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Edmonds DM, Zayts-Spence O, Au INY, Yuen JKY. "They are not taking it seriously": Constructing family dynamics in end-of-life care interactions in Hong Kong. DEATH STUDIES 2024:1-13. [PMID: 39096312 DOI: 10.1080/07481187.2024.2385383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
In Chinese culture, the family is central to the decision-making around care provided to terminally-ill patients. Previous research examined the preferences that patients and relatives have in regard to the family's role in end-of-life care. Our article takes a discourse analytic perspective and focuses on how familial dynamics are interactionally constructed by patients in audio-recorded end-of-life care consultations in Hong Kong hospitals. We document three ways that patients construct family dynamics. First, patients expressed a reluctance to talk to their family members about their condition. Second, patients talked about their families as being reluctant in accepting and "believing" the reality of their condition. Third, patients reported an epistemic divide between themselves and their family regarding knowledge and understanding of their illness. Our findings provide insights into how to conceptualize family dynamics in interactional terms. We also reflect on how our findings can complement existing research on end-of-life care in Chinese contexts.
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Affiliation(s)
| | - Olga Zayts-Spence
- School of English, The University of Hong Kong, Hong Kong, Hong Kong
| | - Irene Nga Yu Au
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jacqueline Kwan Yuk Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Spooner C, Vivat B, White N, Bruun A, Rohde G, Kwek PX, Stone P. What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies. Palliat Med 2023; 37:1345-1364. [PMID: 37586031 PMCID: PMC10548779 DOI: 10.1177/02692163231191148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important. AIM To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies. DESIGN A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022). DATA SOURCES Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients' and informal caregivers' experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion. RESULTS We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use. CONCLUSION Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders' priorities.
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Affiliation(s)
- Caitlin Spooner
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Gudrun Rohde
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Pei Xing Kwek
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Abstract
OBJECTIVES To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures. SETTING The EOL communication settings. PARTICIPANTS This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research. PRIMARY AND SECONDARY OUTCOME MEASURES Research evidence on EOL communication with a focus on family. RESULTS Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication. CONCLUSIONS The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Leslie Fok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
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Ozdemir S, Chaudhry I, Ng S, Teo I, Malhotra C, Finkelstein EA. Prognostic awareness and its association with health outcomes in the last year of life. Cancer Med 2023; 12:4801-4808. [PMID: 36200706 PMCID: PMC9972138 DOI: 10.1002/cam4.5286] [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: 04/19/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Little research has examined changes in prognostic awareness (PA) in the last year of life and the extent PA change was associated with anxiety, depression, and spiritual well-being among metastatic cancer patients. METHODS Two surveys were administered in the last year of life to 176 conveniently sampled Singaporean patients with stage 4 solid cancers. PA was assessed by asking patients whether they were aware that their treatments were unlikely to cure their cancer. Multivariable linear regression models were used to investigate the association of PA change with anxiety, depression, and spiritual well-being. RESULTS The proportion of patients with accurate PA increased (39.2%-45.5%; p < 0.05) from the second-last assessment to the last assessment before death. Those with inaccurate PA decreased (26.1%-20.4%; p < 0.05) while a third of patients remained uncertain at both assessments (34.7% and 34.1%). Compared to patients with inaccurate PA at both assessments, patients who reported accurate PA at both assessments reported worsened anxiety (β = 2.08), depression (β = 3.87), and spiritual well-being (β = -4.45) while patients who reported being uncertain about their prognosis at both assessments reported worsened spiritual well-being (β = - 6.30) at the last assessment before death (p < 0.05 for all). CONCLUSIONS Interventions should dually focus on decreasing prognostic uncertainty at the end-of-life while minimising the psychological and spiritual sequelae associated with being prognostically aware. More research is needed to clarify the causes of prognostic uncertainty.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Sean Ng
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,National Cancer Centre Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Chichua M, Mazzoni D, Brivio E, Pravettoni G. Prognostic Awareness in Terminally Ill Cancer Patients: A Narrative Literature Review of the Processes Involved. Cancer Manag Res 2023; 15:301-310. [PMID: 36994111 PMCID: PMC10042252 DOI: 10.2147/cmar.s395259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/17/2023] [Indexed: 03/31/2023] Open
Abstract
High prognostic awareness (PA) is seen by many as a threat to terminal patients' psychological well-being. Whether this concern is supported by evidence or not is still a matter of discussion, given the heterogeneity of existing findings. This ambiguity points to the importance of considering contextual processes involved in the relationship between high PA and psychological outcomes, as a possible mediator and moderator mechanism. Aiming to capture a holistic image of the relationship between PA and the psychological experiences of patients, we adapted a narrative method to synthesize and discusses patient-related (physical symptoms, coping strategy, spirituality) and external (family support, received medical care) processes as potential explaining mechanisms.
