Quality of life, day hospice needs, and satisfaction of community-dwelling patients with advanced cancer and their caregivers in Japan

Expert Perspectives on the Additional Benefit of Day Hospices and Palliative Day Care Clinics in Germany: A Qualitative Approach

Background: In Germany, hospice and palliative care is well covered through inpatient, outpatient, and home-based care services. It is unknown if, and to what extent, there is a need for additional day care services to meet the specific needs of patients and caregivers. Methods: Two day hospices and two palliative day care clinics were selected. In the first step, two managers from each facility (n = 8) were interviewed by telephone, using a semi-structured interview guide. In the second step, four focus groups were conducted, each with three to seven representatives of hospice and palliative care from the facilities' hospice and palliative care networks. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using qualitative content analysis. Results: The interviewed experts perceived day care services as providing additional patient and caregiver benefits. Specifically, the services were perceived to meet patient needs for social interaction and bundled treatments, especially for patients who did not fit into inpatient settings (due to, e.g., their young age or a lack of desire for inpatient admission). The services were also perceived to meet caregiver needs for support, providing short-term relief for the home care situation. Conclusions: The results suggest that inpatient, outpatient, and home-based hospice and palliative care services do not meet the palliative care needs of all patients. Although the population that is most likely to benefit from day care services is assumed to be relatively small, such services may meet the needs of certain patient groups more effectively than other forms of care.

Status, demand and practice models of palliative day-care clinics and day hospices: a scoping review

BACKGROUND

Little is known about the structure, accessibility, service provision and needs of palliative and hospice day-care in Germany and abroad. Researchers, healthcare providers and policy makers would benefit from a systematic overview.

AIM

The aim was to identify, describe and summarise available evidence on status, demand and practice models of palliative day-care clinics and day hospices. A secondary aim was to disclose research gaps and present recommendations for clinical practice and future research.

DESIGN

The scoping review followed the methodological framework of Arksey and O'Malley. The analysed publications included studies of varying kinds to describe the current state of the art.

DATA SOURCES

Using a highly sensitive search strategy, the authors searched PubMed, Web of Science Core Collection, CINAHL and Google Scholar within the publication window of inception to 12 June 2020. An additional hand search of the reference lists of the identified review articles was conducted.

RESULTS

The authors screened the titles and abstracts of 2643 studies, retrieved 197 full texts and included 32 articles in the review. The review identified nine major themes: (1) the referral process, (2) models of care, (3) patient characteristics, (4) demand, (5) the discharge process, (6) perceptions of services, (7) funding and costs, (8) outcome measurement and (9) education.

CONCLUSIONS

There is a need for further research to identify groups of patients who would receive the most benefit from palliative and hospice day-care and to determine any necessary revisions in admission criteria.

Unmet supportive care needs and determinants among cancer patients treated at University of Gondar Specialized Hospital, Northwest Ethiopia: A prospective cross-sectional study

BACKGROUND

Assessment of supportive care needs is an important requirement to plan supportive care intervention. This study aimed to assess the unmet supportive care needs of cancer patients treated at the University of Gondar Specialized Hospital, Ethiopia.

METHODS

A prospective cross-sectional study was conducted from January 1, 2017 to August 30, 2017. Adult (18 years and greater) cancer patients and those who were receiving therapy were included. The 34-Item short-form Supportive Care Needs Survey(SCNS-SF34) tool was used to assess unmet needs. The data collected were analyzed using SPSS version-21.

RESULTS

A total of 150 interview guides were included in the analysis (97.4% of response rate). In the majority of 65(43.3%) the participants, the disease was metastasized even though they have undergone surgery 78 (52%). The overall mean score level of unmet need for cancer care was 3.49. The highest unmet need mean score was reported from the health system and information need domain. A significant unmet need difference concerning different need domain was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors for unmet supportive care needs.

CONCLUSION

The overall level of unmet need was high. A significant unmet need difference was found in sex, age, residence, occupation status, and monthly income. Sex and residence were found to be independent predicting factors. Hence, professionals working in the oncology unit should be aware of unmet needs and expect changes over time. Certain programs and services to address the identified unmet needs should be urgently provided.

