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Martins H, Silva RS, Bragança J, Romeiro J, Caldeira S. Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis. Healthcare (Basel) 2024; 12:960. [PMID: 38786372 PMCID: PMC11121139 DOI: 10.3390/healthcare12100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.
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Affiliation(s)
- Helga Martins
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Health School, Polytechnic Institute of Beja, 7800-000 Beja, Portugal
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita S. Silva
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Bragança
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Romeiro
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Sílvia Caldeira
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
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Muishout G, El Amraoui A, Wiegers GA, van Laarhoven HWM. Muslim Jurisprudence on Withdrawing Treatment from Incurable Patients: A Directed Content Analysis of the Papers of the Islamic Fiqh Council of the Muslim World League. JOURNAL OF RELIGION AND HEALTH 2024; 63:1230-1267. [PMID: 36446918 DOI: 10.1007/s10943-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them.
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Affiliation(s)
- George Muishout
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Gerard Albert Wiegers
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Wilma Marlies van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Jasbi A, Sand K, Marshman Z, Høiseth M. Investigating hope in oral health promotion for adolescents: an exploratory study based on observations at the dental clinic. FRONTIERS IN ORAL HEALTH 2024; 5:1303933. [PMID: 38445093 PMCID: PMC10913602 DOI: 10.3389/froh.2024.1303933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Maintaining well-being is crucial, especially in challenging conditions, considering the common public health issue of dental caries. Within the context of adolescent oral health, this research explores the techniques employed by dental professionals to potentially foster hope -a positive manner that promotes well-being- in adolescents during consultations, opening a window into the realm of patient engagement and well-being. Materials and methods Data were collected through observations conducted at public dental clinics in Norway, with the participation of three dental professionals and four adolescents between the ages of 12 and 15 years. The data were analyzed using thematic analysis. Practices were observed from dental professionals in their interactions with adolescents, which align with features of hope. Result Three core themes were identified: (1) bonding strategies; (2) verbal and non-verbal strategies for creating positive relationships; and (3) adolescents' empowerment in dental consultations. Conclusion Although a new concept within oral health promotion, it seems that dental professionals in this study were observed to be facilitating hope in adolescents when they were providing their dental care. Consideration should be given to the potential for future approaches to be developed for use in dental consultations to facilitate hope strategically. While these approaches are likely to contribute to improving patient-centredness, consideration is needed of challenges and barriers to their implementation.
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Affiliation(s)
- Arefe Jasbi
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Sand
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Marikken Høiseth
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Trondheim, Norway
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Cheng C, Christensen M. Living with Multimorbidity through Time: A Meta-Synthesis of Qualitative Longitudinal Evidence. Healthcare (Basel) 2024; 12:446. [PMID: 38391821 PMCID: PMC10887575 DOI: 10.3390/healthcare12040446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study's aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals' experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- School of Nursing, Fudan University, Xuhui District, Shanghai 200032, China
| | - Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Yasunaka M, Tsugihashi Y, Hayashi S, Iida H, Hirose M, Shirahige Y, Kurita N. Relationship of life expectancy with quality of life and health-related hope among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study. PLoS One 2023; 18:e0295672. [PMID: 38096245 PMCID: PMC10721024 DOI: 10.1371/journal.pone.0295672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Spiritual care for patients' quality of life (QOL) and hope should be included in home medical care for patients with limited life expectancy. This study aimed to analyze the associations between estimated life expectancy, QOL, and hope among patients receiving home medical care in Japan. This multicenter cross-sectional study involved 29 home medical care facilities in Japan. Patients were categorized by estimated life expectancy, as assessed by home medical care physicians. The outcomes were QOL measured via the Quality-of-Life Scale for Elderly Patients Receiving Professional Home Care (QOL-HC: higher score indicates better QOL), the domain scores of health-related hope ("health," "role and connectedness," and "something to live for"; higher scores indicate higher levels of hope), and life functioning measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0; higher score indicates worse functioning and disability). QOL-HC scores were significantly higher in patients with shorter life expectancy (< 6 m vs. ≥ 1 y, adjusted mean differences: 0.7 points [95%CI 0.1 to 1.3]). Regarding health-related hope, "something to live for" scores were associated with shorter life expectancy (< 6 m vs. ≥ 1 y, -17.7 points [-34.2 to -1.2]), whereas "role and connectedness" scores did not change remarkably with shorter life expectancy (< 6 m vs. ≥ 1 y, -3.3 points [-16.4 to 9.8]). Furthermore, shorter life expectancy was associated with higher WHODAS 2.0 scores (< 6 m vs. ≥ 1 y, 19.6 points [4.3 to 34.8]). Home medical care physicians who engage in spiritual care should facilitate thoughtful dialogue with their patients by recognizing declines in life functions and hope for fulfilment, which are associated with short life expectancy.
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Affiliation(s)
- Masakazu Yasunaka
- Dr. Net Nagasaki, Nagasaki-City, Nagasaki, Japan
- Yasunaka Neurosurgery Clinic, Nagasaki-City, Nagasaki, Japan
| | - Yukio Tsugihashi
- Medical Home Care Center, Tenri Hospital Shirakawa Branch, Tenri-City, Nara, Japan
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara-City, Nara, Japan
| | - Shinu Hayashi
- You Home Clinic, Bunkyo-ku, Tokyo, Japan
- You Home Clinic Heiwadai, Nerima-ku, Tokyo, Japan
| | - Hidekazu Iida
- You Home Clinic, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima-City, Fukushima, Japan
- Center for Next Generation of Community Health, Chiba University Hospital, Chiba-City, Chiba, Japan
| | - Misaki Hirose
- Dr. Net Nagasaki, Nagasaki-City, Nagasaki, Japan
- Hirose Clinic, Nagasaki-City, Nagasaki, Japan
| | - Yutaka Shirahige
- Dr. Net Nagasaki, Nagasaki-City, Nagasaki, Japan
- Shirahige Clinic, Nagasaki-City, Nagasaki, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima-City, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima-City, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE), Fukushima Medical University, Fukushima-City, Fukushima, Japan
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Guldin MB, Leget C. The integrated process model of loss and grief - An interprofessional understanding. DEATH STUDIES 2023; 48:738-752. [PMID: 37883693 DOI: 10.1080/07481187.2023.2272960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Despite the vast developments in research on loss and grief, dominant grief models fall short in reflecting the comprehensive issues grieving persons are facing. Three causes seem to be at play: grief is usually understood to be connected to death and other types of loss are under-researched; the majority of research is done from the field of psychology and on pathological forms of grief, hardly integrating research from other disciplines; and the existential suffering related to grief is not recognized or insufficiently integrated in the dominant models. In this paper, we propose an integrated process model (IPM) of loss and grief, distinguishing five dimensions of grief: physical, emotional, cognitive, social, and spiritual. The integrated process model integrates therapies, tools, and models within different scientific theories and paradigms to connect disciplines and professions. The comprehensive and existential understanding of loss and grief has relevance for research, clinical settings and community support.
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Affiliation(s)
- Mai-Britt Guldin
- Research Unit for General Practice, Institute for Public Health, Aarhus University, Denmark. Center for Grief and Existential Values, Aarhus, Denmark
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
- Center for Grief and Existential Values, Aarhus, Denmark
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Velić S, Qama E, Diviani N, Rubinelli S. Patients' perception of hope in palliative care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107879. [PMID: 37413808 DOI: 10.1016/j.pec.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care. METHODS PubMed, Scopus, SocINDEX, Cochrane, and Web of Science were screened against the eligibility criteria. After familiarization with the data and conduction of the coding process, studies were thematically analyzed using Braun and Clarke's methodology. The research question guiding our analysis was: what is said about hope from patients in PC? RESULTS The database searches yielded 24 eligible studies. Three main themes emerged from the studies: Hope beliefs (encompassing patients' understanding of hope and characteristics assigned to it), Hope functions (including the role that hope plays for patients) and Hope work (highlighting aspects that in patients' perspective cultivate hope). CONCLUSION This review emphasizes the importance of acknowledging patients' understanding of hope, its role, and the efforts required to sustain it. In particular, it suggests that hope serves as a valuable strategy, fostering meaningful personal relationships towards end of life. PRACTICE IMPLICATIONS In order to address communication challenges in clinical practice, a potential fruitful strategy for nurturing hope could involve engaging family and friends in hope interventions facilitated by healthcare professionals.
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Affiliation(s)
- Sanda Velić
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Baptista Peixoto Befecadu F, Stirnemann J, Guerreiro I, Fusi-Schmidhauser T, Jaksic C, Larkin PJ, da Rocha Rodrigues G, Pautex S. PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland - a multicentre longitudinal mixed-methods protocol study. BMJ Open 2023; 13:e068340. [PMID: 37173103 PMCID: PMC10186441 DOI: 10.1136/bmjopen-2022-068340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately. METHODS AND ANALYSIS This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation. ETHICS AND DISSEMINATION This study protocol received ethical approval on 24 May 2022 from the Commission cantonale d'éthique de la recherche sur l'être humain-Canton of Vaud. The identification number is 2021-02477.
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Affiliation(s)
- Filipa Baptista Peixoto Befecadu
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
- Chair of Palliative Care Nursing, Palliative and supportive care service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ivan Guerreiro
- Division of Pneumology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic and Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Cyril Jaksic
- Geneva University Hospitals, Geneva, Switzerland
| | - Philip J Larkin
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Chair of Palliative Care Nursing, Palliative and supportive care service, Lausanne University Hospital, Lausanne, Switzerland
| | - Gora da Rocha Rodrigues
- HES-SO University of Applied Sciences and Arts Western Switzerland, HESAV School of Health Sciences, Lausanne, Switzerland
| | - Sophie Pautex
- Dpt of Readaptation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
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Befecadu FBP, Perrenoud B, Behaghel G, Jaques C, Pautex S, Rodrigues MGDR, Larkin PJ. Experience of hope in adult patients with advanced chronic disease and their informal caregivers: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2025-2031. [DOI: 10.11124/jbies-21-00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Qama E, Diviani N, Grignoli N, Rubinelli S. Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:1470-1487. [PMID: 34593262 DOI: 10.1016/j.pec.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.
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Affiliation(s)
- Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, 6850 Mendrisio, Switzerland.
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Bolton LE, Seymour J, Gardiner C. Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A systematic integrative literature review. Palliat Med 2022; 36:567-580. [PMID: 35176924 PMCID: PMC9006392 DOI: 10.1177/02692163221074539] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.
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Affiliation(s)
| | - Jane Seymour
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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“Keeping the Light On”: A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031561. [PMID: 35162582 PMCID: PMC8834832 DOI: 10.3390/ijerph19031561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
Hope performs an important role in how patients and their families cope with suffering and stressful events. To better inform practice and theory on hope, palliative care research should include both patients and their family carers, given their strong interdependence. The aim of this study was to explore how hope is experienced in dyads formed by end-of-life patients and their family carers. In this qualitative study, data were collected by in-depth interviews with seven Portuguese family dyads. Analysis followed a thematic analysis approach. The analysis of the interviews shed light on the importance of hope for all participants, and the challenges involved. Family dyads noted several barriers and facilitators to perceptions of hope. Barriers to hope included limitations imposed by illness, feelings of anguish and helplessness, and poor communication with clinicians. Hope facilitators included supportive others, positive thinking and sense of humour, connection with nature, faith in religion and science, and a sense of compassion with others and altruism. Given the multidimensional scope of hope, the main challenge for family dyads is to look beyond the disease itself. Thus, palliative care teams should be encouraged to support and foster realistic hope, helping families prepare for death, in the context of advanced cancer.
