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Hughes MC, Vernon E, Egwuonwu C, Afolabi O. Measuring decision aid effectiveness for end-of-life care: A systematic review. PEC INNOVATION 2024; 4:100273. [PMID: 38525314 PMCID: PMC10957449 DOI: 10.1016/j.pecinn.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Objective To systematically review research analyzing the effectiveness of decision aids for end-of-life care, including how researchers specifically measure decision aid success. Methods We conducted a systematic review synthesizing quantitative, qualitative, and mixed-methods study results using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched through February 18, 2023. Inclusion criteria required articles to evaluate end-of-life care decision aids. The review is registered under PROSPERO (#CRD42023408449). Results A total of 715 articles were initially identified, with 43 meeting the inclusion criteria. Outcome measures identified included decisional conflict, less aggressive care desired, knowledge improvements, communication improvements, tool satisfaction, patient anxiety and well-being, and less aggressive care action completed. The majority of studies reported positive outcomes especially when the decision aid development included International Patient Decision Aid Standards. Conclusion Research examining end of life care decision aid use consistently reports positive outcomes. Innovation This review presents data that can guide the next generation of decision aids for end-of-life care, namely using the International Patient Decision Aid Standards in developing tools and showing which tools are effective for helping to prevent the unnecessary suffering that can result when patients' dying preferences are unknown.
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Affiliation(s)
- M. Courtney Hughes
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Pigott 522, Seattle, WA 98122, USA
| | - Chinenye Egwuonwu
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Oluwatoyosi Afolabi
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
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Driller B, Talseth-Palmer B, Hole T, Strømskag KE, Brenne AT. Cancer patients have a reduced likelihood of dying in hospital with advance care planning in primary health care and a summarizing palliative plan: a prospective controlled non-randomized intervention trial. Scand J Prim Health Care 2024; 42:471-482. [PMID: 38662520 PMCID: PMC11332305 DOI: 10.1080/02813432.2024.2346131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/17/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) allows patients to define their goals and preferences. Spending more time at home and less time in the hospital, along with avoiding death in the hospital, are often considered desirable outcomes of palliative care (PC). In 2015, 36% of cancer patients died in the hospital and 13% died at home in Norway. METHOD From 2015 to 2022, this prospective controlled non-randomized intervention trial observed 144 cancer patients with or without an organized ACP conversation in primary health care and a summarizing palliative plan (ClinicalTrials.gov Identifier: NCT02170168, 23 June 2014). The patients were identified through contact with the local cancer outpatient clinic or hospital-based PC team. RESULTS A total of 128 patients died during the observation period. Of these, 67 patients had an organized ACP conversation and summarizing palliative plan (intervention (I) group) and 61 had not (control (C) group). Dying in the hospital was significantly less common for patients in the I group compared to the C group (17.9% vs. 34.4%; X2 (1, n = 128) = 4.55, p = 0.033). There were no differences between the groups in terms of where they spent their time in the last 90 days of life (home, nursing home, or hospital). Most patients (62%) preferred to die at home. The observed differences between the groups regarding preferred and actual places of death did not reach statistical significance. CONCLUSION With organized ACP conversations in primary health care and a summarizing palliative plan, cancer patients died less often in the hospital in our observational study. A structured ACP approach integrating palliative care for cancer patients into primary health care can support patients´ preferences at the end of life.
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Affiliation(s)
- Bardo Driller
- Department of Oncology, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim Norway
| | - Bente Talseth-Palmer
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund Norway
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- NSW Health Pathology, New South Wales, Australia
| | - Torstein Hole
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Erik Strømskag
- Department of Surgery and Emergency Medicine Molde Hospital, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Xu Y, Han PP, Su XQ, Xue P, Guo YJ. Exploration of decision aids to support advance care planning: A scoping review. J Clin Nurs 2024; 33:3477-3497. [PMID: 38661107 DOI: 10.1111/jocn.17187] [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: 12/20/2023] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Advance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision-making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options. OBJECTIVE While decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research. DESIGN Scoping review. METHODS This scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA-ScR list. Six English-language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries. RESULTS Of the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision-making process satisfaction, but their feasibility has yet to be tested. CONCLUSIONS Decision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision-making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application. REPORTING METHOD The paper has adhered to the EQUATOR guidelines and referenced the PRISMAg-ScR checklist. NO PATIENT OR PUBLIC CONTRIBUTION This is a review without patient and public contribution. REGISTRATION https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF.
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Affiliation(s)
- Ying Xu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Ping-Ping Han
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Xiao-Qin Su
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Ping Xue
- Office of Joint Medicine, Taizhou Second People's Hospital, Taizhou, Jiangsu, China
| | - Yu-Jie Guo
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
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Bratches RWR, Wall JA, Puga F, Pilonieta G, Jablonski R, Bakitas M, Geldmacher DS, Odom JN. Patient Portal Use Among Family Caregivers of Individuals With Dementia and Cancer: Regression Analysis From the National Study of Caregiving. JMIR Aging 2023; 6:e44166. [PMID: 38235767 PMCID: PMC10811454 DOI: 10.2196/44166] [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: 11/08/2022] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 01/19/2024] Open
Abstract
Background Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. Despite reported deficiencies, 68% of health systems facilitate sharing information with family caregivers through the patient portal. The patient portal is especially critical in the context of serious illnesses, like advanced cancer and dementia, where caregiving is intense and informational needs change over the trajectory of disease progression. Objective The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine individual characteristics and demographic factors associated with patient portal use among family caregivers of persons living with dementia and those living with cancer. Methods We conducted a secondary data analysis using data from the 2020 NSOC sample of family caregivers linked to National Health and Aging Trends Study. Weighted regression analysis by condition (ie, dementia or cancer) was used to examine associations between family caregiver use of the patient portal and demographic variables, including age, race or ethnicity, gender, employment status, caregiver health, education, and religiosity. Results A total of 462 participants (representing 4,589,844 weighted responses) were included in our analysis. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with higher odds of patient portal use (OR: 2.81, 95% CI 1.05-7.57; P=.04), whereas qualification lower than a college degree was associated with lower odds of patient portal use by family caregiver (OR 0.36, 95% CI 0.18-0.71; P<.001. In the fully adjusted regression model for caregivers of persons living with cancer, no variables were found to be statistically significantly associated with patient portal use at the .05 level. Conclusions In our analysis of NSOC survey data, we found differences between how dementia and cancer caregivers access the patient portal. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why.
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Affiliation(s)
- Reed W R Bratches
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Jaclyn A Wall
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Giovanna Pilonieta
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - Rita Jablonski
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - David S Geldmacher
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
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Fromme EK, Nisotel L, Mendoza K, Thacker A, Lowery K, Sihlongonyane B, DeBartolo KO, Roessner J, Margo JN. Testing the What Matters to Me workbook in a diverse sample of seriously ill patients and caregivers. PEC INNOVATION 2023; 3:100216. [PMID: 37771460 PMCID: PMC10523264 DOI: 10.1016/j.pecinn.2023.100216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
Objectives We evaluated the What Matters to Me Workbook, a patient-facing version of the Serious Illness Conversation Guide co-created by Ariadne Labs and The Conversation Project. Methods We purposively recruited diverse seriously ill patients and caregivers in the US. Participants completed the Workbook, a survey, and a semi-structured in-depth interview about their experience. Qualitative analysis of interviews and notes was employed to extract themes. Simple descriptive statistics were employed to analyze eight investigator authored questions. Results Twenty-nine study participants completed twenty-one interviews and twenty-five surveys. Ratings for safety (3.87/4, SD = 0.43) and acceptability (3.59/4, SD = 0.956) were higher than ratings for ease of use (3.30/4, SD = 0.97) and usefulness (3.24/4, SD = 0.80). Qualitative analysis identified that while the workbook was safe, acceptable, easy to use, and useful, it is more important who is recommending it and how they are explaining it. Conclusion If presented in the right way by a trustworthy person, the What Matters to Me Workbook can be an easy to use, useful, and safe resource for patients with serious illness and their caregivers. Innovation The Workbook focuses on serious illness rather than end-of-life and meshes with a clinician-facing conversation guide and a health-system level intervention.
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Affiliation(s)
- Erik K. Fromme
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Kurt Lowery
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
| | | | | | - Jane Roessner
- The Conversation Project, Institute for Healthcare Improvement, Boston, MA, USA
| | - Judy N. Margo
- Science & Technology Platform, Ariadne Labs, Boston, MA, USA
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Edwards M, Holland‐Hart D, Mann M, Seddon K, Buckle P, Longo M, Byrne A, Nelson A. Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review. Health Expect 2023; 26:2109-2126. [PMID: 37448166 PMCID: PMC10632651 DOI: 10.1111/hex.13822] [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: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision-aids and shared decision-making (SDM) approaches that influence patient outcomes. METHODS We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory. RESULTS From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret. CONCLUSIONS Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer. PATIENT AND PUBLIC CONTRIBUTION We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research.
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Affiliation(s)
- Michelle Edwards
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Daniella Holland‐Hart
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Mala Mann
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Kathy Seddon
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Peter Buckle
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Annmarie Nelson
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
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7
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Kelly R, Gordon P, Thompson R, Semple C. Availability and use of web-based interventions for patients with head and neck cancer: a scoping review. J Cancer Surviv 2023; 17:1309-1326. [PMID: 35088247 PMCID: PMC8794623 DOI: 10.1007/s11764-022-01168-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify and review the nature, scope and use of web-based interventions for patients with head and neck cancer (HNC). METHOD A scoping review guided by the methodological framework described by the Joanna Briggs Institute was performed to review empirical studies and websites. Seven electronic databases (CINAHL, Medline, Scopus, Embase, Cochrane, PubMed and PsycInfo) were searched from 2010 to 2020, data extracted and synthesised using thematic analysis. The Google search engine was employed, identifying the first 100 websites, using the search term head and neck cancer. Websites meeting eligibility criteria were assessed using the QUEST analysis tool, and descriptively summarised. RESULTS Thirteen empirical studies and 32 websites were included. As identified by empirical studies, web-based interventions were developed to provide (1) patient information on HNC and related treatments, (2) advice and support during treatment and (3) management strategies promoting adjustment to life with and beyond HNC. The reviewed websites provided minimal information to aid shared decision-making and facilitate preparedness for treatment, with few utilising patient narratives. Web-based interventions for HNC patients were mainly text based and focused on survivorship. CONCLUSIONS There is a paucity of theory-based, co-designed web-based interventions using patient narratives. IMPLICATIONS FOR CANCER SURVIVORS As patients increasingly look to the internet for advice and support, healthcare professionals are in a position to provide high-quality web-based interventions. There is an opportunity to rigorously develop a web-based intervention, containing narratives of peoples' lives before and after HNC treatment, aiding decision-making, preparedness for treatment and self-management.
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Affiliation(s)
- Rosemary Kelly
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB Ireland
| | - Peter Gordon
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
| | - Ruth Thompson
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
| | - Cherith Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB Ireland
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
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Brean SJ, Recoche K, William L, Lakhani A, Zhong Y, Shimoinaba K. Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2023-004162. [PMID: 37380215 DOI: 10.1136/spcare-2023-004162] [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: 01/05/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes. METHODS A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted. RESULTS Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. SETTINGS hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust. CONCLUSION The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.
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Affiliation(s)
- Samantha Jane Brean
- Advance Care Planning, Eastern Health, Wantirna, Victoria, Australia
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Katrina Recoche
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Ali Lakhani
- La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
| | - Yaping Zhong
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Kaori Shimoinaba
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
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Greenway K, Frisone C, Placidi A, Kumar S, Guest W, Winter SC, Shah K, Henshall C. Using immersive technology and architectural design to assist head and neck cancer patients' recovery from treatment: A focus group and technology acceptance study. Eur J Oncol Nurs 2023; 62:102261. [PMID: 36716531 DOI: 10.1016/j.ejon.2022.102261] [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: 08/30/2022] [Revised: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Head and neck cancer patients can face debilitating treatment related side-effects, resulting in requirement for support and negatively impacting on care outcomes. This study aimed to develop a digital recovery support package and assess its acceptability with head and neck cancer patients to support their information needs and assist with their self-management. It provided additional support through development of a WebXR platform 'recovery' package, which allowed patients to live a 'virtual reality' experience, entering and moving inside a 'virtual room', accessing targeted resources and specific learning materials related to their cancer. METHOD A qualitative intervention development study consisting of three phases. This study followed the COREQ checklist for qualitative research. Phase 1- Focus groups with seven head and neck cancer patients and six healthcare professionals. Phase 2- Development of 'recovery' package based on the focus group data which informed the content and design of the WebXR recovery platform. Phase 3- Technology acceptance study. Once developed, the platform's acceptability of the experience lived inside the virtual room was assessed via qualitative interviews with six different patient participants. RESULTS Most participants felt comfortable using the virtual reality platform, finding it a realistic and useful support for identifying resources and signposting to relevant materials. Participants agreed the WebXR platform was a feasible tool for the head and neck cancer setting and helped reduce anxiety. CONCLUSIONS Head and neck cancer patients welcome specific targeted, information and advice to support their ability to self-manage their rehabilitation and thus focus their nursing care. The platform was implemented during the Covid-19 pandemic, demonstrating its versatility and accessibility in providing complementary support to head and neck cancer patients, to empower them to adjust to their 'new' normal as part of their ongoing cancer journeys.
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Affiliation(s)
- Kathleen Greenway
- Oxford Institute of Nursing Midwifery and Allied Health, Faculty of Health and Life Sciences, Oxford School of Nursing and Midwifery, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 OFL, UK.
| | - Caterina Frisone
- Faculty of Technology, Design and Environment, School of Architecture, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Andrea Placidi
- Faculty of Technology, Design and Environment, School of Architecture, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Sanjay Kumar
- Faculty of Health and Life Sciences, Department of Psychology, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Will Guest
- Faculty of Technology, Design and Environment, School of Computing and Communication Technologies, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Stuart C Winter
- University of Oxford, Consultant Head and Neck Surgeon, Oxford Cancer Centre, Churchill Hospital, Oxford, OX3 7LE, UK.
| | - Ketan Shah
- Oxford Cancer Centre, Churchill Hospital, Oxford, OX3 7LE, UK.
| | - Catherine Henshall
- Oxford Institute of Nursing Midwifery and Allied Health, Faculty of Health and Life Sciences, Oxford School of Nursing and Midwifery, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 OFL, UK.
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Silies KT, Köpke S, Schnakenberg R. Informal caregivers and advance care planning: systematic review with qualitative meta-synthesis. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003095. [PMID: 33952583 DOI: 10.1136/bmjspcare-2021-003095] [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] [Received: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a communication process about a person's values, life goals and preferences for current and future treatment and care. It can improve end-of-life care experiences for care recipients as well as for family caregivers. Knowledge about caregivers' needs might support implementation of ACP interventions suitable to both care recipients and their caregivers. OBJECTIVE To explore the experiences and attitudes of informal family caregivers, and their knowledge, regarding ACP. METHODS A systematic literature search was conducted (participants: family caregivers; intervention: advance care planning; databases: MEDLINE, PsycINFO, CINAHL, Cochrane Library). Thematic synthesis was applied to qualitative and mixed methods studies; quantitative studies were described in relation to the themes of the meta-synthesis. RESULTS 57 studies were included, of these 51 in the meta-synthesis. Three themes emerged: (1) caregiver's individual conceptualisation of ACP, (2) caregiver's relationships and (3) ACP process. These themes were incorporated into a longitudinal perspective on the caregiver's ACP trajectory, encompassing the phases (A) life before, (B) ACP process, (C) utilisation of ACP and (D) life after. The implications for ACP activities are described according to each phase. CONCLUSION For the benefit of care recipients, healthcare professionals should carefully consider caregivers' conceptualisations of ACP as well as the relationships within the family. They need to be skilled communicators, sensitive to individual needs and equipped with sufficient time resources to tailor ACP interventions to their clients' unique situation. Thus, they will support decision-making according to care recipients' wishes, caregivers' end-of-life experience and their life after bereavement. PROSPERO REGISTRATION NUMBER CRD42018082492.
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Affiliation(s)
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rieke Schnakenberg
- Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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11
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When do Physicians and Nurses Start Communication about Advance Care Planning? A Qualitative Study at an Acute Care Hospital in Japan. Asian Bioeth Rev 2021; 12:289-305. [PMID: 33717339 PMCID: PMC7747333 DOI: 10.1007/s41649-020-00135-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 10/28/2022] Open
Abstract
Although advance care planning (ACP) can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis to identify major themes, which included "initiation by patients" and "initiation by healthcare professionals." In the latter case, seven specific triggers were identified: (1) when the patients' medical condition changed in terms of symptom relief, (2) when the patients' medical condition changed in terms of prognostic prediction, (3) when serious events occurred, (4) when a choice of treatment was presented, (5) when the location for end-of-life care was chosen, (6) when the patients' cognitive function deteriorated, and (7) when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients' medical condition, whereas nurses focused more on their patients' desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients' autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital.
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Zwakman M, Milota MM, van der Heide A, Jabbarian LJ, Korfage IJ, Rietjens JAC, van Delden JJM, Kars MC. Unraveling patients' readiness in advance care planning conversations: a qualitative study as part of the ACTION Study. Support Care Cancer 2020; 29:2917-2929. [PMID: 33001268 PMCID: PMC8062377 DOI: 10.1007/s00520-020-05799-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE Patients' readiness for advance care planning (ACP) is often considered a prerequisite for starting ACP conversations. Healthcare professionals' uncertainty about patients' readiness hampers the uptake of ACP in clinical practice. This study aims To determine how patients' readiness is expressed and develops throughout an ACP conversation. METHODS A qualitative sub-study into the ACTION ACP conversations collected as part of the international Phase III multicenter cluster-randomized clinical trial. A purposeful sample was taken of ACP conversations of patients with advanced lung or colorectal cancer who participated in the ACTION study between May 2015 and December 2018 (n = 15). A content analysis of the ACP conversations was conducted. RESULTS All patients (n = 15) expressed both signs of not being ready and of being ready. Signs of being ready included anticipating possible future scenarios or demonstrating an understanding of one's disease. Signs of not being ready included limiting one's perspective to the here and now or indicating a preference not to talk about an ACP topic. Signs of not being ready occurred more often when future-oriented topics were discussed. Despite showing signs of not being ready, patients were able to continue the conversation when a new topic was introduced. CONCLUSION Healthcare professionals should be aware that patients do not have to be ready for all ACP topics to be able to participate in an ACP conversation. They should be sensitive to signs of not being ready and develop the ability to adapt the conversation accordingly.
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Affiliation(s)
- M Zwakman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - M M Milota
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L J Jabbarian
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - M C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.
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13
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Bielinska AM, Archer S, Soosaipillai G, Riley J, Darzi LA, Urch C. Views of advance care planning in caregivers of older hospitalised patients following an emergency admission: A qualitative study. J Health Psychol 2020; 27:432-444. [PMID: 32515241 PMCID: PMC8793289 DOI: 10.1177/1359105320926547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study explores the views of advance care planning in caregivers of older hospitalised patients following an emergency admission. Semi-structured interviews were conducted with eight carers, mostly with a personal relationship to the older patient. Thematic analysis generated three themes: (1) working with uncertainty – it all sounds very fine. . . what is the reality?, (2) supporting the older person – you have to look at it on an individual basis and (3) enabling the process – when you do it properly. The belief that advance care planning can support older individuals and scepticism whether advance care planning can be enabled among social and healthcare challenges are discussed.