Humanistic and economic burden among caregivers of patients with cancer in Japan

Aims: As the number of cancer patients increases in Japan, and people are living longer with cancer, the need for caregivers of cancer patients is expected to increase substantially. This study intended to reveal the humanistic and economic burden among caregivers of cancer patients, and to compare it with the burden among caregivers of patients with other conditions (other caregivers) and non-caregivers.Materials and methods: This cross-sectional analysis used data from the Japan National Health and Wellness Survey 2017. Outcome measures included the Short Form 12-item Health Survey for health-related quality of life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, Work Productivity and Activity Impairment questionnaire for the impact of health on productivity and activity, and indirect costs. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects.Results: A total of 251 caregivers of cancer patients, 1,543 other caregivers, and 27,300 non-caregivers were identified. Caregivers of cancer patients (average 48.0 years old) tended to be younger than non-caregivers (51.5) and other caregivers (54.4) and had the highest education level (57.8% completed university education). Fewer non-caregivers had stress-related comorbidities than caregivers. Non-caregivers had significantly higher EQ-5D index scores than caregivers (average 0.81 vs. 0.73 vs. 0.74). Caregivers of cancer patients had significantly lower mental component summary scores than non-caregivers (40.18 vs. 46.70), and the difference indicated a clinically meaningful decrease in HRQoL. Caregivers of cancer patients had significantly higher presenteeism (37.31% vs. 20.43%), total work productivity impairment (38.85% vs. 21.98%), and activity impairment (40.94% vs. 25.78%) than non-caregivers. Additionally, caregivers of cancer patients had significantly higher total indirect costs (36.34% vs. 20.03% of average annual income).Conclusions: These results have implications for future healthcare planning, suggesting the importance of healthcare systems in Japan to consider the substantial burden borne by caregivers of cancer patients.

[Development of a Japanese Version of the Short-Form FAMCARE Scale for family caregivers of terminal cancer patients at home in Japan]

AIM

To develop a Japanese version of the short-form FAMCARE Scale (Ornstein, 2015) for family caregivers of terminal cancer patients at home.

METHODS

The survey was conducted with 316 family caregivers of terminal cancer patients at home selected as eligible participants in 11 major regions in Japan (the Tokyo metropolitan area, and the prefectures of Tochigi, Ibaraki, Saitama, Chiba, Kanagawa, Nara, Hyogo, Kagawa, Ehime, and Saga). Construct validity was confirmed using a confirmatory factor analysis, and the Caregiver Quality of Life Index-Cancer (CQOLC) scale was administered to assess criterion-related validity.

RESULTS

A total of 120 family caregivers provided valid responses. The mean±standard deviation of the age of the family caregivers was 64.6±12.0 years, and 91 (75.8%) were female. A factor analysis of the results showed that the Japanese version of the 10-item and 5-item short-form FAMCARE Scale was a unidimensional construct, and a confirmatory factor analysis demonstrated a goodness of fit index of 0.910 and 0.972, an adjusted goodness of fit index of 0.835 and 0.916, a comparative fit index of 0.968 and 0.992, and a root mean square error of approximation of 0.095 and 0.081, respectively. The Cronbach's α coefficients of the 10- and 5-item scales were 0.95 and 0.93, respectively. The scale scores were significantly correlated with the family caregiver's quality of life (CQOLC) (10-item r=0.304, P<0.01; 5-item r=0.311, P<0.01).

CONCLUSION

The Japanese version of the 10-item and 5-item short-form FAMCARE Scale was found to have sufficient reliability and validity for assessing family satisfaction with terminal cancer patient at home in Japan.

Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care: a cross-sectional study

Background

Patients’ perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients’ perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.

Method

A cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients’ Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; “medical–technical competence” (MT) (2 factors), “physical–technical conditions” (PT) (one factor), “identity–orientation approach” (ID) (4 factors), “sociocultural atmosphere” (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.

Results

Patients’ perceptions of care received within settings showed high scores for the factors and single items “honesty” (ID) and “atmosphere” (S) in all settings and low scores for “exhaustion” (MT) in three out of four settings. Patients’ perceptions of importance scored high for “medical care” (S), “honesty” (ID), “respect and empathy” (ID) and “atmosphere” (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients’ perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and “medical care” (S), the SC and “atmosphere” (S) for hospice day care, and “medical care” (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.

