An examination of the research priorities for a hospice service in New Zealand: A Delphi study

Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study

BACKGROUND

Acute hospital settings are generally not considered adequate places for end-of-life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future.

AIM

The aim of this study was to investigate family caregivers' experiences of end-of-life care in an acute community hospital in Iceland.

METHODS

Fifteen in-depth qualitative semi-structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis.

FINDINGS

Findings indicated that the acute hospital setting is not a suitable environment for end-of-life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end-of-life care; (3) The dying process. Each of the themes encompassed a variety of subthemes.

CONCLUSIONS

Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well-being. Acknowledging and appreciating the meaning of respect and dignity at the end-of-life from family caregivers' perspective is vital.

International palliative care research priorities: A systematic review

BACKGROUND

There has been increasing evidence and debate on palliative care research priorities and the international research agenda. To date, however, there is a lack of synthesis of this evidence, examining commonalities, differences, and gaps. To identify and synthesize literature on international palliative care research priorities originating from Western countries mapped to a quality assessment framework.

METHODS

A systematic review of several academic and grey databases were searched from January 2008-June 2019 for studies eliciting research priorities in palliative care in English. Two researchers independently reviewed, critically appraised, and conducted data extraction and synthesis.

RESULTS

The search yielded 10,235 articles (academic databases, n = 4108; grey literature, n = 6127), of which ten were included for appraisal and review. Priority areas were identified: service models; continuity of care; training and education; inequality; communication; living well and independently; and recognising family/carer needs and the importance of families. Methodological approaches and process of reporting varied. There was little representation of patient and caregiver driven agendas. The priorities were mapped to the Donabedian framework for assessing quality reflecting structure, process and outcomes and key priority areas.

CONCLUSIONS

Limited evidence exists pertaining to research priorities across palliative care. Whilst a broad range of topics were elicited, approaches and samples varied questioning the credibility of findings. The voice of the care provider dominated, calling for more inclusive means to capture the patient and family voice. The findings of this study may serve as a template to understand the commonalities of research, identify gaps, and extend the palliative care research agenda.

Research prioritisation exercises related to the care of children and young people with life-limiting conditions, their parents and all those who care for them: A systematic scoping review

BACKGROUND

In planning high-quality research in any aspect of care for children and young people with life-limiting conditions, it is important to prioritise resources in the most appropriate areas.

AIM

To map research priorities identified from existing research prioritisation exercises relevant to infants, children and young people with life-limiting conditions, in order to inform future research.

DESIGN

We undertook a systematic scoping review to identify existing research prioritisation exercises; the protocol is publicly available on the project website.

DATA SOURCES

The bibliographic databases ASSIA, CINAHL, MEDLINE/MEDLINE In Process and Embase were searched from 2000. Relevant reference lists and websites were hand searched. Included were any consultations aimed at identifying research for the benefit of neonates, infants, children and/or young people (birth to age 25 years) with life-limiting, life-threatening or life-shortening conditions; their family, parents, carers; and/or the professional staff caring for them.

RESULTS

A total of 24 research prioritisation exercises met the inclusion criteria, from which 279 research questions or priority areas for health research were identified. The priorities were iteratively mapped onto an evolving framework, informed by World Health Organization classifications. This resulted in identification of 16 topic areas, 55 sub-topics and 12 sub-sub-topics.

CONCLUSION

There are numerous similar and overlapping research prioritisation exercises related to children and young people with life-limiting conditions. By mapping existing research priorities in the context in which they were set, we highlight areas to focus research efforts on. Further priority setting is not required at this time unless devoted to ascertaining families' perspectives.

Developing a research agenda for nursing and midwifery: a modified Delphi study

AIM

We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia.

DESIGN

A modified Delphi technique with two rounds of questionnaires.

METHODS

The first round survey was distributed to 448 nurses and midwives with a 19.2% (n=86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale.

RESULTS

Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues.

CONCLUSION

Priorities were congruent with the organisation's strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives.