical, policy, cultural. We suggest that the oncologist, from a certain moment, could take on the role of amicus mortis, a classical figure in the past times, and thus accompanying patients towards the end of their life through palliation and linking them to psychosocial and ethical/existential resources. This presupposes the implementation of Supportive Care in Cancer and the ethical idea of relational autonomy based on understanding patients' needs considering their sociocultural contexts. It is also key to encourage public conversations beyond the area of medicine to re-integrate death into life.
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Pini S, Hugh-Jones S, Shearsmith L, Gardner P. ‘What are you crying for? I don't even know you’ – The experiences of teenagers communicating with their peers when returning to school. Eur J Oncol Nurs 2019; 39:28-34. [DOI: 10.1016/j.ejon.2018.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/21/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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Supporting Supportive Care in Cancer: The ethical importance of promoting a holistic conception of quality of life. Crit Rev Oncol Hematol 2018; 131:90-95. [DOI: 10.1016/j.critrevonc.2018.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/03/2018] [Indexed: 01/01/2023] Open
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17
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Yi J, Kim MA, Parsons BG, Wu YP. Why did I get cancer? Perceptions of childhood cancer survivors in Korea. SOCIAL WORK IN HEALTH CARE 2018; 57:300-314. [PMID: 29436970 PMCID: PMC5927584 DOI: 10.1080/00981389.2018.1436113] [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] [Indexed: 06/08/2023]
Abstract
This study explored whether and how childhood cancer survivors in Korea ask and resolve the question of what may have caused their cancer. Thirty-one childhood cancer survivors participated in in-depth interviews about their self-questioning process in this regard. The findings indicate that Korean childhood cancer survivors pondered this question alone due to the stigma attached to cancer in the family and society. Their answers included internal factors (doing "bad things," having unhealthy eating habits, engaging in magical thinking, having a stress-prone personality, or having a biological susceptibility) or external factors (stressors, random events, the environment, or medical conditions). How they perceived the cause of cancer had an impact on aspects of their current lives. Psychosocial care standards or guidelines are needed in regard to the provision of a safe environment in which Korean cancer survivors and their parents can share their perceptions and process their thoughts.
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Affiliation(s)
- Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Min Ah Kim
- Department of Social Welfare, Myongji University, Seoul, Republic of Korea
| | | | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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Borgan SM, Amarin JZ, Othman AK, Suradi HH, Qwaider YZ. Truth Disclosure Practices of Physicians in Jordan. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:81-87. [PMID: 29368171 DOI: 10.1007/s11673-018-9837-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Disclosure of health information is a sensitive matter, particularly in the context of serious illness. In conservative societies-those which predominate in the developing world-direct truth disclosure undoubtedly presents an ethical conundrum to the modern physician. The aim of this study is to explore the truth disclosure practices of physicians in Jordan, a developing country. In this descriptive, cross-sectional study, 240 physicians were initially selected by stratified random sampling. The sample was drawn from four major hospitals in Amman, Jordan. A closed-ended questionnaire was distributed and completed by self-report. A total of 164 physicians completed the questionnaire. Thirty-seven physicians (23 per cent) usually withheld the diagnosis of "serious illness" from patients, while 127 physicians (77 per cent) usually divulged the information directly. Among the latter, 108 physicians (86 per cent) made exceptions to their disclosure policy. Specialists were more likely to withhold health information (p = 0.04998). Non-disclosure was primarily motivated by request from the patient's family (seventy-one participants, 54 per cent). In twenty cases (15 per cent), non-disclosure was undertaken independently. In conclusion, most respondents opt to disclose the truth; however, the vast majority of these respondents make exceptions. Instances of non-disclosure are primarily motivated by sociocultural constructs.
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Affiliation(s)
- Saif M Borgan
- Department of Internal Medicine, University of Central Florida College of Medicine, 4000 Central Florida Blvd, Orlando, FL, 32816, USA.
| | - Justin Z Amarin
- School of Medicine, The University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Areej K Othman
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Haya H Suradi
- School of Medicine, The University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Yasmeen Z Qwaider
- School of Medicine, The University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
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The ethical plausibility of the 'Right To Try' laws. Crit Rev Oncol Hematol 2018; 122:64-71. [PMID: 29458791 DOI: 10.1016/j.critrevonc.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/27/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022] Open
Abstract
'Right To Try' (RTT) laws originated in the USA to allow terminally ill patients to request access to early stage experimental medical products directly from the producer, removing the oversight and approval of the Food and Drug Administration. These laws have received significant media attention and almost equally unanimous criticism by the bioethics, clinical and scientific communities. They touch indeed on complex issues such as the conflict between individual and public interest, and the public understanding of medical research and its regulation. The increased awareness around RTT laws means that healthcare providers directly involved in the management of patients with life-threatening conditions such as cancer, infective, or neurologic conditions will deal more frequently with patients' requests of access to experimental medical products. This paper aims to assess the ethical plausibility of the RTT laws, and to suggest some possible ethical tools and considerations to address the main issues they touch.