Conclusion

Strengths of services related to identity–orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.

Family Caregiving in Japan: The Influence of Cultural Constructs in the Care of Adults With Cancer

Caring culture is a concept embodying the perceptions and caring practices of caregivers, acknowledging the unique role of cultural beliefs in shaping behavior. A qualitative descriptive study with 13 caregivers of adult family members with a cancer diagnosis in Japan was conducted to gain insight into perceptions and experiences surrounding caregiving. Several major categories were identified, representing rarely reported cultural constructs of high cultural value for the Japanese: On-repayment for what the patient has given, Caregiving as performing a socially expected role, Enryo/meiwaku-restraint in asking for help, Family decision making reflecting strong bonds, Omoiyari-empathizing with the patient's feelings, and Inori-praying to myriad gods and ancestors. The Japanese cultural construct of ie (the strong relationship to family lineage and spiritual connection to past and future generations) is helpful in understanding these categories. Invisible yet powerful cultural constructs permeated caregiving practices. Insights from Japanese cultural concepts and beliefs may foster sensitivity and individualized care in diverse settings, cultures, and societies.

Quality of life and satisfaction with care among palliative cancer patients in Saudi Arabia

OBJECTIVE

This study aimed to determine the relationship between quality of life and satisfaction with care among cancer patients in palliative care in Saudi Arabia.

METHODS

A total of 130 palliative cancer patients were invited to participate in our cross-sectional study. Patients were recruited from a large tertiary hospital within the Ministry of Health in Saudi Arabia. All eligible participants answered a three-part questionnaire that included demographic data and the validated European Organization for Research and Treatment of Cancer (EORTC QLQ-C15-PAL) and (EORTC IN-PATSAT32) questionnaires.

RESULTS

Participants were mostly female (103/130, 79%) and married (93/130, 71%), and more than half had breast cancer (69/130, 53%). They were between 17 and 86 years of age (mean = 46.7, SD = 16.50). The correlation test showed that the relationship with physical function was weak, while emotional function and global health status had a moderate relationship with general satisfaction (r = 0.21, p < 0.01; r = 0.32, p < 0.001; r = 0.26, p < 0.01, respectively). Our results suggest that emotional function is the more important factor in predicting satisfaction with care among palliative cancer patients. An increase in emotional function leads to increased general satisfaction.

SIGNIFICANCE OF RESULTS

The emotional function of palliative cancer patients was more closely associated with overall satisfaction with care than physical function or global health status. All palliative care team members are thus required to provide adequate psychosocial support. It is recommended that interdisciplinary and collaborative approaches be integrated in palliative care of cancer patients.

Psychometric properties of carer-reported outcome measures in palliative care: A systematic review

BACKGROUND

Informal carers face many challenges in caring for patients with palliative care needs. Selecting suitable valid and reliable outcome measures to determine the impact of caring and carers' outcomes is a common problem.

AIM

To identify outcome measures used for informal carers looking after patients with palliative care needs, and to evaluate the measures' psychometric properties.

DESIGN

A systematic review was conducted. The studies identified were evaluated by independent reviewers (C.T.J.M., M.B., M.P.). Data regarding study characteristics and psychometric properties of the measures were extracted and evaluated. Good psychometric properties indicate a high-quality measure.

DATA SOURCES

The search was conducted, unrestricted to publication year, in the following electronic databases: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, PubMed, PsycINFO, Social Sciences Citation Index and Sociological Abstracts.

RESULTS

Our systematic search revealed 4505 potential relevant studies, of which 112 studies met the inclusion criteria using 38 carer measures for informal carers of patients with palliative care needs. Psychometric properties were reported in only 46% (n = 52) of the studies, in relation to 24 measures. Where psychometric data were reported, the focus was mainly on internal consistency (n = 45, 87%), construct validity (n = 27, 52%) and/or reliability (n = 14, 27%). Of these, 24 measures, only four (17%) had been formally validated in informal carers in palliative care.

