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Lahijani S, Rueda-Lara M, McAndrew N, Nelson AM, Guo M, Knight JM, Wiener L, Miran DM, Gray TF, Keane EP, Yek MH, Sannes TS, Applebaum AJ, Fank P, Babu P, Pozo-Kaderman C, Amonoo HL. A Biobehavioral Perspective on Caring for Allogeneic Hematopoietic Stem Cell Transplant Survivors with Graft-Versus-Host Disease. Transplant Cell Ther 2024; 30:S493-S512. [PMID: 39370233 DOI: 10.1016/j.jtct.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 10/08/2024]
Abstract
Among the potential complications of allogeneic hematopoietic stem cell transplantation (HSCT), graft-versus-host disease (GVHD) is common and associated with significant physical and psychosocial symptom burden. Despite substantial advances in GVHD treatment, the global immune suppression that frequently accompanies GVHD treatment also contributes to high rates of physical and emotional suffering and mortality. The complex manifestations of GVHD and its treatment warrant a multidisciplinary team-based approach to managing patients' multi-organ system comorbidities. A biobehavioral framework can enhance our understanding of the complex association between medications, physical symptoms, and psychosocial distress in patients with GVHD. Hence, for this perspective, we highlight the importance of addressing both the physical and psychosocial needs experienced by patients with GVHD and provide guidance on how to approach and manage those symptoms and concerns as part of comprehensive cancer care.
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Affiliation(s)
- Sheila Lahijani
- Department of Psychiatry, Stanford University School of Medicine and Stanford Cancer Center Psychosocial Oncology Program, Stanford, California
| | - Maria Rueda-Lara
- Department of Psychiatry, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Natalie McAndrew
- School of Nursing, College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; Department of Patient Care Research, Froedtert & The Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin
| | - Ashley M Nelson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Michelle Guo
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Damien M Miran
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tamryn F Gray
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emma P Keane
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ming Hwei Yek
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Timothy S Sannes
- Department of Psychiatry, UMass Chan Medical School, Worcester, Massachusetts; UMass Memorial Cancer Center, Worcester, Massachusetts
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patricia Fank
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Pallavi Babu
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Cristina Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Balle CK, Hvidtjørn D, Brintow MLB, Wu C, Prinds C. Existential communication in maternity care - Mixed method evaluation of a postgraduate short course. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:100983. [PMID: 38820691 DOI: 10.1016/j.srhc.2024.100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The birth of a child is a significant life event, possibly accompanied by thoughts and feelings of existential turmoil, which some parents need to share. Maternity care professionals may be unprepared for this, as very few educational initiatives exist with a focus on existential communication. We evaluated the curriculum and delivery of a course in existential communication for midwives. The evaluation was based on participants' experiences of self-reported self-efficacy and self-reflection before and after participation. METHODS A parallel mixed methods design with pre- and post-course questionnaires and field observations. Quantitative data were evaluated using Mann-Whitney analyses, and open-ended questions and field observations were thematised for further analysis. RESULTS Seventy-three maternity care professionals participated in the course. Of these, 69 (95%) completed a pre-course questionnaire, and 71 (97%) a post-course questionnaire. The quantitative data found a significant difference in various participant measures such as increase in self-efficacy in existential communication and understanding of existential communication. Qualitative data from the questionnaires and field observations led to six different themes including topics such as the need for reflection with peers and the presence of existential within maternity care. CONCLUSIONS The course evaluation suggested an increase in participants' awareness of existential aspects of maternity care and improved self-reflection and existential awareness.