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Alzahrani AS, Alqahtani A, Alhazmi M, Gaafar R, Bajabir D, Alharbi IM, Alharbi AM, Kheshaifaty G, Alzahrani A. Attitudes of cancer patients and their families toward disclosure of cancer diagnosis in Saudi Arabia: a Middle Eastern population example. Patient Prefer Adherence 2018; 12:1659-1666. [PMID: 30214168 PMCID: PMC6126501 DOI: 10.2147/ppa.s176651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Particularly in the Middle East, few studies have explored the attitude of cancer patients and their families toward cancer diagnosis disclosure (CDD). This study was conducted to investigate the preference and attitude of a sample of cancer patients and their families in Saudi Arabia toward CDD. METHODS We constructed a questionnaire based on previous studies. The questionnaire assessed preference and attitude toward CDD. Participants were recruited from the King Abdullah Medical City, which has one of the largest cancer centers in Saudi Arabia. RESULTS Three hundred and four cancer patients and 277 of their family members participated in the study. The patient group preferred CDD more than the family group (82.6% vs 75.3%, P<0.05). This preference is especially more evident toward disclosure of detailed cancer information (status, prognosis, and treatment) (83.6% vs 59.9%, P<0.001). In a binary logistic regression, factors associated with preference toward CDD included having information about cancer (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.15-2.84) and being employed (OR, 1.77; 95% CI, 1-2.82) while being from the patient group was the only factor associated with preference toward detailed cancer information (OR, 3.25; 95% CI, 2.11-5.05). In terms of patient reaction after CDD, "fear" was the attitude expected by the family group more than the patient group (56.3% vs 70.4%, P<0.001) while "acceptance" was the attitude anticipated by the patient group more than the family group (38% vs 15.2%, P<0.001). CONCLUSION Patients preferred CDD and disclosure of related information, while their families were more inclined toward scarce disclosure. Family members seem to experience negative attitudes more than the patients themselves.
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Affiliation(s)
- Ahmad S Alzahrani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Abdullah Alqahtani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Maher Alhazmi
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | - Doaa Bajabir
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | | | - Ghufran Kheshaifaty
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Aamer Alzahrani
- College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Villalobos M, Coulibaly K, Krug K, Kamradt M, Wensing M, Siegle A, Kuon J, Eschbach C, Tessmer G, Winkler E, Szecsenyi J, Ose D, Thomas M. A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives. Eur J Cancer Care (Engl) 2017; 27:e12794. [PMID: 29168594 DOI: 10.1111/ecc.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.
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Affiliation(s)
- M Villalobos
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - K Coulibaly
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - A Siegle
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - J Kuon
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - C Eschbach
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - G Tessmer
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | - E Winkler
- National Center for Tumor Diseases, University Heidelberg, Heidelberg, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - D Ose
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M Thomas
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
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Godskesen T, Kihlbom U. "I Have a Lot of Pills in My Bag, You Know": Institutional Norms in the Provision of Hope in Phase I Clinical Cancer Trials. J Oncol Pract 2017; 13:679-682. [PMID: 28837376 DOI: 10.1200/jop.2017.021832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tove Godskesen
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
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Broom A, Chittem M, Bowden V, Muppavaram N, Rajappa S. Illness Experiences, Collective Decisions, and the Therapeutic Encounter in Indian Oncology. QUALITATIVE HEALTH RESEARCH 2017; 27:951-963. [PMID: 27179019 DOI: 10.1177/1049732316648125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social science scholarship on cancer has been almost exclusively focused on Organization for Economic Cooperation and Development (OECD) countries, despite a significant epidemiological transition taking place in many non-OECD contexts, with cancer emerging as a prominent, and strongly feared, illness experience. With cancer gaining an increasingly high profile in India, there is an urgent need to explore how experiences of cancer may be socially and culturally embedded, and in turn, how localized practices may shape the therapeutic encounter. Here, drawing on interviews with 40 people living with cancer in Hyderabad, India, we focus on some specific components of their therapeutic journeys, including diagnostic and prognostic disclosure, collective versus individual decision making, the dynamics of medical authority, and the reception of cancer within their social milieu. These participants' accounts provide insight into a range of cultural sensibilities around illness and care, and reinforce the importance of understanding the cultural inflections of communication, decisions, and illness experiences.