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Iskandar AC, Rochmawati E, Wiechula R. Experiences and perspectives of suffering in cancer: A qualitative systematic review. Eur J Oncol Nurs 2021; 54:102041. [PMID: 34610535 DOI: 10.1016/j.ejon.2021.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Suffering refers to a situation in which a person's illness and condition threaten their integrity. The aim of this systematic review was to synthesize qualitative studies that explored suffering of persons with cancer. METHOD A qualitative systematic review was conducted. Psych Info, PubMed, and CINAHL were searched for relevant studies. Methodological quality was independently assessed using the Critical Appraisal Checklist from Joanna Briggs Institute (JBI). A meta-aggregative approach was utilized to analyze and synthesize the data that focused on how persons with cancer perceive suffering across their illness trajectory. RESULTS Twelve articles reporting the experiences of 230 participants were synthesized. Three synthesized findings were generated from the articles: suffering the loss of normality, suffering in relation to others and existential suffering. Suffering affects the person's normal activities of life and cause the loss of normality. Suffering in relation to others refers patients' suffering also impacts on and is impacted by those around them. The last synthesized finding refers to impact of suffering on patients' whole sense of being. In addition, feelings of hopelessness, and other mental anguish are inevitable responses that lead the patients to think about death. The overall methodological quality resulted in a ConQual rating of moderate for the synthesized findings. CONCLUSION The persons' suffering not only affects themselves but also others, particularly close relatives. The suffering experienced is complex and goes well beyond the immediate impact of physical symptoms and treatment.
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Affiliation(s)
| | - Erna Rochmawati
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia.
| | - Rick Wiechula
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia; Adelaide Nursing School, University of Adelaide, Australia; Centre for Evidence-based Practice South Australia: A Joanna Briggs Institute Centre of Excellence, Australia
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Guedes A, Carvalho MS, Laranjeira C, Querido A, Charepe Z. Hope in palliative care nursing: concept analysis. Int J Palliat Nurs 2021; 27:176-187. [PMID: 34169743 DOI: 10.12968/ijpn.2021.27.4.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hope has long been considered essential to humans in several disciplines, nursing included. At the end-of-life, hope is a complex and dynamic emotion, and there have been different interpretations and conceptions of hope. AIM To develop hope in palliative care as an evidenced-based nursing concept: analyse its attributes, antecedents and consequences. METHOD This study follows Walker and Avant's concept analysis: (a) select a concept; (b) determine the aims or purposes of analysis; (c) identify as many uses of the concept as possible; (d) determine the defining attributes; (e) identify a model case; (f) identify borderline and contrary cases; (g) identify antecedents and consequences; and finally (h) define the empirical referents. FINDINGS Antecedents included symptom control, existential suffering, interpersonal relationships and the establishment of realistic goals. The synthetic attributes were a positive outcome expectancy and a process oriented towards the present and future. The concept's consequences were quality of life, survival, acceptance and a peaceful death. CONCLUSION This study revealed a strong history of publications on the subject. The analysis of attributes, antecedents and consequences of the concept of hope contributed to understanding its relevance to palliative care nursing and provided suggestions for effective interventions and future research.
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Affiliation(s)
- Ana Guedes
- PhD student in Nursing, Catholic University of Portugal, Institute of Health Sciences, Lisbon, Portugal
| | - Matilde Silva Carvalho
- PhD student in Nursing, Catholic University of Portugal, Institute of Health Sciences, Lisbon, Portugal
| | - Carlos Laranjeira
- Associate Professor, Center for Innovative Care and Health Technology (ciTechCare); School of Health Sciences of Polytechnic of Leiria
| | - Ana Querido
- Associate Professor, Center for Innovative Care and Health Technology (ciTechCare); School of Health Sciences of Polytechnic of Leiria
| | - Zaida Charepe
- Associate Professor, Catholic University of Portugal, Institute of Health Sciences, Center for Interdisciplinary Research in Health (CIIS), Lisbon, Portugal
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Beng TS, Xin CA, Ying YK, Khuen LP, Yee A, Zainuddin SI, Chin LE, Loong LC. Hope in Palliative Care: A Thematic Analysis. J Palliat Care 2020; 37:177-182. [PMID: 32791956 DOI: 10.1177/0825859720948976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hope is a positive coping mechanism that is important at all stages of illness, more so for palliative care patients. PURPOSE To explore the experiences of hope of palliative care patients. METHODS A qualitative study was conducted at University of Malaya, Kuala Lumpur, Malaysia. Adult palliative care in-patients were recruited and interviewed with semi structured questions on hope. Transcripts from the interviews were thematically analyzed with qualitative data management software NVIVO. FINDINGS 20 palliative care patients participated in the study. The themes generated from thematic analysis were (1) The notions of hope, (2) The sources and barriers of hope and (3) The contents of hope. CONCLUSION Hope is an ever-present source of energy that gives people strength to carry on even in the most adverse situations. Understanding hope from the palliative care perspective may allow healthcare providers to develop strategies to better foster hope in the terminally ill.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cheah Ai Xin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Yeoh Kee Ying
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Lim Poh Khuen
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
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Robertson E, Bambala A, Kalungia AC, Marshall S, Mbozi P, Munkombwe D. Prescribers' experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia. Hosp Pract (1995) 2020; 48:86-91. [PMID: 32078406 DOI: 10.1080/21548331.2020.1733318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore medical doctors' experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia. METHODS A qualitative, exploratory case study was undertaken. Semi-structured interviews were used to collect data from 14 medical doctors working in the fields of oncology, pediatrics, and internal medicine at a tertiary hospital in Lusaka, Zambia, regarding their experiences and attitudes to prescribing morphine for palliative care. Thematic analysis of interview transcripts was carried out to establish common themes in the data. The study was approved by BSMS and UNZA research ethics committees. RESULTS All participants agreed that doctors were becoming more comfortable with the prescribing of morphine, although experiences were notably different for doctors working in oncology, compared to other departments. Themes of difficulty discussing end-of-life, poor recognition of pain, and fear of patient addiction, were more prominent in the responses of non-cancer doctors. Morphine use was generally restricted to cancer and sickle cell disease patients, with most non-cancer doctors stating that they rarely prescribe morphine for outpatient use. Training in pain management and the presence of a palliative care team were perceived to be facilitators to morphine prescribing. CONCLUSIONS Although there is an increased willingness to prescribe morphine, limited knowledge of pain management, especially for nonmalignant disease, underlies many of the findings in this study. Opportunity exists for professional development in pain management to further improve the acceptance and use of opioids in palliative care, especially for out-patients.
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Affiliation(s)
- Emma Robertson
- School of Veterinary Medicine, University of Surrey , Guildford, UK
| | - Andrew Bambala
- Pharmacy Department, University Teaching Hospitals , Lusaka, Zambia
| | - Aubrey C Kalungia
- Department of Pharmacy, University of Zambia (UNZA) , Lusaka, Zambia
| | - Sarah Marshall
- Brighton and Sussex Medical School (BSMS), University of Sussex , Brighton, UK
| | - Patience Mbozi
- Palliative Care Department, Cancer Diseases Hospital , Lusaka, Zambia
| | - Derick Munkombwe
- Department of Pharmacy, University of Zambia (UNZA) , Lusaka, Zambia
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18
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Olsman E. Witnesses of hope in times of despair: chaplains in palliative care. A qualitative study. J Health Care Chaplain 2020; 28:29-40. [PMID: 32090710 DOI: 10.1080/08854726.2020.1727602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hope is an important topic in spiritual care in palliative care but the experiences of chaplains with hope have hardly been explored. The objective of this study was to explore Dutch chaplains' experiences with hope in palliative care. Semi-structured interviews were conducted, which were thematically analyzed. The 10 chaplains had a variety of ordinations: Muslim, Protestant, Roman Catholic, Humanistic, or otherwise. Participants spoke about changes in patients' hope, often implying despair and surrender, in which patients' self-reflection was pivotal. Participants felt witnesses of hope, not by offering hope, but by acknowledging patients' hope and despair while being with their patients. They criticized other professionals who, not bearing witness to these experiences, tried to offer hope to patients. We conclude that chaplains may become witnesses of hope in times of despair, which includes the (ideological) critical function of spiritual care.