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Affiliation(s)
- Cæcilie Kongsgaard Balle
- University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
| | - Dorte Hvidtjørn
- University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Chunsen Wu
- University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Christina Prinds
- University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; University Hospital South Denmark, Kresten Philipsensvej 15, 6200 Aabenraa, Denmark
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Klimasiński MW, Baum E, Wieczorowska-Tobis K, Stelcer B. Improving Spiritual Well-Being of Polish Pain Outpatients: A Feasibility Mixed Methods Study. J Clin Med 2024; 13:3615. [PMID: 38930144 PMCID: PMC11204423 DOI: 10.3390/jcm13123615] [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: 05/02/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction: A physician in a chronic pain treatment clinic must recognize that the relationship between pain and spirituality is bidirectional. Chronic pain can decrease the level of spiritual well-being, and low spiritual well-being can also significantly intensify the perception of pain and worsen coping with it. Currently, for many scientific and medical communities, it is evident that spiritual care is an indispensable element of holistic medicine. Objective: The authors developed a non-religious spiritual care model provided by a physician at a chronic pain treatment clinic from May 2022 to February 2024. Method: The study utilized a mixed-method approach to conduct the research. The analysis consisted of twelve patients. A FACIT-Sp-12 questionnaire evaluated the individual's spiritual well-being before the intervention. The intervention involved asking patients open-ended questions about their life history, experiences, and spiritual beliefs and the physician's use of active listening and empathetic responses to what patients shared (relationship-building activities). The intervention aimed to assist patients in accepting the limitations of an incurable chronic disease, affirming the value of their lives, enhancing inner harmony, and increasing their sense of belonging to something greater. After the intervention, a re-assessment of the patient's spiritual well-being was conducted using the FACIT-Sp-12 questionnaire. Researchers collected qualitative data through a confidential survey that included the following instructions: "Please express an anonymous opinion on how you perceive the spiritual care provided by the physician". Results: There was an increase in spiritual well-being, assessed using the FACIT-Sp-12 scale, in 9 out of 12 patients. The median, as well as the average, level of spiritual well-being increased in a statistically significant way after the intervention (p < 0.05). This was primarily due to the higher value of the peace subscale of the questionnaire. Qualitative analysis revealed benefits reported by patients (personal development, gratitude, satisfaction, support, hope) resulting from physician's actions. Conclusions: Both qualitative and quantitative data showed that establishing a relationship with the doctor improves the spiritual well-being of patients. Therefore, this model can be recommended for physicians in chronic pain treatment clinics.
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Affiliation(s)
| | - Ewa Baum
- Katedra Nauk Społecznychi Humanistycznych, Uniwersytet Medyczny w Poznaniu, 61-701 Poznań, Poland;
| | | | - Bogusław Stelcer
- Katedra Psychologii Klinicznej, Uniwersytet Medyczny w Poznaniu, 61-701 Poznań, Poland;
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Andersen AH, Illes Z, Roessler KK. Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:2375-2390. [PMID: 36071298 DOI: 10.1007/s10943-022-01658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.
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Affiliation(s)
- Aida Hougaard Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Kirsten Kaya Roessler
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Discussing spiritual health in primary care and the HOPE tool—A mixed methods survey of GP views. PLoS One 2022; 17:e0276281. [PMID: 36346826 PMCID: PMC9642893 DOI: 10.1371/journal.pone.0276281] [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: 05/17/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the UK, the General Medical Council (GMC) and Royal College of General Practitioners (RCGP) require doctors to consider spiritual health in their consultations. There are documented barriers to discussion of spiritual health, and suggested tools to help overcome them. Aim To investigate how comfortable general practitioners (GPs) feel about discussing spiritual health in the consultation, and whether a structured tool (the HOPE tool) would be helpful. Design and setting A mixed-methods online survey completed by GPs in England. Method A mixed methods online survey of practicing GPs in England asked about current comfort with the topic of spiritual health and use of spiritual history-taking tools. The acceptability of the HOPE tool was investigated using patient vignettes drawn from clinical practice. Results 177 GPs responded. 88 (49.71%) reported that they were comfortable asking patients about spiritual health. GPs felt most comfortable raising the topic after a patient cue (mean difference between pre and post cue 26%). The HOPE tool was viewed as acceptable to use with patients by 65% of participants, although its limitations were acknowledged. Qualitative data showed concerns about regulator (the GMC) and peer disapproval were major barriers to discussions, especially in the case of discordance between patient and doctor background. Conclusion Only half of GPs are comfortable discussing spiritual health. Dedicated training, using a structured approach, with regulatory approval, may help overcome barriers to GPs discussing spiritual health. Further research into the benefits, and risks, of discussion of spiritual health in the GP consultation is recommended.