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Affiliation(s)
| | | | | | - Julia Riley
- Imperial College London, UK.,The Royal Marsden NHS Foundation Trust, UK
| | - Lord Ara Darzi
- Imperial College London, UK.,Imperial College Healthcare NHS Trust, UK
| | - Catherine Urch
- Imperial College London, UK.,Imperial College Healthcare NHS Trust, UK
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14
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Bakitas M, Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Taylor R, Tucker R, Elk R. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol 2020; 38:963-973. [PMID: 32023156 DOI: 10.1200/jco.18.02432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
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Affiliation(s)
| | | | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Ronit Elk
- University of Alabama at Birmingham, Birmingham, AL
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15
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Morelli N, Barello S, Mayan M, Graffigna G. Supporting family caregiver engagement in the care of old persons living in hard to reach communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1363-1374. [PMID: 31441179 DOI: 10.1111/hsc.12826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Today, 8.5% of the world's population is 65 and over, and this statistic will reach 17% by 2050 (He et al., U.S. Census Bureau, international population reports, P95/16-1, An ageing world: 2015, U.S., 2016). They are the people who, with increasing age, will find themselves more closely interfacing with the national health system, which in many countries shows strong imbalances between rural and urban areas. In this context, a fundamental role is played by the relatives who find themselves becoming informal caregivers to compensate for lack of services. To date, however, little has been done to help these people. In this article, we want to identify the nature and extent of research evidence that had its objective to help informal caregivers in rural, hard to reach areas (Grant & Booth, Health Information & Libraries Journal, 2009, 26, 91). Following the approach set out by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19), we conducted a scoping review in May 2018 and closed the review with an update in September 2018. We identified 14 studies published from 2012, the European Year of Active Ageing, promoted by the European Commission, which had three domains of implementation: emotional support to decrease the emotional burden of caregivers, educational support to increase their skills, and organisational support to improve the mobility of caregivers and carereceivers. Although informal caregivers play a fundamental role in many countries, the studies that have been involved in alleviating their caring burden are few; nevertheless, they provide interesting indications. This lack of attention confirms how this portion of the population is still neglected by scientific research and risks having unequal access to health and social care. Future research is needed, not only to create and improve services to caregivers in rural, hard to reach areas, but also to evaluate and focus on the participation and the engagement of caregivers in the co-design of these services.
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Affiliation(s)
- Niccolò Morelli
- Department of Sociology and Business Law, Engage Minds Hub Consumer & Health Research Center, Università di Bologna, Bologna, Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Consumer & Health Research Center, Università Cattolica del Sacro Cuore (Milano), Milano, Italy
| | - Maria Mayan
- Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Consumer & Health Research Center, Università Cattolica del Sacro Cuore (Milano), Milano, Italy
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16
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Fulton JJ, LeBlanc TW, Cutson TM, Porter Starr KN, Kamal A, Ramos K, Freiermuth CE, McDuffie JR, Kosinski A, Adam S, Nagi A, Williams JW. Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis. Palliat Med 2019; 33:123-134. [PMID: 30488781 PMCID: PMC7069657 DOI: 10.1177/0269216318812633] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. AIM: We evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. DESIGN: Following a standard protocol (PROSPERO: CRD42017057541), investigators independently screened reports to identify randomized controlled trials or quasi-experimental studies that evaluated the effect of integrated outpatient palliative and oncology care interventions on quality of life, survival, and healthcare utilization among adults with advanced cancer. Data were synthesized using random-effects meta-analyses, supplemented with qualitative methods when necessary. DATA SOURCES: English-language peer-reviewed publications in PubMed, CINAHL, and Cochrane Central through November 2016. We subsequently updated our PubMed search through July 2018. RESULTS: Eight randomized-controlled and two cluster-randomized trials were included. Most patients had multiple advanced cancers, with median time from diagnosis or recurrence to enrollment ranging from 8 to 12 weeks. All interventions included a multidisciplinary team, were classified as “moderately integrated,” and addressed physical and psychological symptoms. In a meta-analysis, short-term quality of life improved, symptom burden improved, and all-cause mortality decreased. Qualitative analyses revealed no association between integration elements, palliative care intervention elements, and intervention impact. Utilization and caregiver outcomes were often not reported. CONCLUSIONS: Moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival. Evidence for effects on healthcare utilization and caregiver outcomes remains sparse.