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Affiliation(s)
- Erik Olsman
- Section of Medical Ethics & Health Law, Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Spiritual Care, Hospice Bardo, Hoofddorp, The Netherlands
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Buiting HM, van Ark MAC, Dethmers O, Maats EPE, Stoker JA, Sonke GS. Complex challenges for patients with protracted incurable cancer: an ethnographic study in a comprehensive cancer centre in the Netherlands. BMJ Open 2019; 9:e024450. [PMID: 30928932 PMCID: PMC6475444 DOI: 10.1136/bmjopen-2018-024450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Advances in oncology increasingly result in protracted disease trajectories for patients with incurable cancer. In this disease phase, patients are aware of the incurable nature of cancer although they are not yet approaching the last phase of life. We explored the challenges for patients confronted with protracted incurable cancer. DESIGN Ethnographic study (2015-2017) based on conversations with patients, observations at a day-care unit and a selection of information from the medical records of patients who died during the study period. SETTING The day-care unit of a comprehensive cancer centre in the Netherlands. PARTICIPANTS Nineteen patients with stage IV breast cancer (in remission, >1 year after diagnosis) and 11 patients with stage IV lung-cancer (in remission, >6 months after diagnosis). RESULTS In patients who had died during the study period, the treatment response often fluctuated between stable, remission and progression throughout the course of the disease. Patients reported that this fluctuation could be overwhelming. However, as patients grew accustomed to having protracted incurable cancer, the distress associated with fluctuations (perceived in scan results) slowly faded. Patients reported that cancer became part of who they were. At the day-care unit, most patients talked about their disease in an optimistic or neutral way and expressed delight in life. They often expressed gratefulness for the possible prolongation of life, expressed hope and tried to stay optimistic. This was frequently reinforced by optimistic doctors and nurses. Relatives, however, could downplay such optimism. Moreover, some patients acknowledged that hope was qualified by their personal challenges regarding their disease. CONCLUSIONS In situations where tumours remained in remission or were stable for extended periods, patients grew accustomed to having cancer. At the day-care unit, medical professionals typically encouraged an attitude of being hopeful and optimistic, which could be downplayed by relatives. More research is warranted to explore this protracted disease phase and this optimistic view among healthcare professionals.
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Affiliation(s)
- Hilde M Buiting
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen A C van Ark
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Clinical Psychology, Department of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Otto Dethmers
- Oncology day-care unit, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emma P E Maats
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jogien A Stoker
- Medical Psychology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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20
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Wichmann AB, van Dam H, Thoonsen B, Boer TA, Engels Y, Groenewoud AS. Advance care planning conversations with palliative patients: looking through the GP's eyes. BMC FAMILY PRACTICE 2018; 19:184. [PMID: 30486774 PMCID: PMC6263059 DOI: 10.1186/s12875-018-0868-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022]
Abstract
Background Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences. Methods Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis. Results Four themes were identified: ACP and society, the GP’s perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a ‘hot topic’. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy. Conclusions ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP’s focus on the patient’s direction and the right not to know can be difficult, ACP has to be tailored to each individual patient. Electronic supplementary material The online version of this article (10.1186/s12875-018-0868-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne B Wichmann
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands.
| | - Hanna van Dam
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
| | - Bregje Thoonsen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Theo A Boer
- Section Ethics, University Kampen, Kampen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - A Stef Groenewoud
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
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Soleimani MA, Bahrami N, Zarabadi-Pour S, Motalebi SA, Parker A, Chan YH. Predictors of death anxiety among patients with heart disease. DEATH STUDIES 2018; 44:160-167. [PMID: 30407129 DOI: 10.1080/07481187.2018.1527416] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/13/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
Objective: This research examines whether or not socio-demographic factors and hope predict death anxiety among patients with heart disease.Materials and Methods: Our sample consisted of 500 respondents who were hospitalized in a medical institution in Iran. Data were collected using the Templer Death Anxiety Scale (TDAS) and the Herth Hope Index (HHI).Results: The results of current study indicated that higher economic status, having one's main source of income from friends, increased age, increased religious belief, and increased hope were associated with lower death anxiety.Conclusion: These results highlight that improving hope, and religiosity among cardiac patients may be an effective means by which to reduce their death anxiety.
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Affiliation(s)
- Mohammad Ali Soleimani
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nasim Bahrami
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Simin Zarabadi-Pour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyedeh Ameneh Motalebi
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Averil Parker
- Psychology Department, Concordia University, Montreal, Quebec, Canada
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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22
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Rosa F, Bagnasco A, Ghirotto L, Rocco G, Catania G, Aleo G, Zanini M, Dasso N, Hayter M, Sasso L. Experiences of older people following an acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study. J Clin Nurs 2018; 27:e1110-e1119. [DOI: 10.1111/jocn.14189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Francesca Rosa
- Department of Health Sciences; University of Genoa; Genoa Italy
| | | | - Luca Ghirotto
- Local Health Authority - IRCCS, Reggio Emilia; Reggio Emilia Italy
| | - Gennaro Rocco
- Italian Nurses' National Social Security Council (ENPAPI); Roma Italy
| | | | - Giuseppe Aleo
- Department of Health Sciences; University of Genoa; Genoa Italy
| | - Milko Zanini
- Department of Health Sciences; University of Genoa; Genoa Italy
| | - Nicoletta Dasso
- Department of Health Sciences; University of Genoa; Genoa Italy
| | - Mark Hayter
- School of Health and Social Work; University of Hull; Hull UK
| | - Loredana Sasso
- Department of Health Sciences; University of Genoa; Genoa Italy
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Bjørnnes AK, Parry M, Lie I, Falk R, Leegaard M, Rustøen T. The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. BMC WOMENS HEALTH 2018; 18:2. [PMID: 29291728 PMCID: PMC5749023 DOI: 10.1186/s12905-017-0501-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
Background Cardiac surgery is a major life event, and outcomes after surgery are associated with men’s and women’s ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. Methods We did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure. Results For the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3 ± 5.1 at 3 months to 38.7 ± 5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3) I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period. Conclusion Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. Trial registration Clinical Trials gov Identifier: NCT01976403. Date of registration: November 28, 2011.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Irene Lie
- Center for patient centered heart- and lung research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Marit Leegaard
- Faculty of Health Sciences, Institute of Nursing, Oslo and Akershus University College of Applied Sciences, P.O Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway.,Institute of Health and Society, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
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24
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Olsman E, Veneberg B, van Alfen C, Touwen D. The value of metaphorical reasoning in bioethics: An empirical-ethical study. Nurs Ethics 2017; 26:50-60. [PMID: 28438074 PMCID: PMC7324142 DOI: 10.1177/0969733017703695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Metaphors are often used within the context of ethics and healthcare but have hardly been explored in relation to moral reasoning. Objective: To describe a central set of metaphors in one case and to explore their contribution to moral reasoning. Method: Semi-structured interviews were conducted with 16 parents of a child suffering from the neurodegenerative disease CLN3. The interviews were recorded, transcribed, and metaphors were analyzed. The researchers wrote memos and discussed about their analyses until they reached consensus. Ethical considerations: Participants gave oral and written consent and their confidentiality and anonymity were respected. Findings: A central set of metaphors referred to the semantic field of the hands and arms and consisted of two central metaphors that existed in a dialectical relationship: grasping versus letting go. Participants used these metaphors to describe their child’s experiences, who had to “let go” of abilities, while “clinging” to structures and the relationship with their parent(s). They also used it to describe their own experiences: participants tried to “grab” the good moments with their child and had to “let go” of their child when (s)he approached death. Participants, in addition, “held” onto caring for their child while being confronted with the necessity to “let go” of this care, leaving it to professional caregivers. Discussion: The ethical analysis of the findings shows that thinking in terms of the dialectical relationship between “grasping” and “letting go” helps professional caregivers to critically think about images of good care for children with CLN3. It also helps them to bear witness to the vulnerable, dependent, and embodied nature of the moral self of children with CLN3 and their parents. Conclusion: Metaphorical reasoning may support the inclusion of marginalized perspectives in moral reasoning. Future studies should further explore the contribution of metaphorical reasoning to moral reasoning in other cases.