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Larsen BH, Lundeby T, Gulbrandsen P, Førde R, Gerwing J. Physicians' responses to advanced cancer patients' existential concerns: A video-based analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:3062-3070. [PMID: 35738963 DOI: 10.1016/j.pec.2022.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE In a recent study, we explored what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation and how they communicate such concerns. The current study builds on these results, investigating how the physicians responded to those concerns. METHODS We analyzed video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. RESULTS We identified 185 immediate physician-responses to the 127 patient existential utterances we had previously identified. The responses demonstrated three approaches: giving the patient control over the content, providing support, and taking control over the content. The latter was by far the most common, through which the physicians habitually kept the discussion around biomedical aspects and rarely pursued the patients' existential concerns. CONCLUSIONS Although the physicians, to some extent, allowed the patients to talk freely about their concerns, they systematically failed to acknowledge and address the patients' existential concerns. PRACTICE IMPLICATIONS Physicians should be attentive to their possible habit of steering the agenda towards biomedical topics, hence, avoiding patients' existential concerns. Initiatives cultivating behavior enhancing person-centered and existential communication should be implemented in clinical practice and medical training.
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Affiliation(s)
- Berit Hofset Larsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Tonje Lundeby
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pål Gulbrandsen
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.
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Yan L, Tan J, Chen H, Yao L, Li Y, Zhao Q, Xiao M. Experience and support of Chinese healthcare professionals as second victims of patient safety incidents: A cross-sectional study. Perspect Psychiatr Care 2022; 58:733-743. [PMID: 33993485 DOI: 10.1111/ppc.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the experience and support of Chinese healthcare professionals as second victims of PSIs. DESIGN AND METHODS A cross-sectional study with anonymous online self-report questionnaires was adopted. A total of 1357 Chinese healthcare professionals participated in this study. The Chinese version of the Second Victim Experience and Support Tool (C-SVEST) was used to evaluate the experience of second victims and the quality of support resources. Descriptive and inferential statistics were employed to analyze the data. FINDINGS This study showed that 350 participants (25.8%) had been involved in PSIs during their careers. The majority of respondents who had experienced PSIs agreed they suffered more from psychological distress, followed by professional self-efficacy distress, and physical distress. Besides, they regarded colleague support and management support as the most desirable support. Statistically significant differences were reported in some items. First, compared with medical staff without professional titles, staff with professional titles suffered more from psychological distress but gained more support from colleagues. PRACTICE IMPLICATIONS The second victim phenomenon deserves further attention. The programs focusing on training qualified colleagues to provide emotional support should be developed, implemented, and evaluated. Moreover, it is necessary to build a better patient safety culture with nonpunitive responses and encourage the disclosure and reporting of PSIs.
