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Wahyuni S, Gautama MSN, Simamora TY. A Literature Review of Nurses Challenges and Barriers in Assisting Patients and Families Facing Breaking Bad News. Indian J Palliat Care 2023; 29:243-249. [PMID: 37700890 PMCID: PMC10493690 DOI: 10.25259/ijpc_128_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/22/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Breaking bad news (BBN) is a challenging task for healthcare professionals, including nurses. The manner in which bad news is delivered can have a significant impact on patients and their families, either positive or negative. Understanding the roles, methods, obstacles, and challenges that nurses face in the process of delivering bad news is crucial for improving the quality of the delivery process. Material and Methods This narrative review synthesises related studies. The search was conducted through PubMed, Scopus, ScienceDirect and Sage, with no restriction on publication year. The main keywords were 'nurse's challenge', 'nurse's barrier', 'bad news', 'breaking bad news', and 'communicating bad news.' A total of 12 articles were selected from 1075 articles. Results Nurses play a key role in BBN before, during and after the process. Their activities include preparing patients to receive bad news, supporting patients and families when doctors deliver bad news and clarifying information obtained by patients and families regarding the prognosis of their illness. Nurses should possess skills such as building interpersonal relationships, therapeutic communication and providing emotional care for patients and their families. The main challenges and barriers for nurses in implementing BBN are due to a lack of skills and unpreparedness for patient and family reactions. After BBN, the most reported roles of nurses were supporting patients and families and helping them understand the information received from doctors. It is essential for nurses to have the necessary skills and preparedness to effectively deliver bad news to patients and their families. Conclusion Nurses play a crucial role in delivering bad news to patients and their families. They should be equipped with the necessary skills to effectively communicate with patients and their families during this difficult time. Further training for nurses in therapeutic communication, emotional care for patients and their families, and building interpersonal relationships could help to improve the quality of the delivery process.
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Affiliation(s)
- Surya Wahyuni
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Made Satya Nugraha Gautama
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tiur Yulianta Simamora
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Sun C, Meng D. Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China. Front Public Health 2023; 11:1170594. [PMID: 37342270 PMCID: PMC10277793 DOI: 10.3389/fpubh.2023.1170594] [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: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. Methods We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). Results This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. Conclusion This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.
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Ness TM, Silan W. "We Tried to Take Care of Her, but it Got Too Exhausting": A Study of the Transition From Family Carer to Employer. Glob Qual Nurs Res 2023; 10:23333936231202876. [PMID: 37854877 PMCID: PMC10580710 DOI: 10.1177/23333936231202876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
In Taiwan an increasing number of families are employing live-in carers from abroad to cope with care responsibilities, including the Indigenous Tayal. The aim of this research was to understand the transition from Indigenous family carer to employer with older family members who have extensive care needs. Six Indigenous employers were interviewed, and a narrative hermeneutic analysis was performed. The Tayal caregivers' cases revealed that their transition to employing live-in carers was complex and filled with ethical dilemmas due to their vulnerable positions. They tried to ensure person-centered care for their family members, but by doing this they risked reproducing vulnerability when transferring their own vulnerability to the live-in carer. The results indicate the interwoven nature of care dependency when it is defined by multiple vulnerabilities, Indigeneity and migration, and the multifaceted components of cultural safety.
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Applebaum AJ, Loschiavo M, Morgan K, Mennin DS, Fresco DM, Hoyt MA, Schofield E, O’Toole MS, Cohn J, Jacobs JM. A randomized controlled trial of emotion regulation therapy for cancer caregivers: A mechanism-targeted approach to addressing caregiver distress. Contemp Clin Trials 2022; 122:106923. [PMID: 36115638 PMCID: PMC9769581 DOI: 10.1016/j.cct.2022.106923] [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: 02/15/2022] [Revised: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Caregivers of patients with cancer play a crucial role in the health of the person they care for, and in the healthcare system at large. Family caregivers receive minimal support, despite being at greater risk for anxiety and depression than patients themselves. Cognitive behavioral therapy (CBT), an effective therapy for anxiety and depression, has shown mixed efficacy when delivered to cancer caregivers. Emotion Regulation Therapy (ERT), a contemporary CBT, may uniquely target processes underlying distress associated with caregiving. Therefore, we adapted both CBT and ERT to target the needs of caregivers (i.e., CBT-C and ERT-C) and are conducting a multi-site randomized trial to examine the comparative efficacy of these interventions. METHODS Family cancer caregivers (n = 200) reporting distress related to caregiving are recruited from two academic cancer centers and randomly assigned to either ERT-C or CBT-C. Caregivers in both interventions engage in eight weekly one-hour sessions by videoconference with a trained interventionist. Caregiver participants complete study assessments at baseline, post-treatment, 3-and 6-months follow-up. Patients of each caregiver can also enroll in the study and complete assessments at baseline and 3-months follow-up. Outcome measures include psychosocial constructs such as anxiety, depression, quality of life, as well as proposed mechanistic constructs and salivary markers of stress and inflammation. CONCLUSIONS The results of this study will advance the science of caregiving interventions in cancer by addressing a critical gap in our ability to mitigate anxiety and depression in caregivers, as well as further our understanding of how these changes may influence patients' outcomes.
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Affiliation(s)
| | - Morgan Loschiavo
- Memorial Sloan Kettering Cancer Center, NY, New York, United States of America
| | - Katherine Morgan
- Massachusetts General Hospital Cancer Center, Boston, MA, United States of America
| | - Douglas S. Mennin
- Teachers College, Columbia University, NY, New York, United States of America
| | - David M. Fresco
- University of Michigan, Ann Arbor, MI, United States of America
| | - Michael A. Hoyt
- University of California- Irvine, Irvine, CA, United States of America
| | - Elizabeth Schofield
- Memorial Sloan Kettering Cancer Center, NY, New York, United States of America
| | | | - Julia Cohn
- Massachusetts General Hospital Cancer Center, Boston, MA, United States of America
| | - Jamie M. Jacobs
- Massachusetts General Hospital Cancer Center, Boston, MA, United States of America,Corresponding author at: 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America. (J.M. Jacobs)
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5
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Kieninger J, Wosko P, Pleschberger S. Support towards the end of life and beyond: Non-kin care commitment for older people living alone in Austria. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5196-e5203. [PMID: 35894108 PMCID: PMC7614260 DOI: 10.1111/hsc.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/24/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Non-kin carers provide vital resources for older people living alone with increasing care needs, especially if they cannot rely on the support of family members. However, this kind of commitment presents numerous challenges throughout the care trajectory and beyond. To explore these aspects in more depth, a qualitative study was designed including a retrospective interpretation of interview data with non-kin carers (n = 15) and additional in-depth interviews (n = 8) with people who had cared for an older person living alone with no family nearby. Analyses of the verbatim transcriptions followed coding procedures and were supported by MaxQDA software. Our findings demonstrate that non-kin carers had to negotiate personal boundaries continuously over the end-of-life trajectory to deal with the increasing complexity of care demands and overburdening situations. Following the older person's death, non-kin carers were involved in funeral arrangements and settled practical or legal matters when no family members were available or had little inclination to contribute. The findings highlight that non-kin carers make a great effort to safeguard the interests and needs of older people living alone, ensuring their autonomy and dignity towards the end of life and beyond. However, the burdens experienced require future research to better understand the support needs of non-kin carers providing end-of-life care for an older person living alone.