CONCLUSION

A broad range of outcome measures have been used for informal carers of patients with palliative care needs. Little formal psychometric testing has been undertaken. Furthermore, development and refinement of measures in this field is required.

Measuring Experience With End-of-Life Care: A Systematic Literature Review

CONTEXT

Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care.

OBJECTIVES

To evaluate the instruments currently in use to inform next steps for research and policy in this area.

METHODS

We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed.

RESULTS

We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated.

CONCLUSION

This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.

Findings from a nursing scholarship study tour to inform a proposal for a day hospice model in South Australia

South Australia releases national and international travel scholarships every year to the nursing and midwifery workforce to enable them to undertake observational site visits to inform the development of service models that can be introduced into care practices back in South Australia. Ten sites across New Zealand, Canada, and the UK agreed to host a site visit as part of a scholarship to look at day hospice (DH) programmes. The author undertook an observational study that included participation in DH programmes and discussions with staff and patients. There were many similarities across the three countries, in particular in the structure of the programmes, the staff makeup, and the support of the volunteer workforce. Two distinct models were observed: social and medical. Each has its value and both need to be incorporated to ensure services and participants have their needs met. Based on the site visits and other research, the author devised a proposal for South Australia to commence with a time-limited sessional group DH programme with a focus on maintenance of function for participants coupled with caregiver education and information provision.

Family caregiver satisfaction with home-based nursing and physician care over the palliative care trajectory: results from a longitudinal survey questionnaire

BACKGROUND

A limited understanding of satisfaction with home-based palliative care currently exists.

AIM

This study measured family caregivers' satisfaction with home-based physician and nursing palliative care services, and explored predictors of satisfaction, across the palliative care trajectory.

DESIGN

A longitudinal, cohort design was used. Family caregivers were interviewed by telephone by-weekly from palliative care admission until death. Satisfaction was assessed using the Quality of End-of-Life care and Satisfaction with Treatment (QUEST) questionnaire. Multiple logistic regression models were used to determine the extent to which demographic, quality of care, and service related variables predicted satisfaction.

SETTING/PARTICIPANTS

Family caregivers (N=104) of palliative care patients.

RESULTS

Each of the nine quality of care parameters were consistently found to be significant predictors of overall satisfaction with palliative care.

CONCLUSIONS

The results may inform key health policy issues. Specifically, knowledge of how quality of care parameters predict family caregivers' satisfaction over the course of the palliative care trajectory may aid managers responsible for resource allocation and the determination of home care standards.

Evaluation of an admission and discharge programme at a UK specialist palliative day hospice

This paper reports on a system of managing admissions and discharges from a specialist palliative day hospice (SPDH) in the south of England. SPDH is a well established component of palliative care provision in the UK, but studies have rarely addressed issues around admission and discharge. Case study methodology was used to evaluate the programme. Interviews were conducted with five patients who had attended the day hospice, taken a break or been discharged and returned; their carer(s); the key worker from the day hospice; and any other health professional who was involved in the patient's care during the admission. Communication issues were found within the team regarding referral and discharge processes, documentation of care, decision making, and information giving. Family members did not feel involved in decision making in relation to the programme. The most significant finding was the emotional and psychological impact on the patients of taking the break. Discharge from SPDH is known to be a difficult and sensitive issue, especially when patients are living with life-limiting illnesses that can change quickly. The patients in this study all had some form of dependency on the service and four of the five would have chosen to continue attending if they could. They experienced deterioration in psychological and physical wellbeing during the period in which they did not attend.

Reporting of "quality of life": a systematic review and quantitative analysis of research publications in palliative care journals

CONTEXT

Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL).

AIM

This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL.

SETTINGS AND DESIGN

This was a systematic review of palliative care journals.

MATERIALS AND METHODS

Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original article category was further classified according to study designs.

STATISTICAL ANALYSIS USED

Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5.

RESULTS

The overall reporting rate among all journals was 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting.

CONCLUSIONS

The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.

The outcomes of palliative care day services: a systematic review

This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. Fewer studies utilized validated outcome measures to determine the effect of PDS on attendees' wellbeing and small sample sizes combined with high attrition rates influenced the significance of some the results. However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.