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Affiliation(s)
- Alex Broom
- 1 The University of New South Wales, Sydney, Australia
| | | | | | | | - Senthil Rajappa
- 3 Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Suurmond J, Lieveld A, van de Wetering M, Schouten-van Meeteren AYN. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28370728 DOI: 10.1111/ecc.12680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers.
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Affiliation(s)
- J Suurmond
- Department of Public Health, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - A Lieveld
- OLVG West, Amsterdam, The Netherlands
| | - M van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - A Y N Schouten-van Meeteren
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Tang WR, Hong JH, Rau KM, Wang CH, Juang YY, Lai CH, Fujimori M, Fang CK. Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices. Psychooncology 2016; 26:999-1005. [DOI: 10.1002/pon.4257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Kun-Ming Rau
- Department of Hematology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Hsu Wang
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chien-Hong Lai
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Maiko Fujimori
- Center for Suicide Prevention, National Institute of Mental Health; National Center for Neurology & Psychiatry; Tokyo Japan
| | - Chun-Kai Fang
- Department of Psychiatry, Suicide Prevention Center & Hospice and Palliative Care Center; MacKay Memorial Hospital; Taipei Taiwan
- Department of Medicine; MacKay Medical College; New Taipei Taiwan
- Department of Thanatology and Health Counseling; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
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Alsirafy SA, Abdel-Kareem SS, Ibrahim NY, Abolkasem MA, Farag DE. Cancer diagnosis disclosure preferences of family caregivers of cancer patients in Egypt. Psychooncology 2016; 26:1758-1762. [PMID: 27362334 DOI: 10.1002/pon.4206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 06/03/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family caregivers (FCs) of cancer patients are frequently seen as a barrier to honest communication with patients in Egypt. This study was conducted to investigate the attitude of FCs of cancer patients toward cancer diagnosis disclosure (CDD) and its determinants. METHODS A structured interview was used to assess the preferences of 288 FCs regarding CDD. RESULTS According to the FCs, 85% of patients were aware of their diagnosis. The majority (81%) of FCs preferred CDD to patients. In case they developed cancer, 92% of FCs wanted to know their diagnosis and 88% wanted to inform their families. In a univariate analysis, factors associated with FCs' negative attitude toward CDD to patients were as follows: patient's lower level of education (P = .001), patient's rural residence (P < .001), hematological malignancies (P < .001), FC's belief that the patient is unaware of diagnosis (P < .001), FC's unwillingness to know his/her own cancer diagnosis (P < .001), and FC's unwillingness to inform his/her family about his/her cancer diagnosis (P < .001). Only 2 factors predicted independently the negative attitude of FCs toward CDD, the FC's belief that the patient is unaware of diagnosis (P < .001), and the FC's unwillingness to know his/her own cancer diagnosis (P = .049). CONCLUSIONS The results suggest that the majority of FCs of Egyptian cancer patients prefer CDD to patients. The finding that the vast majority of FCs of aware patients preferred CDD suggests that the reaction of Egyptian patients to CDD is acceptable by FCs. Family caregivers with a negative attitude toward CDD may be reflecting their own fears.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Shady S Abdel-Kareem
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
- Port Said General Hospital, Port Said, Egypt
| | - Noha Y Ibrahim
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Abolkasem
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dina E Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Surbone A, Baider L. Are oncologists accountable only to patients or also to their families? An international perspective. Am Soc Clin Oncol Educ Book 2016:e15-9. [PMID: 24451822 DOI: 10.14694/edbook_am.2012.32.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In most societies, health professionals traditionally carry responsibility only toward their patients. However, this is not the case in all cultures. In the contemporary practice of oncology in Western cultures, there is a shift toward assuming broader responsibility for patients with cancer' families during the illness course, the grieving stage, and in cancer prevention and genetic counseling. Traditional family, community, and religious values play a central role in determining people's perceptions and attitudes toward life and death as well as toward caregiving for a sick relative. The meaning of cancer illness within the family culture is thus influenced not only by each individual's values and beliefs but also by the family's makeup and dynamics, as well as their taboos and secrets. Global cancer care should therefore be directed at the family as a unit, while respecting patient autonomy and privacy. This reappraisal of our traditional understanding of physicians' duty as solely directed at the patient is reflected in the recent US trend toward a patient- and family-centered care approach. An additional challenge for oncology professionals is to integrate and tailor interventions toward the needs of both care recipients and caregivers and relate it to this dyad as the basic and enduring unit of care.