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Affiliation(s)
- Judith Kieninger
- Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Vienna, Austria
| | - Paulina Wosko
- Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Vienna, Austria
| | - Sabine Pleschberger
- Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Vienna, Austria
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Noerup ES, Skorstengaard MH, Jensen AB, Guldin MB, Neergaard MA. Does advance care planning affect relatives’ healthcare-seeking behaviour? PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2119326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | | | | | - Mai-Britt Guldin
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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Akter S, Sarker M, Hossain P, Ahmad N, Zaman S. Solidarity and suffering: enrolled terminal patients’ and their caregiver’s experiences of the community-based palliative care programme in an urban slum of Bangladesh. Palliat Care Soc Pract 2022; 16:26323524221095104. [PMID: 35548025 PMCID: PMC9081719 DOI: 10.1177/26323524221095104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Palliative care has been recognised as a global health challenge. Although accessibility has increased, there is little recognition of the importance of palliative care in low- and middle-income countries. In Bangladesh, institutional palliative care is not accessible due to a lack of awareness, financial constraints, and fewer facilities. Hence, there needs to be a better understanding of providing and improving existing community-based palliative care. For this, it is essential to understand the experiences of patients and their caregivers who require palliative care. With this aim, this study explores the experiences of palliative patients and their primary caregivers enrolled in a palliative care project, ‘Momotamoy Korail’ run by Bangabandhu Sheikh Mujib Medical University in an urban slum, Dhaka. Methods: This research is a part of a larger qualitative study that relied on a focused ethnographic approach. For this study, we used 19 in-depth interviews following a semi-structured guideline with the palliative care patients and their primary caregivers enrolled in the community-based palliative care project. Results: Mostly women (wives and daughters-in-law) are the primary caregivers in a family. Therefore, male patients are more likely to receive family care than female patients. Both male and female patients expressed the desire for a death free of suffering. All patients felt lonely and socially abandoned with a perception of being a burden to their families. Despite the diversity in physical, social, psychological, and financial suffering, patients and caregivers were optimistic towards a healthy life free of illness. All respondents were satisfied with the care they received from the palliative care assistants, which provide them hope and dignity for life. Conclusion: Experiences of the respondents can improve the quality of the existing community-based palliative care services and add great value to the discipline of palliative care in public health. The findings provided an understanding of what would be required to extend community-based palliative care to other healthcare settings. More awareness through community mobilisation about the need for and benefit of palliative care is needed to make it sustainable.
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Affiliation(s)
- Sayema Akter
- Research Fellow, BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka 1213, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg University, Heidelberg, Germany
| | - Puspita Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Health Research Methods, McMaster University, Hamilton, ON, Canada
| | | | - Shahaduz Zaman
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK
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8
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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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9
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Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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10
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Grierson L, Vanstone M. The rich potential for education research in family medicine and general practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:753-763. [PMID: 32986222 DOI: 10.1007/s10459-020-09994-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Medical education is a rapidly growing field of research, incorporating diverse disciplinary perspectives to assist physician trainees in developing the complex skills needed for practice. Education science is happening in many medical specialties; however, Family Medicine or General Practice settings have not seen a proportional share of theory-driven education research. The limited nature of education research in Family Medicine is surprising, given that there are several aspects of general practice that make it a particularly unique and interesting context to study issues of general importance to medical education, and there is a particular need for education research to further the discipline of Family Medicine. It is important that the community of medical education researchers in Family Medicine have a strong understanding and perspective on the breadth and potential impact of their work, and what this means for the training that occurs within and for the discipline. This Reflection aims to inform strategic thinking, collaboration, and innovation in medical education research as it pertains to Family Medicine. It does so by discussing four hallmarks of Family Medicine practice and outlining their independent and interactive potential for medical education research.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA.
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA.
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA
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11
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Bagnasco A, Rosa F, Dasso N, Aleo G, Catania G, Zanini M, Rocco G, Turci C, Ghirotto L, Hayter M, Sasso L. Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences. J Clin Nurs 2021; 30:2246-2257. [PMID: 33350526 DOI: 10.1111/jocn.15613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. BACKGROUND The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. DESIGN Phenomenology. METHODS This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. RESULTS Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. CONCLUSIONS Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.
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Affiliation(s)
| | - Francesca Rosa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicoletta Dasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gennaro Rocco
- National Social Security Council (ENPAPI, Roma, Italy
| | - Carlo Turci
- Ordine Professioni Infermieristiche di Roma, Roma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Emilia, Italy
| | - Mark Hayter
- School of Health & Social Work, University of Hull, Hull, UK
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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12
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Røen I, Brenne AT, Brunelli C, Stifoss-Hanssen H, Grande G, Solheim TS, Kaasa S, Knudsen AK. Spiritual quality of life in family carers of patients with advanced cancer-a cross-sectional study. Support Care Cancer 2021; 29:5329-5339. [PMID: 33661369 PMCID: PMC8295139 DOI: 10.1007/s00520-021-06080-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
Purpose Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer. Methods Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models. Results In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R2) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age. Conclusion The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.
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Affiliation(s)
- Ingebrigt Røen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway.
- Chaplaincy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hans Stifoss-Hanssen
- Center of diakonia and professional practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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13
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Itadera S, Kobayashi T, Nakanishi J, Aoyama T, Hasegawa Y. Towards physical interaction-based sequential mobility assistance using latent generative model of movement state. Adv Robot 2020. [DOI: 10.1080/01691864.2020.1844797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Shunki Itadera
- Department of Micro-Nano Mechanical Science and Engineering, Nagoya University, Nagoya, Japan
| | - Taisuke Kobayashi
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Jun Nakanishi
- Department of Mechanical Engineering, Meijo University, Nagoya, Japan
| | - Tadayoshi Aoyama
- Department of Micro-Nano Mechanical Science and Engineering, Nagoya University, Nagoya, Japan
| | - Yasuhisa Hasegawa
- Department of Micro-Nano Mechanical Science and Engineering, Nagoya University, Nagoya, Japan
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14
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Tang J, Ryburn B, Doyle C, Wells Y. The Psychology of Respite Care for People with Dementia in Australia. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2010.00005.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Judy Tang
- Australian Institute for Primary Care, Lincoln Centre for Ageing, Melbourne, Victoria, Australia
| | - Bridget Ryburn
- Australian Institute for Primary Care, Lincoln Centre for Ageing, Melbourne, Victoria, Australia
| | - Colleen Doyle
- Australian Institute for Primary Care, Lincoln Centre for Ageing, Melbourne, Victoria, Australia
| | - Yvonne Wells
- Australian Institute for Primary Care, Lincoln Centre for Ageing, Melbourne, Victoria, Australia
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15
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Capodanno I, Rocchi M, Prandi R, Pedroni C, Tamagnini E, Alfieri P, Merli F, Ghirotto L. Caregivers of Patients with Hematological Malignancies within Home Care: A Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114036. [PMID: 32517057 PMCID: PMC7312962 DOI: 10.3390/ijerph17114036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
The role of caregivers in homecare settings is relevant to the patient’s wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was to explore the experience of primary caregivers of patients with hematological malignancies within home care. We conducted a phenomenological study based on interviews with 17 primary caregivers of hematological patients. Analysis of the contents led to the identification of five main themes. Perhaps, the innovative aspects of this study can be summarized in three points: This service was demonstrated to fulfil the ethical aspects of providing the patient with a dignified accompaniment to the end of life. Secondly, the efficiency of the service and the benefit are directly dependent on the caregivers’ wellbeing, so knowledge of the dynamics and emotions involved can lead to the development and implementation of programs for hematological malignancies. Lastly, a collaborative caregivers–professionals relationship can improve a sense of accomplishment for all parties involved, lessening the family’s frustration related to not having done their best. Home care brings significant benefits for both the patient and the caregivers and fulfils the ethical obligation of providing the patient dignified end-of-life care.
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Affiliation(s)
- Isabella Capodanno
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Mirta Rocchi
- Hospice “Casa Madonna dell’Uliveto” Via Oliveto, 34-42020 Albinea, Reggio Emilia, Italy;
| | - Rossella Prandi
- Servizio Infermieristico Domiciliare, Azienda USL di Modena, piazzale dei Donatori di Sangue, 3-41012 Carpi, Italy;
| | - Cristina Pedroni
- Direzione delle Professioni Sanitarie Azienda USL-IRCCS di Reggio Emilia Viale Amendola, 2-42122 Reggio Emilia, Italy;
| | - Enrica Tamagnini
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia Viale Amendola, 2-42122 Reggio Emilia, Italy;
| | - Pierluigi Alfieri
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Francesco Merli
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia Viale Umberto I, 50-42123 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-2956-17
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16
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Jeong A, Shin D, Park JH, Park K. Attributes of caregivers' quality of life: A perspective comparison between spousal and non-spousal caregivers of older patients with cancer. J Geriatr Oncol 2020; 11:82-87. [DOI: 10.1016/j.jgo.2019.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 11/16/2022]
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17
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Tarberg AS, Kvangarsnes M, Hole T, Thronæs M, Madssen TS, Landstad BJ. Silent voices: Family caregivers' narratives of involvement in palliative care. Nurs Open 2019; 6:1446-1454. [PMID: 31660172 PMCID: PMC6805263 DOI: 10.1002/nop2.344] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
AIM To explore how family caregivers experience involvement in palliative care. DESIGN A qualitative design with a narrative approach was used. METHODS Purposive sampling and narrative interviews were conducted. Eleven bereaved family caregivers for patients with cancer receiving palliative care were interviewed in Mid-Norway between November 2016-May 2017. RESULTS We identified four themes related to family caregivers' experiences of involvement in the early, middle, terminal and bereavement phases of palliative care: (a) limited involvement in the early phase; (b) emphasis on patient-centred care in the middle phase; (c) lack of preparation for the dying phase; and (d) lack of systematic follow-up after death. Family caregivers experienced low level of involvement throughout the palliative pathway. CONCLUSION The involvement of family caregivers in palliative care may not be proportional to their responsibilities. The needs of family caregivers should be addressed in nursing education to give nurses competence to support family caregivers in providing home-based care.
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Affiliation(s)
- Anett Skorpen Tarberg
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Marit Kvangarsnes
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- Faculty of Medicine and Health Sciences, Institute of Health Sciences ÅlesundNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Torstein Hole
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Morten Thronæs
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olav HospitalTrondheim University HospitalTrondheimNorway
| | - Torfinn Støve Madssen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Bodil J. Landstad
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Levanger HospitalNord‐Trøndelag Hospital TrustLevangerNorway
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18
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Guo Q, Zheng R, Jacelon CS, McClement S, Thompson G, Chochinov H. Dignity of the patient-–family unit: further understanding in hospice palliative care. BMJ Support Palliat Care 2019; 12:e599-e606. [DOI: 10.1136/bmjspcare-2019-001834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022]
Abstract
ObjectivesThis study aimed to explore the construct of dignity of the patient–family dyad in hospice palliative care, as well as its influencing factors from the perspective of hospice palliative care staff.MethodsA qualitative descriptive study was conducted with 34 staff members from a residential hospice in Amherst, USA, and an inpatient palliative care unit in Winnipeg, Canada, between September 2013 and December 2016. Data were collected through semistructured interviews and were analysed using the thematic analysis approach.ResultsFindings suggested that staff members viewed dignity as something that is reciprocally supported within the patient–family unit. Themes including respect, comfort, privacy, being informed and quality family time were common in the conceptualisation of dignity in patients and families; themes of being human and being self, autonomy and living with dignity were uniquely used to conceptualise patient dignity. Themes solely constituting family dignity included being included in care, being capable and being treated fairly. Cultural considerations, environmental factors, teamwork and patient/family–staff relationship were the factors identified by staff members that affected dignity in hospice palliative care.ConclusionFindings of this study provide insights into the development of strategies to support the dignity of the patient–family unit in hospice palliative care.
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19
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Vermorgen M, De Vleminck A, Leemans K, Van den Block L, Van Audenhove C, Deliens L, Cohen J. Family carer support in home and hospital: a cross-sectional survey of specialised palliative care. BMJ Support Palliat Care 2019; 10:e33. [PMID: 31243021 DOI: 10.1136/bmjspcare-2019-001795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate: (1) to what extent family carers of people supported by specialised palliative care services felt they had been provided with information, support and aftercare and (2) how this varied by type of palliative care service, length of enrolment and characteristics of deceased. METHODS A cross-sectional postal survey was conducted using a structured questionnaire with nine items on information, support and aftercare provided by specialised palliative care services to family carers. Flemish family carers of people who had made use of specialised palliative care services at home or in hospital were contacted. RESULTS Of all primary family carers (response rate of 53.5% resulting in n=1504), 77.7% indicated they were asked frequently by professionals how they were feeling. Around 75% indicated they had been informed about specific end-of-life topics and around 90% felt sufficiently supported before and immediately after the death. Family carers of people who had died in a palliative care unit, compared with other types of specialised palliative care services, indicated having received more information, support and aftercare. CONCLUSIONS Family carers evaluate the professional assistance provided more positively when death occurred in a palliative care unit. Policy changes might be needed to reach the same level of care across all specialised palliative care services.
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Affiliation(s)
- Maarten Vermorgen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Kathleen Leemans
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Department of Radiotherapy, Brussels University Hospital, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy, University of Leuven, Leuven, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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20
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Simpson AC, Rocker GM. Advanced Chronic Obstructive Pulmonary Disease: Impact on Informal Caregivers. J Palliat Care 2019. [DOI: 10.1177/082585970802400107] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Graeme M. Rocker
- Division of Respirology, QEII Health Sciences Centre, and Dalhousie University, Halifax, Nova Scotia, Canada
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21
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Holtslander LF, Duggleby W, Williams AM, Wright KE. The Experience of Hope for Informal Caregivers of Palliative Patients. J Palliat Care 2019. [DOI: 10.1177/082585970502100408] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Wendy Duggleby
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - Karen E. Wright
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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22
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Hasson F, Spence A, Waldron M, Kernohan G, Mclaughlin D, Watson B, Cochrane B. Experiences and needs of Bereaved Carers during Palliative and End-Of-Life Care for People with Chronic Obstructive Pulmonary Disease. J Palliat Care 2018. [DOI: 10.1177/082585970902500302] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: This study explored the experiences of palliative care that bereaved carers had while providing care to a dying loved one with chronic obstructive pulmonary disease (COPD). Method: Semi-structured interviews were undertaken with nine carers who had lost a loved one in the preceding 6 to 24 months. These interviews explored levels of satisfaction with disease management, symptom management, and end-of-life care. With permission, interviews were tape recorded, transcribed, and subjected to content analysis. Findings: Three themes emerged from the data: the impact of the caring experience, the lack of support services, and end-of-life and bereavement support. Carers experienced carer burden, lack of access to support services, a need for palliative care, and bereavement support. Conclusion: The findings provide a first insight into the experiences of carers of patients with advanced COPD. Bereaved carers of patients who had suffered advanced COPD reported that they had received inadequate support and had a range of unmet palliative care needs. Special attention should be paid to educating and supporting carers during their caring and bereavement periods to ensure that their quality of life is maintained or enhanced.