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Affiliation(s)
- Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingxing Tan
- School of Nursing, University of South China, Hunan, China
| | - Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Nissen RD, Viftrup DT, Hvidt NC. The Process of Spiritual Care. Front Psychol 2021; 12:674453. [PMID: 34557128 PMCID: PMC8453153 DOI: 10.3389/fpsyg.2021.674453] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of this article is to illustrate and outline an understanding of spiritual care as a process involving a number of organically linked phases: (1) the identification of spiritual needs and resources, (2) understanding the patient's specific needs, (3) developing the individual spiritual care treatment plan, hereunder involving the relevant healthcare/spiritual care professionals, (4) the provision of spiritual care, and (5) evaluating the spiritual care provided. The focus on spiritual care in healthcare research has increased throughout the past decades, showing that existential, spiritual, and/or religious considerations and needs increase with life-threatening illness, that these needs intensify with the severity of disease and with the prospect of death. Furthermore, research has shown that spiritual care increases quality of life, but also that failing to provide spiritual care leads to increased chance of depression and lowered health conditions. The World Health Organization accordingly emphasizes that providing spiritual care is vital for enhancing quality-of-life. Looking at spiritual care as a process suggests that working within a defined conceptual framework for providing spiritual care, is a recommendable default position for any institution where spiritual care is part of the daily work and routines. This so, especially because looking at spiritual care as a process highlights that moving from identifying spiritual needs in a patient to the actual provision of spiritual care, involves deliberate and considered actions and interventions that take into account the specific cultural and ontological grounding of the patient as well as the appropriate persons to provide the spiritual care. By presenting spiritual care as a process, we hope to inspire and to contribute to the international development of spiritual care, by enabling sharing experiences and best-practices internationally and cross-culturally. This so to better approach the practical and daily dimensions of spiritual care, to better address and consider the individual patient's specific spiritual needs, be they secular, spiritual and/or religious. In the final instance, spiritual care has only one ambition; to help the individual human being through crisis.
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Affiliation(s)
- Ricko Damberg Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Andersen AH, Assing Hvidt E, Hvidt NC, Roessler KK. 'Maybe we are losing sight of the human dimension' - physicians' approaches to existential, spiritual, and religious needs among patients with chronic pain or multiple sclerosis. A qualitative interview-study. Health Psychol Behav Med 2020; 8:248-269. [PMID: 34040871 PMCID: PMC8114351 DOI: 10.1080/21642850.2020.1792308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Research suggests that existential, spiritual, and religious issues are important for patient’s psychological adjustment when living with chronic pain and multiple sclerosis. However, there is a paucity of studies investigating how physicians experience and approach these patients’ needs. Design Physicians’ experiences with and approaches to existential, spiritual, and religious needs when treating chronic pain or multiple sclerosis were studied in eight semi-structured interviews and analysed using interpretative phenomenological analysis (IPA). Results Physicians found that only few patients had spiritual and religious needs; however, they experienced that every patient were struggling with existential challenges related to the illness and rooted in a changed identity and approaching death. How the physicians approached these needs appeared to be influenced by six conditions: Their medical culture, training, role, experiences of time pressure, their personal interests, and interpersonal approach. Conclusion Physicians’ training seems better suited to meet biomedical objectives and their patients’ concrete needs than patients’ wish for a relational meeting focused on their subjective lifeworld. This challenge is discussed in relation to modern patient-centeredness, doctor-patient relationship, culturally constructed experiences of privacy, and future clinical practice and research needs.
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Affiliation(s)
- Aida Hougaard Andersen
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.,Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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Abstract
Spiritual care has been a growing focus in international healthcare research over the last decades. The approaches to spiritual care are many and derive from many different medical fields and different cultural contexts and often remain unknown across healthcare areas. This points to a potential knowledge gap between existing instruments and the knowledge and use of them cross-disciplinarily and cross-culturally, and thus best practice insights are not sufficiently shared. This article contributes to the growing field of spiritual care by providing an overview of the various approaches (henceforth instruments) to assess patients’ spiritual needs in view of improving spiritual care. This was done through a scoping review method. The results of the review were collected and catalogued and presented here as ‘The Catalogue of Spiritual Care Instruments’. The included instruments derive from a wide range of geographical contexts and healthcare areas and are aimed at patients and healthcare professionals alike, clearly showing that spiritual care is a focus in healthcare internationally. However, it also shows the difficulties of defining spiritual care, the importance of local contexts, and the difficulties of cross-cultural validity. The catalogue contains 182 entries and is available as an interactive platform for the further development of spiritual care internationally.
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Skovlund PC, Ravn S, Seibaek L, Thaysen HV, Lomborg K, Nielsen BK. The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings. J Patient Rep Outcomes 2020; 4:10. [PMID: 32048085 PMCID: PMC7013008 DOI: 10.1186/s41687-020-0174-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. METHODS PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patient-centred communication, a literature review, and didactic considerations. RESULTS The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. CONCLUSIONS This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should be applied in other clinical settings were patients are seen regularly. An evaluation of the tool is planned to be performed in future studies. Training in PROmunication may further systematic and consistent use of PRO data in the consultation, leading to patient-centred consultations and increased patient involvement.