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Affiliation(s)
- Antonella Surbone
- From the Department of Medicine, New York University Medical School, New York, NY; and the Hebrew University Medical School, Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - Lea Baider
- From the Department of Medicine, New York University Medical School, New York, NY; and the Hebrew University Medical School, Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel
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Weber O, Sulstarova B, Singy P. Cross-Cultural Communication in Oncology: Challenges and Training Interests. Oncol Nurs Forum 2016; 43:E24-33. [DOI: 10.1188/16.onf.e24-e33] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Wood LA. Experimental subjects and partial truth telling during technological change in radiotherapy. Nurs Ethics 2016; 24:441-451. [PMID: 26719350 DOI: 10.1177/0969733015614881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cone Beam Computed Tomography (CBCT), the focus of a number of radiotherapy fundraising campaigns in the mid-2000s, was introduced accompanied by a fanfare of newness and discourses of 'hope', 'inspiring clinical confidence' and 'accuracy'. The CBCT system, used in the delivery of Radiotherapy treatment, was incorporated into strategic planning priorities across the United Kingdom based on a rationale of self-evidence. During this time, the way in which the new system was discussed with patients was variable. RESEARCH OBJECTIVES The purpose of this study was to uncover how experimental practices were embedded and enacted during the use of a new technological system, specifically relating to how patients were enrolled during introductory phases of technology adoption. Research design and context: Drawing on ethnographic work and interviews with staff members in one hospital, the study examines staff discussions prior to the introduction of the Cone-Beam CT imaging system in radiotherapy. It considers how staff views were at odds with practices that occurred during the 'experimental' stages of use and how these were shared with patients. Ethical considerations: Approval was obtained from the Local National Health Service Research Ethics Committee and National Health Service Main Research Ethics Committee (REC 07/Q1308/16) for the interview and ethnographic stages, respectively. All names have been changed and participants signed a consent form. FINDINGS Staff reported a lack of evidence, absence of proof and perturbing doubts with the X-ray volumetric imaging. Both patients' and practitioners' partial understanding about the risks and benefits of the system created incommensurable ideas regarding its use and what the patients' role was during these introductory stages. CONCLUSION Maintaining partial truth telling renders patients' experiences of new treatment at odds with 'experimental' practice. This has wide-reaching implications for practice.
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Coyne I, Amory A, Gibson F, Kiernan G. Information-sharing between healthcare professionals, parents and children with cancer: more than a matter of information exchange. Eur J Cancer Care (Engl) 2015; 25:141-56. [DOI: 10.1111/ecc.12411] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- I. Coyne
- School of Nursing & Midwifery; Trinity College Dublin; Dublin Ireland
| | - A. Amory
- School of Nursing & Midwifery; Trinity College Dublin; Dublin Ireland
| | - F. Gibson
- Children and Young People's Cancer Care; Great Ormond Street Hospital for Children NHS Foundation Trust; London
- School of Health and Social Care; Department of Children's Nursing; London South Bank University; London UK
| | - G. Kiernan
- School of Nursing & Human Sciences; Dublin City University; Dublin Ireland
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Costantini A, Grassi L, Picardi A, Brunetti S, Caruso R, Nanni MG, Bonetti L, de Feudis R, Barni S, Marchetti P. Awareness of cancer, satisfaction with care, emotional distress, and adjustment to illness: an Italian multicenter study. Psychooncology 2015; 24:1088-96. [DOI: 10.1002/pon.3768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Anna Costantini
- Psycho-Oncology Departmental Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance, and Health Promotion; Italian National Institute of Health; Rome Italy
| | - Serena Brunetti
- Psycho-Oncology Departmental Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Luisa Bonetti
- Psycho-Oncology Service; Azienda Ospedaliera Treviglio; Treviglio Italy
| | - Rossana de Feudis
- Clinical Psychology Unit, Medical Oncology Unit; San Paolo Hospital; Bari Italy
| | - Sandro Barni
- Division of Medical Oncology; Azienda Ospedaliera Treviglio; Treviglio Italy
| | - Paolo Marchetti
- Unit of Medical Oncology, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
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Experiences of truth disclosure in terminally ill cancer patients in palliative home care. Palliat Support Care 2015; 9:173-80. [PMID: 24468485 DOI: 10.1017/s1478951511000046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to explore the experiences and preferences of terminally ill cancer patients regarding truth telling in the communication of poor prognoses. METHOD We recorded and transcribed interviews with 45 patients who knew their cancer was terminal, and analyzed their responses hermeneutically. RESULTS Patients identified three different modes of truth: (1) the absolute objective truth that they are dying; (2) the partial truth about their condition including some facts but not all of the details; and (3) the desired truth, originating in the patient's own beliefs about a healthy or better life. Coping strategies were related to patients' preferred mode of truth: (1) facing the truth in order to take action; (2) facing some parts of the truth in order to maintain hope; and (3) hovering between facing and avoiding the truth. In their struggle for existential survival, patients used different coping strategies, changing from one to another depending upon the circumstances. SIGNIFICANCE OF RESULTS Varying use of different coping strategies impacts on patient preferences concerning communication about bad news with their doctors. Truth-telling entails more than merely providing information related to the forthcoming death. It also concerns how physicians or other healthcare staff can support the patient's existential survival by fine-tuning the communication of "truth" according to the individuals' preferences.
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Goldzweig G, Abramovitch A, Brenner B, Perry S, Peretz T, Baider L. Expectations and Level of Satisfaction of Patients and Their Physicians: Concordance and Discrepancies. PSYCHOSOMATICS 2014; 56:521-9. [PMID: 25596021 DOI: 10.1016/j.psym.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying discrepancies between patients׳ expectations for support provided by their physicians, and physicians׳ appraisal of the support they provide to their patients, is a key factor in constructing effective doctor-patient communication. OBJECTIVE The current study proposes and explores a paradigm for assessing possible gaps and overlaps between perceptions of patients with cancer and physicians about the "actual" and the "ideal" (desired) emotional and cognitive support oncologists provide to patients. METHODS Participants included 1027 patients with cancer and 47 senior oncologists. Patients׳ and physicians׳ levels of expectations and satisfaction with the emotional and cognitive support offered by physicians were assessed using a quantitative measure of discrepancy between the actual and the ideal situation. The measure was developed for this study and tested on a random sample of 200 patients and 17 oncologists. RESULTS The results indicated consistency between physicians׳ and patients׳ perceptions of the needs and support that the patients received. Nevertheless, oncologists did not feel highly trusted by their patients, oncologists desired less involvement of patients in the treatment plan than the patients expected. Oncologists thought that they actually provided the desired levels of explanation to patients׳ families, whereas patients thought their families got less explanations than expected. CONCLUSION Actual and ideal levels of communication should be described from the points of view of both physicians and patients to better understand the complex picture of patient satisfaction. Oncologists should consider patients׳ expectations for support vs their own expectations to effectively address patients׳ needs.
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Affiliation(s)
- Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel (GG).
| | - Amitai Abramovitch
- OCD and Related Disorders Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA (AA)
| | - Baruch Brenner
- Institute of Oncology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel (BB, SP)
| | - Shlomit Perry
- Institute of Oncology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel (BB, SP)
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel (TP)
| | - Lea Baider
- Institute of Oncology, Assuta Medical Center, Tel-Aviv, Israel (LB)
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Seyedrasooli A, Rahmani A, Howard F, Zamanzadeh V, Mohammadpoorasl A, Aliashrafi R, Pakpour V. Iranian Cancer Patient Perceptions of Prognosis and the Relationship to Hope. Asian Pac J Cancer Prev 2014; 15:6205-10. [DOI: 10.7314/apjcp.2014.15.15.6205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shin DW, Cho J, Kim SY, Chung IJ, Kim SS, Yang HK, Ahn E, Park BR, Seo H, Park JH. Discordance among patient preferences, caregiver preferences, and caregiver predictions of patient preferences regarding disclosure of terminal status and end-of-life choices. Psychooncology 2014; 24:212-9. [PMID: 25099223 DOI: 10.1002/pon.3631] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 05/31/2014] [Accepted: 07/04/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The complexity of end-of-life (EOL) communication in cancer care is often increased by family caregivers, who frequently affect the information and decision-making process. We assessed cancer patient preferences (PP), family caregiver preferences (FCP), and family caregiver predictions of patient preferences (FCPPP) regarding the disclosure of terminal status, family involvement in the disclosure process, and EOL choices, and we evaluated the concordances among them. METHODS A national, multicenter, cross-sectional survey of 990 patient-caregiver dyads (participation rate = 76.2%) was performed. A set of paired questionnaires was independently administered to patients and their caregivers. RESULTS While patients and family caregivers had wide spectra of preferences, patients significantly preferred disclosure, direct disclosure by a physician, and palliative care options (all P < 0.001). Family caregiver predictions were similar to PP with regard to terminal disclosure (P = 0.35) but significantly different with regard to family involvement in the disclosure process and EOL choices (P < 0.001). The concordances of PP and FCP (κ = 0.08-0.13), and those of PP and FCPPP (κ = 0.09-0.17), were poor. The concordances of FCP and FCPPP were fair to moderate (κ = 0.35-0.67). Discrepancies between PP and FCP and between PP and FCPPP were associated with dysfunctional family communication. CONCLUSIONS Family caregivers do not generally concur with patients in their preferences, nor do they reliably predict PP. Open dialogue between patient and family caregivers would reduce the discrepancy. More emphasis on incorporating family caregivers in EOL communication is needed from clinical, research, and training perspectives.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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Baider L, Surbone A. Universality of aging: family caregivers for elderly cancer patients. Front Psychol 2014; 5:744. [PMID: 25076927 PMCID: PMC4097431 DOI: 10.3389/fpsyg.2014.00744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 06/25/2014] [Indexed: 02/03/2023] Open