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Affiliation(s)
- Felicity Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, Northern Ireland
| | - Allison Spence
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast, Northern Ireland
| | - Mary Waldron
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, Northern Ireland
| | - George Kernohan
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, Northern Ireland
| | - Dorry Mclaughlin
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast, Northern Ireland
| | - Barbara Watson
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast, Northern Ireland
| | - Barbara Cochrane
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast, Northern Ireland
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23
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McCabe MP, Goldhammer D, Mellor D, Hallford D, Davison T. Evaluation of A Training Program to Assist Care Staff to Better Recognize and Manage Depression among Palliative Care Patients and Their Families. J Palliat Care 2018. [DOI: 10.1177/082585971202800203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed pre-intervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.
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Affiliation(s)
- Marita P. McCabe
- MP McCabe (corresponding author): School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Denisa Goldhammer
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Mellor
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Hallford
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - Tanya Davison
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
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24
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Fu F, Chen YY, Li Q, Zhu F. Varieties of Hope Among Family Caregivers of Patients With Lymphoma. QUALITATIVE HEALTH RESEARCH 2018; 28:2048-2058. [PMID: 29890900 DOI: 10.1177/1049732318779051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, 16 family caregivers of patients with lymphoma were interviewed on their changing perceptions of hope. The changing process starts from diagnosis to the present treatment state. We found that the changing perception of hope can be divided into three stages: the stage of generalized hope focusing merely on treatment and passive hope focusing on harm-avoidance, the stage of specified hope and active hope aiming at comfort-seeking, and the stage of multifaceted hope. Family caregivers' understanding of the past experience of and new information on the disease are the foundation of the perception of hope. The perception of hope in cancer patients' family caregivers develops from "therapeutic hope" to "psychosocial hope," shifting from "consequential hope" to "procedural hope."
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Affiliation(s)
- Fang Fu
- 1 Fudan University, Shanghai, China
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25
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Pooler C, Richman-Eisenstat J, Kalluri M. Early integrated palliative approach for idiopathic pulmonary fibrosis: A narrative study of bereaved caregivers' experiences. Palliat Med 2018; 32:1455-1464. [PMID: 30056786 DOI: 10.1177/0269216318789025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis has an uncertain and rapid trajectory after diagnosis. Palliative care is rarely utilized, although both patients and caregivers experience a distressingly high symptom burden. Most patients die in hospital. AIM The purpose of this study was to explore bereaved caregivers' experiences and perceptions of an early integrated palliative approach implemented at a Multidisciplinary Interstitial Lung Disease Clinic. DESIGN A narrative approach was used, with thematic and content analysis of open-ended interviews. SETTING/PARTICIPANTS The clinic is located in a large western Canadian city. Caregivers of deceased patients were recruited through purposive sampling. The eight participants were either spouses or adult children. RESULTS Five major themes were identified: Having a Terminal Disease; Planning Goals and Wishes for Care; Living Life and Creating Memories; Feeling Strain and Responsibility; and Nearing the End. Caregivers had little understanding of prognosis prior to advance care planning conversations at the clinic. Advance care planning conversations enabled caregivers to know and support patients' goals and wishes. Caregivers described feeling informed, prepared, and supported when death was near. They expressed neither distress nor anxiety related to patients' symptoms or strain of relationships. CONCLUSION Collaboration and close communication among caregivers, respirologists, and home care enabled effective symptom management and out of hospital deaths. Patients and caregivers had opportunities to enjoy events, create memories, determine preferences, and make plans. Further research on an early integrated palliative approach in Idiopathic Pulmonary Fibrosis is warranted related to quality of life, experience with death and dying, and caregiver bereavement.
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Affiliation(s)
- Charlotte Pooler
- 1 Palliative and End of Life Care & Community Programs, Continuing Care, Alberta Health Services, Edmonton, AB, Canada
| | - Janice Richman-Eisenstat
- 2 Faculty of Medicine & Dentistry, University of Alberta.,3 Alberta Health Services, Edmonton, AB, Canada
| | - Meena Kalluri
- 2 Faculty of Medicine & Dentistry, University of Alberta.,3 Alberta Health Services, Edmonton, AB, Canada
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26
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Kuo SC, Chou WC, Hou MM, Wu CE, Shen WC, Wen FH, Tang ST. Changes in and modifiable patient- and family caregiver-related factors associated with cancer patients’ high self-perceived burden to others at the end of life: A longitudinal study. Eur J Cancer Care (Engl) 2018; 27:e12942. [DOI: 10.1111/ecc.12942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/18/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Su-Ching Kuo
- Department of Nursing; Yuanpei University of Medical Technology; Hsinchu Taiwan
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Taoyuan Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Chiao-En Wu
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Fur-Hsing Wen
- Department of International Business; Soochow University; Taipei Taiwan
| | - Siew-Tzuh Tang
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Nursing; Chang Gung University; Taoyuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Kaohsiung; Kaohsiung Taiwan
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27
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Danielsen BV, Sand AM, Rosland JH, Førland O. Experiences and challenges of home care nurses and general practitioners in home-based palliative care - a qualitative study. BMC Palliat Care 2018; 17:95. [PMID: 30021583 PMCID: PMC6052702 DOI: 10.1186/s12904-018-0350-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norway has one of the lowest home death rates in Europe. However, it is the health authorities´ ambition to increase this by facilitating palliative care at home. The aim of this study was to achieve more insight, through home care nurses and general practitioners, of conditions that facilitate or hamper more time at home and more home deaths for patients with terminal disease and short life expectancy. METHODS We used a qualitative research design with four focus groups with a total of 19 participants, of either home care nurses or general practitioners, using semi-structured question guides. The data were processed by systematic text condensation and encompassed thematic analysis of meaning and content of data across cases, which included four steps of analysis. RESULTS Three main themes were identified: 1) The importance of a good start for the patient and family with five sub-themes, 2) 'Passing the baton' - the importance of collaboration across the health system with four sub-themes, and 3) Avoiding new hospitalization by establishing collaboration and competence within primary health care with four sub-themes. CONCLUSIONS This study demonstrates that optimum palliative care at home depends on close collaboration and dialogue between the patient, family, home care nurses and general practitioner. It suggests the need for safer discharge routines and planning when hospitals transfer patients with terminal disease to their homes. A good start for the patient and family, where the initial interdisciplinary collaboration meeting takes place in the patient's home, is crucial for a good result. The general practitioners' perception of their 'disconnection' during hospitalization and prior to discharge has the potential to reduce patient safety. The family seems to be fundamental in gaining more time at home for the patient and supporting the patient to eventually die at home. Home-based palliative care demands experience and competence as well as regular supportive mentoring.
