Perspectives of Elderly Veterans Regarding Communication with Medical Providers about End-of-Life Care

Psychometric evaluation of the patient perspective on care and rehabilitation scale in geriatric patients

OBJECTIVES

This methodological study was conducted to psychometrically evaluate the Patient Perspective on Care and Rehabilitation Scale in geriatric patients.

METHODS

This study was conducted with 209 elderly individuals aged 65 years or older who were hospitalized in a hospital in Turkey between March and September 2017. The data were collected by using the Elderly Information Questionnaire prepared by the researcher and the Turkish version of the Patient Perspective on Care and Rehabilitation Scale. Cronbach's Alpha and item-total correlation for the internal consistency, reliability and intraclass correlation coefficients for the test-retest reliability, and Bartlett's test and Kaiser-Meyer-Olkin (KMO) were used for the validity of the scale.

RESULTS

that the result of the KMO test was significant at .87, and the result of the Bartlett's test was significant on the level of p: .001. The Cronbach's Alpha value was found as 0.89 for the overall PaPeR scale and between .84 and .87 for the subscales of PaPeR. In factor analysis, the eigenvalue was above 1, the scale covered 2 factors and accounted for 53.7% of the total variance.

CONCLUSION

The validity and reliability analysis conducted in this study provided evidence for the acceptability of the scale. The Turkish version of the scale is easy to understand and allows evaluation of patient perspectives on quality of care and rehabilitation in geriatric patients. It is recommended to reach larger populations and apply the scale in different regions.

Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies

BACKGROUND

Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging.

AIM

To understand the experiences and perspectives of older people regarding advance care planning.

DESIGN

A systematic review of qualitative studies and meta-synthesis was conducted.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched.

RESULTS

A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care.

CONCLUSION

Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

A systematic review of the associations between empathy measures and patient outcomes in cancer care

OBJECTIVE

Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology.

METHOD

With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes.

RESULTS

Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping).

CONCLUSION

Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed.

Nebraska veterans' preferences for end-of-life care

More than 1,800 veterans die in a variety of healthcare settings each day, illustrating a need to improve their end-of-life (EOL) care. In 2006, the Nebraska End-of-Life Survey was mailed to 2,713 urban and rural Nebraskan adults' homes; 44 of 324 first-time respondents (14%) were veterans. This article compares survey responses from veterans and nonveterans and discusses four issues: personal desires during the dying process, fear of dying, completion of advance directives, and communication preferences. Compared to nonveterans, veterans were significantly less likely to want friends or family visiting at EOL, less likely to place importance on being at peace spiritually, less afraid of dying alone, more likely to turn to a spouse to initiate EOL conversations, and less trusting of primary physicians on EOL issues. In addition, veterans had higher rates of completion of advance directives. Examining the survey responses can help guide clinical oncology nurses in delivering EOL care to veterans.

Family caregivers, patients and physicians: ethical guidance to optimize relationships

Family caregivers play a major role in maximizing the health and quality of life of more than 30 million individuals with acute and chronic illness. Patients depend on family caregivers for assistance with daily activities, managing complex care, navigating the health care system, and communicating with health care professionals. Physical, emotional and financial stress may increase caregiver vulnerability to injury and illness. Geographically distant family caregivers and health professionals in the role of family caregivers may suffer additional burdens. Physician recognition of the value of the caregiver role may contribute to a positive caregiving experience and decrease rates of patient hospitalization and institutionalization. However, physicians may face ethical challenges in partnering with patients and family caregivers while preserving the primacy of the patient-physician relationship. The American College of Physicians in conjunction with ten other professional societies offers ethical guidance to physicians in developing mutually supportive patient-physician-caregiver relationships.

A comfortable place to say goodbye

No death is easy, but we hope to die peacefully, with our loved ones surrounding us, comforted by each other's presence and the knowledge that the right decision has been made. The nurse's actions in the intensive care unit setting can promote hope for a comfortable place to say goodbye for the patient and his/her loved ones and the nursing staff and physicians. When nurses make the intensive care unit a comfortable place for the dying patients and their loved ones, we also make the patients' deaths comfortable for us. The problems encountered in implementing end-of-life care are explored in this article, as well as strategies to instill hope in families.

Latinas with abnormal breast findings: patient predictors of timely diagnostic resolution

BACKGROUND

Incomplete or delayed diagnostic resolution of breast abnormalities suspicious for cancer may contribute to poor breast cancer outcomes among ethnic minority women. We examine the effects of socioeconomic characteristics, knowledge, barriers to healthcare, communication, and clinical variables on diagnostic resolution in Latina women with breast abnormalities at two Los Angeles County public hospitals.

METHODS

We analyzed telephone survey data for 714 women. The outcome--timely diagnostic resolution--was based on medical record data and defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral. Predictors of the outcome were obtained from a telephone survey and examined with bivariate and multivariable logistic regression models.

RESULTS

Only 60% of women received timely diagnostic resolution; however, the proportion was higher at hospital B (73%) compared with hospital A (56%). In the total sample, the odds of timely diagnostic resolution increased by 8% for every point increase in the scale of satisfaction with how physicians explained the breast abnormality. At hospital B, the odds of timely resolution increased by 57% for every 10-year increase in age.

CONCLUSIONS

Consistent with findings of other studies, our data indicate low diagnostic resolution among Latina women. Satisfaction with how physicians explained breast abnormalities and the interaction of hospital with age affected timely diagnostic resolution. Future research might focus on developing interventions that offer concrete communication strategies to patients and providers. Health systems must also establish systems that facilitate effective patient-provider communication.

Medical residents' perspectives on discussions of advanced directives: can prior experience affect how they approach patients?

INTRODUCTION

Resident physicians are inadequately taught how to communicate with patients about end-of-life decision making. Their beliefs about resuscitation and prior experiences with end-of-life care may impact the manner in which they approach patients.

OBJECTIVE

To explore residents' perceptions of end-of-life discussions, determine the features they find most important, and discern the challenges they face in this process.

METHODS

Internal medicine residents were surveyed about their experiences discussing resuscitation with patients including perceptions of patient understanding, outcomes of resuscitation, and regret about attempting to resuscitate patients. They were asked what features of these discussions are most important and which are the most challenging. Qualitative content analysis was used to examine the responses to open-ended questions.

RESULTS

Fifty-five residents completed the survey. Residents reported rarely feeling satisfied with the results of these discussions and disagreed with the decision for resuscitation numerous times. They perceive that few patients and families understand resuscitation. In their description of important features, they focus on the content of the discussion rather than the process, with the most common responses centering on a description of resuscitation. In contrast, the greatest challenge they identify is dealing with the emotional aspects of the discussion.

CONCLUSIONS

Residents report internal conflict about their experiences discussing resuscitation with patients. Their approach to these discussions focuses on resuscitation itself with less attention paid to processes that might improve patient decision making. The challenges they describe may be overcome with improved education about end-of-life communication.

Communication Strategies and Cultural Issues in the Delivery of Bad News

Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. This article provides an overview of the evidence for communication strategies in delivering bad news and discussing advance care planning. In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.