Abstract
The world population is aging, with the proportion of older people (65+ years) expected to reach 21% in 2050 and to exceed the number of younger people (aged 15 or less) for the first time in history. Because cancer is particularly a chronic disease of older people, a large increase in the number of elderly patients with cancer is anticipated. The estimated number of new cancer cases worldwide among people over 65 is expected to grow from about 6 million in 2008 to more than 11 million during the coming decade. By 2030, individuals over 65 are expected to account for 70% of all cancer patients in the Western world. Along with the increase in oncology patients, the number of older people caring for their ill spouses or other relatives is also growing, with the ensuing toll on these caregivers causing major concern, especially in western countries. In different societies the characteristics of family caregiver stressors, cultural norms concerning caregiving, and the availability of support have a huge impact on those providing care. Any study of older caregivers of older cancer patients requires an integrative evaluation of aging that takes into account cultural, social, psychological, and behavioral variables. This review proposes a critical discussion of the multidimensionality of the caregiving and of the impact that age, culture, and gender have on it.
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Affiliation(s)
- Lea Baider
- Institute Sharett of Oncology, Hadassah University Hospital Jerusalem, Israel ; Department of Oncology, Assuta Medical Center Tel-Aviv, Israel
| | - Antonella Surbone
- Department of Medicine, New York University School of Medicine New York, NY, USA
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Daher M. Ethical issues in the geriatric patient with advanced cancer 'living to the end'. Ann Oncol 2014; 24 Suppl 7:vii55-58. [PMID: 24001765 DOI: 10.1093/annonc/mdt262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer cases over the next 20 years, and the biggest rates of increase will occur in the developing world. Owing to technical advances in the care of critical illness, as it is the case in elderly people with advanced cancer, physicians, patients and families are often confronted with ambiguous circumstances in which medical advances may inadvertently prolong suffering and the dying process rather than bring healing and recovery. In this review of the ethical issues confronting physicians who care for patients with advanced life-limiting illnesses like cancer, a philosophical debate continues in the medical community regarding the rightness or wrongness of certain actions (e.g. physician-assisted death, euthanasia), while at the same time there is a strong desire to find a common ground for moral discourse that could guide medical decision-making in this difficult period in the lives of our patients. We will discuss how a good palliative care can be an alternative to these ethical dilemmas. Although some issues (e.g. the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, no malfeasance, beneficence, autonomy and justice. Thus, the physician's primary commitment must always be the patient's welfare and best interests, whether the physician is treating illness or helping patients to cope with illness, disability and death. A key skill here is the communication of bad news and to negotiate a treatment plan that is acceptable to the patient, the family and the healthcare team. Attention to psychosocial issues demands involvement of the patients and their families as partners. Physicians should be sensitive to the range of psychosocial distress and social disruption common to dying patients and their families. Spiritual issues often come to the fore. An interdisciplinary healthcare team can help in these areas. The goals of this review are to raise the awareness of doctors, nurses and other members of the healthcare team to the important ethical issues that must be addressed in providing medical care to elderly patients with advanced cancer; and also to encourage members of the healthcare team to take the ethical issues seriously so that we can improve the circumstances of a vulnerable group of patients-the elderly patients with cancer.