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Affiliation(s)
- Pernille C. Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sissel Ravn
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Lene Seibaek
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 137, 8200 Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
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Affiliation(s)
- Erik Olsman
- a Section of Medical Ethics, Department of General Practice, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands.,b Section of Ethics and Law of Healthcare, Department of Neurology , Leiden University Medical Centre , Leiden , The Netherlands.,c Department of Spiritual Care , Hospice Bardo , Hoofddorp , The Netherlands
| | - Dick L Willems
- a Section of Medical Ethics, Department of General Practice, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
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13
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Schrøder K, Edrees HH, Christensen RD, Jørgensen JS, Lamont RF, Hvidt NC. Second victims in the labor ward: Are Danish midwives and obstetricians getting the support they need? Int J Qual Health Care 2018; 31:583-589. [DOI: 10.1093/intqhc/mzy219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/10/2018] [Accepted: 10/10/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katja Schrøder
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
- College of Health Sciences, Saudi Electronic University, Ministry of Education, Riyadh, Kingdom of Saudi Arabia
- Ministry of Economy & Planning, Riyadh, Kingdom of Saudi Arabia
| | - René dePont Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jan Stener Jørgensen
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ronald Frances Lamont
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Surgery, Northwick Park Institute for Medical Research Campus, University College London, London
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Hvidt EA, Ammentorp J, Søndergaard J, Timmermann C, Hansen DG, Hvidt NC. Developing and evaluating a course programme to enhance existential communication with cancer patients in general practice. Scand J Prim Health Care 2018; 36:142-151. [PMID: 29623752 PMCID: PMC6066852 DOI: 10.1080/02813432.2018.1459235] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our objective was to describe the development and evaluation of a course programme in existential communication targeting general practitioners (GPs). DESIGN The UK Medical Research Council's (MRC) framework for complex intervention research was used as a guide for course development and evaluation and was furthermore used to structure this paper. The development phase included: identification of existing evidence, description of the theoretical framework of the course, designing the intervention and deciding for types of evaluation. In the evaluation phase we measured self-efficacy before and after course participation. To explore further processes of change we conducted individual, semi-structured telephone interviews with participants. SUBJECTS AND SETTING Twenty practising GPs and residentials in training to become GPs from one Danish region (mean age 49). RESULTS The development phase resulted in a one-day vocational training/continuing medical education (VT/CME) course including the main elements of knowledge building, self-reflection and communication training. Twenty GPs participated in the testing of the course, nineteen GPs answered questionnaires measuring self-efficacy, and fifteen GPs were interviewed. The mean scores of self-efficacy increased significantly. The qualitative results pointed to positive post course changes such as an increase in the participants' existential self-awareness, an increase in awareness of patients in need of existential communication, and an increase in the participants' confidence in the ability to carry out existential communication. CONCLUSIONS A one-day VT/CME course targeting GPs and including the main elements of knowledge building, self-reflection and communication training showed to make participants more confident about their ability to communicate with patients about existential issues and concerns. Key points Patients with cancer often desire to discuss existential concerns as part of clinical care but general practitioners (GPs) lack confidence when discussing existential issues in daily practice. In order to lessen barriers and enhance existential communication in general practice, we developed a one-day course programme. Attending the course resulted in an increase in the participants' confidence in the ability to carry out existential communication. This study adds knowledge to how confidence in existential communication can be increased among GPs.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark;
- CONTACT Elisabeth Assing HvidtJ.B. Winsløwsvej 9A, DK-5000 Odense C, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, and Institute for Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark;
| | - Connie Timmermann
- Health Services Research Unit, Lillebaelt Hospital, and Institute for Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Dorte Gilså Hansen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark;
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark;
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