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Affiliation(s)
- Britt Viola Danielsen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
| | - Anne Marit Sand
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jan Henrik Rosland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital Bergen, Bergen, Norway
| | - Oddvar Førland
- Centre for Care Research - Western Norway, Western Norway University of Applied Sciences, Bergen, Norway.,Faculty of Health Studies, VID Specialized University, Bergen, Norway
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28
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Delalibera M, Coelho A, Presa J, Barbosa A, Leal I. Circunstâncias e consequências do cuidar: estudo prospetivo em cuidados paliativos. CIENCIA & SAUDE COLETIVA 2018; 23:2351-2362. [DOI: 10.1590/1413-81232018237.09512016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo As várias circunstâncias que afetam a prestação de cuidados em fim-de-vida podem ter um papel determinante no resultado desta experiência, nomeadamente nos níveis de morbilidade psicológica antes e depois da perda. Este estudo tem por objetivos descrever a prevalência da sobrecarga e sintomatologia psicopatológica dos cuidadores familiares em cuidados paliativos e identificar as circunstâncias que lhe estão associadas. Pretendemos ainda avaliar a evolução da sintomatologia, identificando os fatores circunstanciais que interferem na fase aguda do luto. A amostra foi constituída por 75 cuidadores portugueses, a maioria do sexo feminino e filhas do doente. Os resultados revelam que as pessoas mais envolvidas nos cuidados ao doente apresentam mais sobrecarga e estão mais propensas a sintomatologia psicopatológica, a qual tem tendência a manter-se no luto. Ficou também demonstrada a existência de sintomas peritraumáticos que parecem contribuir significativamente para o estado geral de distress no luto agudo. O suporte social tem efeito protetor nos diferentes quadros sintomatológicos e está relacionado com o funcionamento familiar. Estes resultados sugerem a possibilidade de identificar precocemente os cuidadores mais vulneráveis e as circunstâncias adversas que os afetam.
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Affiliation(s)
| | | | | | | | - Isabel Leal
- Instituto Superior de Psicologia Aplicada, Portugal
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Delalibera M, Barbosa A, Leal I. Circunstâncias e consequências do cuidar: caracterização do cuidador familiar em cuidados paliativos. CIENCIA & SAUDE COLETIVA 2018; 23:1105-1117. [DOI: 10.1590/1413-81232018234.12902016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/25/2016] [Indexed: 02/04/2023] Open
Abstract
Resumo Os cuidadores familiares desempenham um importante papel ao cuidar de um paciente em situação de doença avançada. Este estudo teve como objetivo caracterizar o cuidador familiar de cuidados paliativos, avaliando as circunstâncias e as consequências da prestação de cuidados e a preparação para a perda do ente querido. Trata-se de um estudo quantitativo, prospectivo e longitudinal. A amostra foi constituída por 60 cuidadores familiares, maioritariamente mulheres, casadas, com idade média de 44,53 anos. A maioria dos cuidadores coabita com o paciente, dedica a maior parte do seu dia aos cuidados ao doente e uma parcela significativa deixou de trabalhar ou reduziu as horas de trabalho para poder acompanhar o paciente. Os cuidadores mais sobrecarregados apresentaram maiores níveis de ansiedade, depressão, somatização e menos apoio social. As familiares mais disfuncionais referiram pouco apoio social e os familiares que estavam menos preparados para a morte do paciente apresentaram mais sintomas de experiência dissociativa peritraumática. A maioria dos cuidadores tinha conhecimento sobre a gravidade da doença do seu familiar e a proximidade da morte, e consideraram que o paciente foi muito bem cuidado no serviço de cuidados paliativos.
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Affiliation(s)
| | | | - Isabel Leal
- Instituto Superior de Psicologia Aplicada, Portugal
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Fringer A, Hechinger M, Schnepp W. Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis. BMC Palliat Care 2018; 17:22. [PMID: 29402242 PMCID: PMC5799924 DOI: 10.1186/s12904-018-0275-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances. Methods A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000–2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories. Results In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles. Conclusions In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients’ and families’ perspectives.
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Affiliation(s)
- André Fringer
- Institute of Applied Nursing Science, University of Applied Sciences St. Gallen, Rosenbergstrasse 59, Postfach, 9001, St. Gallen, Switzerland.
| | - Mareike Hechinger
- Institute of Applied Nursing Science, University of Applied Sciences St. Gallen, Rosenbergstrasse 59, Postfach, 9001, St. Gallen, Switzerland
| | - Wilfried Schnepp
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Strasse 12, 58453, Witten, Germany
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Wahid AS, Sayma M, Jamshaid S, Kerwat D, Oyewole F, Saleh D, Ahmed A, Cox B, Perry C, Payne S. Barriers and facilitators influencing death at home: A meta-ethnography. Palliat Med 2018; 32:314-328. [PMID: 28604232 DOI: 10.1177/0269216317713427] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM To identify and understand the barriers and facilitators influencing death at home. DESIGN Meta-ethnography. DATA SOURCES The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
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Affiliation(s)
- Abdul Samad Wahid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Meelad Sayma
- 2 Imperial College Business School, London, UK.,3 Peninsula College of Medicine & Dentistry, Plymouth, UK
| | - Shiraz Jamshaid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Doa'a Kerwat
- 2 Imperial College Business School, London, UK.,4 Bart's and the London School of Medicine and Dentistry, London, UK
| | - Folashade Oyewole
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Dina Saleh
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Aaniya Ahmed
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Benita Cox
- 2 Imperial College Business School, London, UK
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Rakic M, Escher M, Elger BS, Eckstein S, Pacurari N, Zwahlen S, Wienand I. Feelings of Burden in Palliative Care: A Qualitative Analysis of Medical Records. J Palliat Care 2018; 33:32-38. [PMID: 29301449 DOI: 10.1177/0825859717750522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Care for palliative care patients is often provided by unpaid caregivers (eg, family members) who take care of the patient's daily needs (eg, bathing, dressing). Family members of palliative care patients are involved in numerous ways. These tasks and responsibilities can make them feel burdened and even overburdened. AIM We specifically looked at patients' medical records to determine what is being reported about burden and overburden and who seems to be mostly affected. Burden was understood as a weight or task that is difficult to accept or carry, whereas overburden indicates that this weight or task cannot be carried anymore. METHODS We looked at 300 medical records of palliative care patients written by health-care professionals. Written notes were analyzed using latent content analysis as it helps to analyze large amounts of textual data qualitatively and to understand the underlying concepts of what was said. RESULTS Most (73.5%) patients had a cancer diagnosis. Mean age was 67.6 years (range, 22-98 years). Burden and overburden were identified as main categories and further divided into the following subcategories: for patients and families. According to the written notes, patients often felt burdened by their disease, financial problems, situation at home, and families' reactions to their disease. By and large, patients felt overburdened by their own disease. Families often felt burdened because of issues related to patients' medical condition, providing home care, or financial and social aspects. Families mentioned home care and the decision-making process as being overburdening. CONCLUSION Findings in the palliative care patients' medical records are inasmuch important, as they point at the health-care staff's awareness of possible weights and tasks that might be burdensome for patients and their families. Attention should be drawn to the documentation of medical records in order to identify recurrent difficulties and to help discuss these.