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Affiliation(s)
- M Daher
- Medical Ethics, University of Balamand, Saint George Hospital-UMC, Achrafieh, Beirut, Lebanon.
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41
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Howard AF, Tan de Bibiana J, Smillie K, Goddard K, Pritchard S, Olson R, Kazanjian A. Trajectories of social isolation in adult survivors of childhood cancer. J Cancer Surviv 2014; 8:80-93. [PMID: 24202698 PMCID: PMC3923114 DOI: 10.1007/s11764-013-0321-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 10/15/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Long-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors' perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated. The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer. METHODS Data from 30 in-depth interviews with survivors (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, constant comparative methods. RESULTS Experiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better or (3) delayed social isolation: it hit me later on. CONCLUSIONS Knowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge. IMPLICATIONS FOR CANCER SURVIVORS Assessing and addressing social outcomes, including isolation, might promote comprehensive long-term follow-up care for childhood cancer survivors.
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Affiliation(s)
- A Fuchsia Howard
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada,
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Wang DC, Guo CB, Peng X, Su YJ. Psychological morbidity and health-related quality of life in patients with differing awareness of cancer diagnosis: a cross-sectional study. Psychooncology 2014; 23:975-80. [PMID: 24577849 DOI: 10.1002/pon.3512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 12/08/2013] [Accepted: 02/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Dian Can Wang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Chuan Bin Guo
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Yan Jie Su
- Department of Psychology; Peking University; Beijing China
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Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Sociomed 2014; 26:65-7. [PMID: 24757408 PMCID: PMC3990376 DOI: 10.5455/msm.2014.26.65-67] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/15/2014] [Indexed: 11/03/2022] Open
Abstract
Good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also they should devote time to the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only based on the physical abilities of nurses, but also on education and experience.
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Affiliation(s)
- Lambrini Kourkouta
- Nursing Department, Technological Educational Institute of Thessaloniki, Greece
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Park AR, So HS, Chae MC. Recognition of Patients, Families, Nurses, and Physicians about Clinical Decision-making and Biomedical Ethics. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ae Ran Park
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Hyang Sook So
- College of Nursing, Chonnam National University, Gwangju, Korea
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45
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Xue D, Wheeler JL, Abernethy AP. Cultural differences in truth-telling to cancer patients: Chinese and American approaches to the disclosure of ‘bad news’. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wiskin C, Doherty EM, von Fragstein M, Laidlaw A, Salisbury H. How do United Kingdom (UK) medical schools identify and support undergraduate medical students who 'fail' communication assessments? A national survey. BMC MEDICAL EDUCATION 2013; 13:95. [PMID: 23834990 PMCID: PMC3720201 DOI: 10.1186/1472-6920-13-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 06/17/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND The doctor's ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students' clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who 'fail' communication assessments across all UK medical schools. METHODS Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education. RESULTS All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes. CONCLUSIONS This survey has demonstrated that few Medical Schools have no identifiable system of managing their students' clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.
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Affiliation(s)
- Connie Wiskin
- Primary Care Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, Birmingham, UK
| | - Eva M Doherty
- The Royal College of Surgeons in Ireland, National Surgical Training Centre, St Stephens Green, Dublin, Ireland
| | - Martin von Fragstein
- Division of Primary Care, Community Health Sciences, University of Derby, Derby, UK
| | - Anita Laidlaw
- Medical School, University of St Andrews, St Andrews, Fife, Scotland, UK
| | - Helen Salisbury
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Schultz M, Bar-Sela G. Initiating palliative care conversations: lessons from Jewish bioethics. ACTA ACUST UNITED AC 2013; 11:1-7. [PMID: 23089233 DOI: 10.1016/j.suponc.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/17/2022]
Abstract
What are the ethical responsibilities of the medical staff (doctors, nurses, social workers, and chaplains) regarding the preservation of meaningful life for their patients who are approaching the end of life (EOL)? In particular, what is the staff's ethical responsibility to initiate a conversation with their patient regarding palliative care? By subjecting traditional Jewish teachings to an ethical analysis and then exploring the underlying universal principles, we will suggest a general ethical duty to inform patients of the different care options, especially in a manner that preserves hope. The principle that we can derive from Jewish bioethics teaches that the medical staff has a responsibility to help our patients live in a way that is consistent with how they understand their task or responsibility in life. For some patients, the best way to preserve a meaningful life in which they can fulfill their sense of purpose in the time that remains is to focus on palliation. For this reason, although palliative and supportive care are provided from the time of diagnosis, it is critical we make sure our patients realize that they have the opportunity to make a decision between either pursuing additional active treatments or choosing to focus primarily on palliative therapies to maximize quality of life. The Jewish tradition and our experience in spiritual care suggest the importance of helping patients preserve hope while, simultaneously, honestly acknowledging their situation. Staff members can play a vital role in helping patients make the most of this new period of their lives.
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Affiliation(s)
- Michael Schultz
- Division of Oncology, Rambam-Health Care Campus, Haifa, Israel.
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Millar C, Reid J, Porter S. Refractory cachexia and truth-telling about terminal prognosis: a qualitative study. Eur J Cancer Care (Engl) 2012; 22:326-33. [PMID: 23279159 DOI: 10.1111/ecc.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 11/30/2022]
Abstract
The purpose of this paper is to examine the consequences that medical practitioners' decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study that used focus groups and semi-structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end-of-life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia.
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Affiliation(s)
- C Millar
- Northern Ireland Biobank, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
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Besson C, Rannou S, Elmaaroufi H, Guirimand N, Tresvaux du Fraval F, Cartron L, Jenny S, Festy P, Fenaux P, Leplège A. Disclosure of myelodysplastic syndrome diagnosis: improving patients' understanding and experience. Eur J Haematol 2012; 90:151-6. [PMID: 23215858 DOI: 10.1111/ejh.12048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE How a diagnosis of cancer is disclosed can affect psychological morbidity. Haematological malignancy specialised terminology may make the disclosure difficult. We analysed how disclosure of a diagnosis of myelodysplastic syndrome (MDS) is experienced by patients. METHODS Patients from the French MDS support group were questioned about their demographic and clinical characteristics, diagnosis disclosure circumstances as well as experiences and expectations. After a phase test, a written questionnaire was sent to the 150 members of the support group. RESULTS Of the 73 patients who returned a useable questionnaire, disclosure had been experienced negatively by 32 patients (45%). Only 53% of those patients were satisfied with the information provided compared with 80% of those who had positive/neutral feelings (P = 0.02). Overall, patients felt they should have been given fuller information at the time of disclosure. In retrospect, almost all patients (94%) thought that comprehensive, accurate information should be provided at disclosure, even if the truth might be hard to cope with. Patients reporting not having been given satisfactory information complained about a lack of perspective (3) or clarity (7), eight (11%) mentioned cancer during the interview, and four explicitly expressed that this word should be more frequently used. CONCLUSION Many patients had experienced disclosure negatively, frequently finding that the information provided had been insufficient and feeling that MDS was not well understood as a disease. Haematologists disclosing diagnosis to patients with a blood malignancy may benefit from following the same guidelines as oncologists in delivering comprehensive, understandable information.
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Affiliation(s)
- Caroline Besson
- UF D'hématologie Clinique Ambulatoire, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris, Université Paris XI F-94275.
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Mackenzie LJ, Carey ML, Sanson-Fisher RW, D'Este CA, Hall AE. Cancer patients' willingness to answer survey questions about life expectancy. Support Care Cancer 2012; 20:3335-41. [PMID: 22576980 PMCID: PMC3480580 DOI: 10.1007/s00520-012-1477-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to determine the proportion and characteristics of radiation oncology outpatients who were willing to answer questions about their life expectancy. METHODS A cross-sectional patient self-report survey was conducted using touch screen computers in Australian radiation oncology treatment centers. The primary outcome was the respondent's willingness to complete a survey subsection about life expectancy. Demographic and disease characteristics were also collected, and level of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. RESULTS Of the 469 oncology outpatients who completed the survey, 327 (70 %; 95 % CI, 65 %, 74 %) indicated that they were willing to answer questions about life expectancy. Being female (p < 0.001), older (p < 0.05), born in Asia (p < 0.05), and being diagnosed with cancer types other than breast and prostate cancer (p < 0.01) were associated with lower odds of answering life expectancy questions. CONCLUSIONS The opportunity to opt-out of survey questions about sensitive issues such as life expectancy is a feasible method for accessing important information about patient preferences while minimizing burden. Further research may be needed to improve acceptability of life expectancy research to some patient groups.
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Affiliation(s)
- L J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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