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Affiliation(s)
- Erik Olsman
- Leiden University Medical Center, The Netherlands; Academic Medical Center, The Netherlands; Hospice Bardo, The Netherlands
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Fradelos EC, Tzavella F, Koukia E, Tsaras K, Papathanasiou IV, Aroni A, Alikari V, Ralli M, Bredle J, Zyga S. THE TRANSLATION, VALIDATION AND CULTURAL ADAPTATION OF FUNCTIONAL ASSESSMENT OF CHRONIC ILLNESS THERAPY - SPIRITUAL WELL-BEING 12 (FACIT-SP12) SCALE IN GREEK LANGUAGE. Mater Sociomed 2016; 28:229-34. [PMID: 27482168 PMCID: PMC4949019 DOI: 10.5455/msm.2016.28.229-234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/15/2016] [Indexed: 11/03/2022] Open
Abstract
Background: According to World Health Organization (WHO), spirituality is an important domain of quality of life especially in terminal, life threatens chronic diseases. For many people spirituality and religion are not just very important dimensions of their existence, but also a source of support that contributes to wellbeing and coping with everyday difficulties of life. Aim: Aim of the study was the translation of the Facit Spiritual Well Being Scale (Facit-Sp12) in Greek language and the validation of the scale for the Greek population. Material and Methods: The Facit-Sp12 questionnaire is an anonymous self-administered questionnaire that contains twelve, four point Likert scale, closed questions (0=Not at all, 1=A little bit, 2=Some-what, 3=Quite a bit, 4=Very Much). The questionnaire was translated into Greek language and then back translated in the English in order to be checked for any inconsistencies. The sample of the study was 183 chronic kidney disease patients, undergoing hemodialysis. Exploratory factor analysis, with principal components analysis with Varimax rotation was performed for checking the construct validity of the questionnaire. The test–retest reliability and the internal consistency were also examined. Statistical analysis performed by the use of SPSS 21.0. Statistical significance level was set at p=0.05 Results: The final Greek version of the questionnaire includes all of the twelve questions. The mean age of the participants was 61.81±13.9. Three factors were exported from the statistical analysis. The Cronbach-α coefficient was 0.77 for the total questionnaire and for each subscale was 0.70 for “meaning”, 0.73 for “peace” and 0.87 for “faith”. Between the three subscales “meaning” had the highest score (mean 12.49, SD=2.865). Conclusions: The Facit Spiritual Wellbeing Scale–Facit-Sp12, is a valuable and reliable questionnaire of three dimensions that can be used for assessing spirituality and spiritual wellbeing in Greek population.
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Affiliation(s)
- Evangelos C Fradelos
- Department of Nursing, Faculty of Human Movement and Quality of Life, University of Peloponnese, Sparta, Greece
| | - Foteini Tzavella
- Department of Nursing, Faculty of Human Movement and Quality of Life, University of Peloponnese, Sparta, Greece
| | | | - Konstantinos Tsaras
- Department of Nursing, Technological Educational Institute of Thessaly, Larissa, Greece
| | | | - Adamantia Aroni
- Department of Nursing, Faculty of Human Movement and Quality of Life, University of Peloponnese, Sparta, Greece
| | - Victoria Alikari
- Department of Nursing, Faculty of Human Movement and Quality of Life, University of Peloponnese, Sparta, Greece
| | - Maria Ralli
- Hemodialisys Unit, General Hospital of Kalamata, Kalamata, Greece
| | | | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life, University of Peloponnese, Sparta, Greece
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