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Affiliation(s)
- Milenko Rakic
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Monica Escher
- 2 Division of Clinical Pharmacology and Toxicology, Pain and Palliative Care Consultation, Geneva University Hospitals, Geneva, Switzerland
| | - Bernice S Elger
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Sandra Eckstein
- 3 Palliative Care, University Hospital Basel, Basel, Switzerland
| | - Nadia Pacurari
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Susanne Zwahlen
- 4 Centre for Palliative Care, University Hospital Bern, Bern, Switzerland
| | - Isabelle Wienand
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Cohen-Mansfield J, Skornick-Bouchbinder M, Cohen R, Brill S. Treatment and Communication–That Is What Matters: An Analysis of Complaints Regarding End-of-Life Care. J Palliat Med 2017; 20:1359-1365. [DOI: 10.1089/jpm.2017.0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jiska Cohen-Mansfield
- Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Rinat Cohen
- Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shai Brill
- Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Beit Rivka Medical Center, Petah Tikva, Israel
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Delalibera M, Presa J, Barbosa A, Leal I. [Burden of caregiving and its repercussions on caregivers of end-of-life patients: a systematic review of the literature]. CIENCIA & SAUDE COLETIVA 2017; 20:2731-47. [PMID: 26331505 DOI: 10.1590/1413-81232015209.09562014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Caring for a family member with an advanced and/or terminal illness can be a great emotional, physical and financial burden that has an impact on the quality of life of the caregivers. The scope of this study was to conduct a systematic review of the literature on the burden of caregiving, related factors and the consequences for family caregivers of advanced stage cancer patients or patients in end-of-life or palliative care. A search for scientific papers published in the EBSCO, Web of Knowledge and BIREME databases was conducted since records on this topic began in the databases through March 2014. Of the 582 articles found, only 27 were selected. The majority of the articles found that family caregivers were overburdened. Some studies found that the care-giving burden was associated with characteristics of the patients and their illnesses while, in other studies, it was associated with poor health of the caregiver, greater psychopathological symptoms (anxiety, depression, emotional distress) and with the development of complications in the grieving process. However, hope, social support, the ability of the caregiver to attribute meaning to the experience of caring and feeling comfortable with the tasks of caring were associated with lower levels of burden.
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Affiliation(s)
| | - Joana Presa
- Unidade de Medicina Paliativa, Centro Hospitalar Lisboa Norte, PT
| | - António Barbosa
- Unidade de Medicina Paliativa, Centro Hospitalar Lisboa Norte, PT
| | - Isabel Leal
- Instituto Superior de Psicologia Aplicada, Lisboa, PT,
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Thomsen KT, Guldin MB, Nielsen MK, Ollars CL, Jensen AB. A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care. BMC Palliat Care 2017; 16:23. [PMID: 28390401 PMCID: PMC5385034 DOI: 10.1186/s12904-017-0196-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far. Methods This study tested the feasibility of an intervention based on key elements of the “Bereavement support standards for specialist palliative care services” in a Danish specialised palliative home care team. We followed the UK Medical Research Council’s guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors. Results The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. Conclusion The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.
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Affiliation(s)
- Kia Toft Thomsen
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
| | - Mai-Britt Guldin
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark.,The Palliative Team, Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
| | - Mette Kjærgaard Nielsen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark
| | - Chaitali Laura Ollars
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
| | - Anders Bonde Jensen
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
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Rosa F, Bagnasco A, Aleo G, Kendall S, Sasso L. Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review. Nurs Open 2017; 4:61-75. [PMID: 28286662 PMCID: PMC5340167 DOI: 10.1002/nop2.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/29/2016] [Indexed: 11/24/2022] Open
Abstract
AIMS This paper was a report of the synthesis of evidence on examining the origins and definitions of the concept of resilience, investigating its application in chronic illness management and exploring its utility as a means of understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease. BACKGROUND Resilience is a concept that is becoming relevant to understanding how individuals and families live with illness, especially long-term conditions. Caregivers of adults with Chronic Obstructive Pulmonary Disease must be able to respond to exacerbations of the condition and may themselves experience cognitive imbalances. Yet, resilience as a way of understanding family caregiving of adults with COPD is little explored. DESIGN Literature review - integrative review. DATA SOURCES CINAHL, PubMed, Google Scholar and EBSCO were searched between 1989-2015. REVIEW METHODS The principles of rapid evidence assessment were followed. RESULTS We identified 376 relevant papers: 20 papers reported the presence of the concept of resilience in family caregivers of chronic diseases patients but only 12 papers reported the presence of the concept of resilience in caregivers of Chronic Obstructive Pulmonary Disease patients and have been included in the synthesis. The term resilience in Chronic Obstructive Pulmonary Disease caregiving is most often understood using a deficit model of health.
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Affiliation(s)
- Francesca Rosa
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | | | - Giuseppe Aleo
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Sally Kendall
- Centre for Research in Primary and Community Care (CRIPACC)University of HertfordshireHatfieldUK
| | - Loredana Sasso
- Department of Health SciencesUniversity of GenoaGenoaItaly
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Heaslip V, Hean S, Parker J. The etemic model of Gypsy Roma Traveller community vulnerability: is it time to rethink our understanding of vulnerability? J Clin Nurs 2017; 27:3426-3435. [PMID: 27505706 DOI: 10.1111/jocn.13499] [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] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To present a new etemic model of vulnerability. BACKGROUND Despite vulnerability being identified as a core consequence of health and health experiences, there has been little research exploring the meaning of vulnerability as a concept. Yet, being vulnerable is known to have dire physical/mental health consequences. It is therefore a fundamental issue for nurses to address. To date, the meaning of the term vulnerability has been influenced by the work of Spiers (Journal of Advanced Nursing, 31, 2000, 715, The Essential Concepts of Nursing: Building Blocks for Practice, 2005, Elsevier, London). Spiers identified two aspects of vulnerability: the etic (external judgment of another persons' vulnerability) and the emic (internal lived experience of vulnerability). This approach has led to a plethora of research which has explored the etic (external judgment) of vulnerability and rendered the internal lived (or emic) experience invisible. Consequences of this, for marginalised communities such as Gypsy Roma Travellers include a lack of culturally sensitive services compounding health inequalities. DESIGN Position paper. METHOD Drawing upon a qualitative phenomenological research study exploring the lived experience of vulnerability from a Gypsy Roma Travelling community (published previously), this paper presents a new model of vulnerability. This etemic model of vulnerability values both external and internal dimensions of vulnerability and argues for a fusion of these two opposing perspectives. CONCLUSIONS If nurses and other health- and social care professionals wish to develop practice that is successful in engaging with Gypsy Roma Travellers, then there is a need to both understand and respect their community. This can be achieved through an etemic approach to understanding their vulnerability achieved by eliciting lived experience alongside the appreciation of epidemiological studies. RELEVANCE TO CLINICAL PRACTICE If nurses and health practitioners used this etemic approach to practice then it would enable both the development and delivery of culturally sensitive services facilitating health access to this community. Only then, will their poor health status be successfully addressed.