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Affiliation(s)
- Jessica J Fulton
- 1 Durham VA Health Care System, Durham, NC, USA.,2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Thomas W LeBlanc
- 4 Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,5 Duke Cancer Institute, Durham, NC, USA
| | - Toni M Cutson
- 1 Durham VA Health Care System, Durham, NC, USA.,6 Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kathryn N Porter Starr
- 3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,6 Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,7 Geriatric Research, Education and Clinical Center (GRECC), Durham VA Health Care System, Durham, NC, USA
| | - Arif Kamal
- 5 Duke Cancer Institute, Durham, NC, USA.,8 Duke Fuqua School of Business, Duke University, Durham, NC, USA
| | - Katherine Ramos
- 1 Durham VA Health Care System, Durham, NC, USA.,3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,7 Geriatric Research, Education and Clinical Center (GRECC), Durham VA Health Care System, Durham, NC, USA
| | | | - Jennifer R McDuffie
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,11 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Andrzej Kosinski
- 12 Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Soheir Adam
- 13 Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Avishek Nagi
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
| | - John W Williams
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,11 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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17
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Zwakman M, Jabbarian LJ, van Delden JJM, van der Heide A, Korfage IJ, Pollock K, Rietjens JAC, Seymour J, Kars MC. Advance care planning: A systematic review about experiences of patients with a life-threatening or life-limiting illness. Palliat Med 2018; 32:1305-1321. [PMID: 29956558 PMCID: PMC6088519 DOI: 10.1177/0269216318784474] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Advance care planning is seen as an important strategy to improve end-of-life communication and the quality of life of patients and their relatives. However, the frequency of advance care planning conversations in practice remains low. In-depth understanding of patients' experiences with advance care planning might provide clues to optimise its value to patients and improve implementation. AIM To synthesise and describe the research findings on the experiences with advance care planning of patients with a life-threatening or life-limiting illness. DESIGN A systematic literature review, using an iterative search strategy. A thematic synthesis was conducted and was supported by NVivo 11. DATA SOURCES The search was performed in MEDLINE, Embase, PsycINFO and CINAHL on 7 November 2016. RESULTS Of the 3555 articles found, 20 were included. We identified three themes in patients' experiences with advance care planning. 'Ambivalence' refers to patients simultaneously experiencing benefits from advance care planning as well as unpleasant feelings. 'Readiness' for advance care planning is a necessary prerequisite for taking up its benefits but can also be promoted by the process of advance care planning itself. 'Openness' refers to patients' need to feel comfortable in being open about their preferences for future care towards relevant others. CONCLUSION Although participation in advance care planning can be accompanied by unpleasant feelings, many patients reported benefits of advance care planning as well. This suggests a need for advance care planning to be personalised in a form which is both feasible and relevant at moments suitable for the individual patient.
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Affiliation(s)
- M Zwakman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Marieke Zwakman, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - LJ Jabbarian
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - JJM van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - IJ Korfage
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - K Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - JAC Rietjens
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Seymour
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - MC Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Tartaglione EV, Vig EK, Reinke LF. Bridging the Cultural Divide Between Oncology and Palliative Care Subspecialties: Clinicians' Perceptions on Team Integration. Am J Hosp Palliat Care 2017; 35:978-984. [PMID: 29258319 DOI: 10.1177/1049909117747288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Palliative care improves symptom burden, distress, patient and family satisfaction, and survival for patients with cancer. Oncology professional societies endorse the integration of palliative care into routine care for patients with advanced cancers. Despite this, cultural differences between medical subspecialties and the limited number of clinicians trained in palliative care lower the adoption of integrated care models. We assessed oncologists' and palliative care clinicians' perceptions about integrating oncology and palliative care using a nurse delivering palliative care to patients newly diagnosed with lung cancer. METHODS We conducted semistructured telephone interviews with 7 oncology clinicians and 12 palliative care clinicians purposively sampled across 6 geographically diverse Department of Veterans Affairs medical centers (VAs). Oncologists were asked about their perspectives and experiences with consulting palliative care services. Palliative care clinicians were asked about their experiences with receiving consultations from subspecialties. Both were asked about utilizing a registered nurse to deliver telephone-based palliative care to patients newly diagnosed with lung cancer. Interviews were analyzed using traditional content analysis approaches. RESULTS We identified 2 main themes: (1) tensions, differences, and mistrust between services occur in the least integrated teams and (2) open communication, sharing common goals, and promoting oncology "buy in" build trust and foster collaboration between teams. Clinicians described qualities important to possess to promote successful adoption of a nurse-led model of palliative care. CONCLUSIONS Integration between oncology and palliative care among the 6 VA medical centers varies considerably. Nurses delivering palliative care embedded in oncology teams may facilitate the integration of these subspecialties.
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Affiliation(s)
- Erica V Tartaglione
- 1 Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA
| | - Elizabeth K Vig
- 2 Department of Veterans Affairs, Puget Sound Health Care System, Geriatrics and Extended Care, Seattle, WA, USA.,3 Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lynn F Reinke
- 1 Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, Seattle, WA, USA.,4 Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
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