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Affiliation(s)
- Vanessa Heaslip
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sarah Hean
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.,University of Stavanger, Stavanger, Norway
| | - Jonathan Parker
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Jeong A, An JY, Park JH, Park K. What cancer means to the patients and their primary caregivers in the family-accounted Korean context: A dyadic interpretation. Psychooncology 2017; 26:1777-1783. [PMID: 28035731 DOI: 10.1002/pon.4364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE When cancer hits a family, the entire family members start to adapt to the new status. This study aimed to investigate the main issue of the family with cancer patient and their way of solving it. METHODS In-depth interviews were conducted as a qualitative research. Thirty-three participants described their experience either as cancer patients or as family caregivers. RESULTS Guided by the grounded theory, we identified the main concern of the families being primary caregiver selection. The primary caregiver was determined by the conditions of the patient and the family, but the primary caregiver accepted his/her role believing no alternative was plausible in the family. The processes of the entire family have change since cancer showed their "adapting living," which was identified as the core variable. CONCLUSIONS On the basis of the current study's limitations, suggestions were made for future studies in which cultural attributes are distinguished from the medical system attributes.
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Affiliation(s)
- Ansuk Jeong
- Department of Psychology, University of Utah Asia Campus, Incheon, South Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, South Korea
| | - Keeho Park
- Department of Cancer Control and Policy/ Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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Martín JM, Olano-Lizarraga M, Saracíbar-Razquin M. The experience of family caregivers caring for a terminal patient at home: A research review. Int J Nurs Stud 2016; 64:1-12. [DOI: 10.1016/j.ijnurstu.2016.09.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
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Abma TA. Struggling with the Fragility of Life: a relational-narrative approach to ethics in palliative nursing. Nurs Ethics 2016; 12:337-48. [PMID: 16045242 DOI: 10.1191/0969733005ne799oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In nursing ethics the role of narratives and dialogue has become more prominent in recent years. The purpose of this article is to illuminate a relational-narrative approach to ethics in the context of palliative nursing. The case study presented concerns a difficult relationship between oncology nurses and a husband whose wife was hospitalized with cancer. The husband’s narrative is an expression of depression, social isolation and the loss of hope. He found no meaning in the process of dying and death. The oncology nurses were not able to recognize his emotional and existential problems. A narrative perspective inspired by relational ethics indicates that participants may develop a relational narrative that seeks good for all involved in a situation. In palliative nursing this entails open communication about the fragility of life and approaching death. In relational narratives, answers to these ethical dilemmas are co-authored, contingent and contextual.
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Affiliation(s)
- Tineke A Abma
- Institute for Healthcare Ethics and Philosophy, University of Maastricht, Post Box 616, 6200 MD Maastricht, The Netherlands.
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42
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Mohamed NE, Gilbert F, Lee CT, Sfakianos J, Knauer C, Mehrazin R, Badr H, Wittmann D, Downs T, Berry D, Given B, Wiklund P, Steineck G. Pursuing Quality in the Application of Bladder Cancer Quality of Life Research. Bladder Cancer 2016; 2:139-149. [PMID: 27376136 PMCID: PMC4927895 DOI: 10.3233/blc-160051] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient-reported outcomes (PRO), including health-related quality of life (HRQOL) measures, represent important means for evaluating patients' health outcomes and for guiding health care decisions made by patients, practitioners, investigators, and policy makers. In spite of the large number of studies examining HRQOL in patients with bladder cancer, very few review articles investigated this topic. Because these review studies report mixed results, incorporating bladder cancer HRQOL measures into standard urological practice is not a viable option. In this non-systematic review of the literature and commentary we note some general concerns regarding PRO research, but our primary focus is on the HRQOL methodology within the context of two types of bladder cancer: muscle invasive and non-muscle invasive bladder cancer. Considering bladder cancer HRQOL as the interaction of four areas of the assessment process (i.e., what model of HRQOL to choose, what instruments are available to fit the choice, how interpretation of the resulting data fits the model, and how to derive some utility from the chosen model) and the two types of disease (i.e., muscle invasive and non-muscle invasive) may move us toward a better understanding of bladder cancer HRQOL. Establishing a useful model of perceived general health or specific symptoms is the first and most important step in developing the responsive bladder cancer HRQOL measures necessitated by clinical settings.
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Affiliation(s)
- N E Mohamed
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | | | - C T Lee
- Department of Urology, University of Michigan , Ann Arbor, MI, USA
| | - J Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - C Knauer
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - R Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - H Badr
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | | | - T Downs
- Department of Urology, University of Wisconsin , Madison, WI, USA
| | - D Berry
- Dana-Farber Cancer Institute , Boston, MA, USA
| | - B Given
- Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute , Boston, MA, USA
| | - P Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - G Steineck
- Division of Clinical Cancer Epidemiology, Sahlgrenska universitetssjukhuset , Göteborg, Sweden
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Royackers A, Regan S, Donelle L. The eShift model of care: informal caregivers’ experience of a new model of home-based palliative care. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1179/1743291x15y.0000000006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Robinson J, Gott M, Gardiner C, Ingleton C. A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs. Palliat Med 2015; 29:703-10. [PMID: 25769983 DOI: 10.1177/0269216315575841] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The acute hospital plays a significant role in caring for people with a life-limiting illness. Most research to date has focused exclusively upon the negative aspects of hospitalisation. Currently, there is little known about the benefits of hospital admissions for patients with palliative care needs. AIM The aim of this study was to explore the benefits of hospital admissions, from the perspectives of patients with palliative care needs. DESIGN A qualitative study design was adopted. Longitudinal, semi-structured, face-to-face interviews were used to elicit the views of patients admitted to hospital in one large urban acute hospital in New Zealand. SETTING/PARTICIPANTS The study sample comprised 14 patients admitted to Auckland City Hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need. RESULTS Through a process of thematic analysis, four themes were identified from the data: being cared for and feeling safe, receiving care to manage at home, relief for family and 'feeling better and/or getting better'. The benefits of being in hospital were reported to extend beyond treatments received. Most participants reported their preference was to come to hospital even if they had been able to access the care they received in hospital at home. CONCLUSION This research contributes to a greater understanding of the benefits associated with hospitalisation for patients with palliative care needs. The findings suggest that such benefits extend beyond the treatment patients receive and challenge current assumptions regarding the role of the acute hospital in palliative care.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand Auckland City Hospital, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Clare Gardiner
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Morris SM, King C, Turner M, Payne S. Family carers providing support to a person dying in the home setting: A narrative literature review. Palliat Med 2015; 29:487-95. [PMID: 25634635 PMCID: PMC4436280 DOI: 10.1177/0269216314565706] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND This study is based on people dying at home relying on the care of unpaid family carers. There is growing recognition of the central role that family carers play and the burdens that they bear, but knowledge gaps remain around how to best support them. AIM The aim of this study is to review the literature relating to the perspectives of family carers providing support to a person dying at home. DESIGN A narrative literature review was chosen to provide an overview and synthesis of findings. The following search terms were used: caregiver, carer, 'terminal care', 'supportive care', 'end of life care', 'palliative care', 'domiciliary care' AND home AND death OR dying. DATA SOURCES During April-May 2013, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Pubmed, Cochrane Reviews and Citation Indexes were searched. Inclusion criteria were as follows: English language, empirical studies and literature reviews, adult carers, perspectives of family carers, articles focusing on family carers providing end-of-life care in the home and those published between 2000 and 2013. RESULTS A total of 28 studies were included. The overarching themes were family carers' views on the impact of the home as a setting for end-of-life care, support that made a home death possible, family carer's views on deficits and gaps in support and transformations to the social and emotional space of the home. CONCLUSION Many studies focus on the support needs of people caring for a dying family member at home, but few studies have considered how the home space is affected. Given the increasing tendency for home deaths, greater understanding of the interplay of factors affecting family carers may help improve community services.
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Affiliation(s)
- Sara M Morris
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Claire King
- Health and Care Directorate, Cumbria County Council, Carlisle, UK
| | - Mary Turner
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sheila Payne
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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46
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Totman J, Pistrang N, Smith S, Hennessey S, Martin J. 'You only have one chance to get it right': A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer. Palliat Med 2015; 29:496-507. [PMID: 25634637 DOI: 10.1177/0269216314566840] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relatives looking after a terminally ill family member at home face numerous challenges. Studies into relatives' experiences of home caregiving have been criticised for their descriptive nature and lack of theoretical underpinnings. AIM To explore the emotional challenges faced by home caregivers, and their experiences of healthcare professionals, from the perspective of existential psychology. DESIGN A qualitative study using semi-structured interviews. Transcripts were analysed thematically using the Framework approach. SETTING/PARTICIPANTS The study took place within an inner-city London hospice. Participants (n = 15) were recently bereaved adult relatives of cancer patients who cared for their family member at home. RESULTS Participants' experiences of being a caregiver and of professional support were highly varied. The analysis generated 15 themes which were organised into a framework based on Yalom's four 'existential conditions': responsibility (e.g. 'being the linchpin of care'; 'you only have one chance to get it right'), isolation (e.g. 'being on my own', 'being held in mind'), death (e.g. 'knowing but not knowing') and meaningfulness (e.g. 'giving something back', 'acceptance and gratitude'). Healthcare professionals were perceived as influential in both helping and hindering relatives in meeting the challenges they faced. CONCLUSION Existential psychology provides a theoretical perspective from which to understand the psychological complexity of the emotional challenges home caregivers face and a framework which may usefully inform research and clinical practice. Professionals' attentiveness to caregivers' needs can have powerful effects in assuaging anxiety, reducing isolation and enabling relatives to connect with the meaningfulness of caregiving.
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Affiliation(s)
- Jonathan Totman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nancy Pistrang
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Susan Smith
- Dimbleby Cancer Care Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Jonathan Martin
- St Joseph's Hospice Hackney, London, UK Harris Manchester College, University of Oxford, Oxford, UK
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Doherty LC, Fitzsimons D, McIlfatrick SJ. Carers’ needs in advanced heart failure: A systematic narrative review. Eur J Cardiovasc Nurs 2015; 15:203-12. [DOI: 10.1177/1474515115585237] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/13/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Leanne C Doherty
- Institute of Nursing and Health Research, Ulster University, Northern Ireland
- All-Ireland Institute for Hospice and Palliative Care, Our Lady’s Hospice, Ireland
| | - Donna Fitzsimons
- Institute of Nursing and Health Research, Ulster University, Northern Ireland
- Belfast Health and Social Care Trust, Malone Place Clinic, Ireland
| | - Sonja J McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Northern Ireland
- All-Ireland Institute for Hospice and Palliative Care, Our Lady’s Hospice, Ireland
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Selman L, Beynon T, Radcliffe E, Whittaker S, Orlowska D, Child F, Harding R. ‘We're all carrying a burden that we're not sharing’: a qualitative study of the impact of cutaneous T-cell lymphoma on the family. Br J Dermatol 2015; 172:1581-1592. [DOI: 10.1111/bjd.13583] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- L.E. Selman
- Department of Palliative Care, Policy and Rehabilitation; Cicely Saunders Institute; King's College London; Bessemer Rd London SE5 9PJ U.K
| | - T. Beynon
- Department of Palliative Care, Policy and Rehabilitation; Cicely Saunders Institute; King's College London; Bessemer Rd London SE5 9PJ U.K
| | - E. Radcliffe
- Department of Palliative Care, Policy and Rehabilitation; Cicely Saunders Institute; King's College London; Bessemer Rd London SE5 9PJ U.K
| | - S. Whittaker
- St. John's Institute of Dermatology; Guy's and St. Thomas' NHS Foundation Trust; London U.K
| | - D. Orlowska
- St. John's Institute of Dermatology; Guy's and St. Thomas' NHS Foundation Trust; London U.K
| | - F. Child
- St. John's Institute of Dermatology; Guy's and St. Thomas' NHS Foundation Trust; London U.K
| | - R. Harding
- Department of Palliative Care, Policy and Rehabilitation; Cicely Saunders Institute; King's College London; Bessemer Rd London SE5 9PJ U.K
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Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse. Palliat Med 2015; 29:138-46. [PMID: 25249242 DOI: 10.1177/0269216314551813] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND UK District Nurses have an important role in enabling a good death. Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. District Nurses spend a lot of time with patients and families during the dying phase and are ideally placed to recognise and discuss the transition to dying. AIM To explore the role of District Nurses in breaking bad news of transition to dying. DESIGN Qualitative focus groups. SETTING Primary care (District Nurse service); Four National Health Service Trusts, North West England. PARTICIPANTS A total of 40 District Nurses across the Trusts, all Registered General Nurse qualified. Median number of years as a District Nurse was 12.5. All had palliative cancer patients on their caseloads. RESULTS District Nurses' role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients' responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work. CONCLUSIONS District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care.
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Affiliation(s)
- Jane Griffiths
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Charlotte Wilson
- Barts & The London School of Medicine Centre for Primarly care and Public Health, London, UK
| | - Michael Connolly
- Supportive and Palliative Care, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Measuring caregiver outcomes in palliative care: a construct validation study of two instruments for use in economic evaluations. Qual Life Res 2014; 24:1255-73. [PMID: 25381122 DOI: 10.1007/s11136-014-0848-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Providing care to patients nearing the end of life can place a considerable burden on caregivers. Hence, policy decisions on interventions in palliative care should be guided by information on this burden. This study investigates construct validation of two preference-based caregiver outcome instruments suitable for economic evaluations: the Carer Experience Scale (CES) and the Care-related Quality of Life (CarerQol) instrument. Moreover, this study reports caregiver experiences in end-of-life care. METHODS Data were collected with written questionnaires among caregivers of patients receiving palliative care services in the Southern metropolitan area of Adelaide, South Australia (n = 97). The effect of caregiving on caregivers was measured with the CES, CarerQol, Process Utility (PU) and Caregiver Strain Index (CSI). Convergent, discriminative and clinical validity were studied. RESULTS As hypothesized, higher negative effect of caregiving measured on the CES was associated with higher negative effect on the CarerQol. Both the CES and CarerQol were associated in the expected positive direction with less strain from caregiving (CSI), more positive care experiences and more PU from caring. Caregivers' and care recipients' health status and duration of caregiving were negatively associated with caring experiences. CONCLUSIONS Our findings suggest that the CES and CarerQol validly assess the effect of caregiving on caregivers in end-of-life care. Economic evaluations in end-of-life care should attempt to incorporate such instruments to provide a more holistic assessment of the true impact of interventions, especially where family and friends are heavily involved in caregiving.
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