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Affiliation(s)
- Mariam Chichua
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20121, Italy
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
| | - Eleonora Brivio
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20121, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20121, Italy
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Abstract
Despite the use of aggressive multimodality therapies, the prognosis of brain tumor patients remains poor. Tumors of glial origin typically have the worst prognosis, with a predicted median survival of 12-15months for glioblastoma multiforme (WHO grade IV) and 2-5years for anaplastic glioma (WHO grade III). Palliative care problems and needs in patients with primary and secondary brain tumors are significantly different, both due to different trajectory of disease and to variable prognosis which in metastatic brain tumors is related to the natural history of primary tumors. This chapter describes the complex interactions influencing communication and the treatment decision process in primary brain tumor patients. The whole trajectory of disease and particularly the end-of-life (EOL) phase of brain tumor (BT) patients are quite different in respect to the expected trajectory observed in the general cancer population. The need to improve the communication of prognosis in BT patients has been clearly reported in neuro-oncological literature, but several issues may hinder a good communication in these patients. Adequate prognostic awareness (PA) is important for several reasons: to respect patient autonomy, to obtain her/his preferences about treatments and goal of care, and to share EOL treatment decisions. The high incidence of cognitive deficits in BT patients is one of the most challenging issues influencing the quality of communication and the participation of patients in the process of treatment decisions. Impaired neurocognitive functions may impact capacities of understanding, appreciation, reasoning, and expression of choice, reducing Medical Decisions Capacity (MDC). The lack of capacity to express preferences about EOL treatment decisions represents an important ethical issue, with a great impact on both the patient's family and healthcare professionals involved in the decision processes. Also, patients' coping styles may have an important influence in critical aspects of care such as communication of diagnosis and prognosis, discussion with patients and their caregivers about goal of treatments, early introduction of PC, and advanced planning of patients' preferences concerning EOL treatment and issues. Several barriers hinder good communication in BT patients. This chapter analyzes emerging literature data and possible strategies to improve communication about prognosis and goals of care and to promote patients' involvement in the treatment decision process particularly in the palliative care setting.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Antonio Tanzilli
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Dario Benincasa
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety, Depression and Spiritual Well-Being: A Multi-Country Study in Asia. Clin Oncol (R Coll Radiol) 2021; 34:368-375. [PMID: 34930691 DOI: 10.1016/j.clon.2021.11.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
AIMS The associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer). MATERIALS AND METHODS In total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics. RESULTS Compared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes. CONCLUSIONS The results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness.
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Chan WCH, Yu TK. Conducting an advance care planning group among older adults living in residential care homes: An initiative of social workers in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1960-1970. [PMID: 33560570 DOI: 10.1111/hsc.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to examine the effects of an advance care planning (ACP) group which was developed by social workers in Hong Kong for older adults. A quasi-experimental study was conducted. Participants were recruited from 14 residential care homes. The ACP intervention group included 59 participants for analyses, and the control group 58. Three major outcomes were measured at two time points: (a) Quality-of-life concerns, (b) End-of-life preference and (c) Advance directive (AD)-related outcomes (awareness of AD, AD completion, willingness to complete AD and communication with family members about AD). Findings indicate that the ACP group enhanced participants' awareness of AD compared with the control group. Participants were also more willing to complete AD, and more participants communicated with family members about AD after participating in the ACP group. No significant difference was found in other outcomes. This study demonstrates the efforts of social workers in promoting ACP in Hong Kong and the effectiveness of an ACP group for enhancing older adults' awareness of AD. Findings support the role of social workers in promoting ACP for deprived groups, like frail older adults. The ACP group could be considered a first step in enhancing older adults' awareness of and willingness to discuss end-of-life issues. Further follow-up is required to develop individualised ACP for older adults.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
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Cultural implications for disclosure of diagnosis and prognosis toward terminally ill cancer patients in China: A literature review. Palliat Support Care 2021; 20:283-289. [PMID: 33947500 DOI: 10.1017/s1478951521000535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Health professionals in China tend to avoid open communication with terminally ill cancer patients concerning their diagnosis and prognosis. This review aims to explore Chinese cultural beliefs and attitudes concerning disclosure and death among health professionals and cancer patients in China and to investigate preferences of terminally ill cancer patients for a "good death." METHOD A narrative literature review was conducted in May 2020 on MEDLINE, EMBASE, and WEB OF SCIENCE to include all studies with clear study design which presented its own study data or referred to data within underlying studies, published between January 2000 and May 2020, having cancer patients and/or healthcare professionals as participants, conducted in Mainland China, Hong Kong, or Taiwan and containing relevant data concerning "medical disclosure" or "good death." Quality assessment of publications was conducted using the NIH and CASP checklists. RESULTS Primary database search revealed a total of 108 papers of which 9 were ultimately included. The additional hand search led to the inclusion of eight further papers. In total, there were 11 quantitative studies, 4 qualitative studies and 2 literature reviews included in this review. Our findings indicated that most terminally ill cancer patients in China want to know the truth about their diagnosis and prognosis and preferred to be informed by their doctors. Terminally ill cancer patients valued a good relationship with family and medical staff as well as being respected as an individual and wanted to be able to prepare for death. SIGNIFICANCE OF RESULTS Terminally ill cancer patients in China often have a substantial need for information about their condition while their preferences are widely consistent with those in Western societies. Training for health professionals needs to focus on communication skills in order to overcome barriers in patient interaction.
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Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care 2021; 11:128-132. [PMID: 33762267 DOI: 10.1136/bmjspcare-2020-002700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/04/2022]
Abstract
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed. METHODOLOGY In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation. RESULTS Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution. CONCLUSION Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
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Affiliation(s)
| | - Jan Illing
- Royal College of Surgeons in Ireland, Dublin, Ireland
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11
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Chung H, Harding R, Guo P. Palliative Care in the Greater China Region: A Systematic Review of Needs, Models, and Outcomes. J Pain Symptom Manage 2021; 61:585-612. [PMID: 32916261 DOI: 10.1016/j.jpainsymman.2020.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations. OBJECTIVES This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China. METHODS Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence. RESULTS Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence. CONCLUSION Palliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.
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Affiliation(s)
- Huei Chung
- Department of Pharmacy, Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Willemsen AM, Paal P, Zhang S, Mason S, Elsner F. Chinese medical teachers' cultural attitudes influence palliative care education: a qualitative study. BMC Palliat Care 2021; 20:14. [PMID: 33435961 PMCID: PMC7805147 DOI: 10.1186/s12904-020-00707-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China. METHODS We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied. RESULTS Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China. CONCLUSIONS According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.
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Affiliation(s)
- Antonia M. Willemsen
- Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Piret Paal
- Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Silja Zhang
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Stephen Mason
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Frank Elsner
- Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
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Wattanapisit S, Wagland R, Hunt K. Prognostic disclosure and quality of life in palliative care: a systematic review. BMJ Support Palliat Care 2020; 11:361-370. [PMID: 33257406 DOI: 10.1136/bmjspcare-2020-002460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Prognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of palliative care patients. However, the effects of prognostic disclosure on QoL across different cultures and countries are unclear. OBJECTIVE To review the effects of prognostic disclosure on QoL of palliative care patients. METHODS A systematic review was conducted across seven databases (AMED, CINAHL plus, Cochrane Library, Medline (via the PubMed interface), Embase, Scopus and Web of Science). All primary studies, of any design, that explored the effects of prognostic disclosure on QoL of adult palliative care patients were eligible. RESULTS A total of 1926 records were screened for eligibility. Twenty-five articles were included (11 cross-sectional, 10 cohort, 3 mixed methods and 1 qualitative study). Studies were conducted in 11 countries. Five studies reported the sources of prognostic disclosure, while 20 studies did not. Emotional QoL was the most reported domain among the studies. The effects of prognostic disclosure on emotional aspects, overall QoL and other domains, including symptoms, physical functions, role functions, social functions and cognitive functions, were inconsistent. CONCLUSIONS The effects of prognostic disclosure on QoL across cultures and countries are inconsistent. Cultural differences are not sufficient to explain the effects. Future research is needed to explore the association between prognostic disclosure and QoL, and develop tools to support clinicians to share prognostic information in the most sensitive and supportive way.
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Affiliation(s)
- Sanhapan Wattanapisit
- School of Health Sciences, University of Southampton, Southampton, UK .,Palliative Care Unit, Thasala Hospital, Thasala, Nakhon Si Thammarat, Thailand
| | - Richard Wagland
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, UK
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Hu L, Chu Q, Fan Z, Chen Y. Discussion of Advance Care Planning on end of life decisions with lung cancer patients in Wuhan China: Attitude, Timing, and Future Directions. Intern Med J 2020; 51:2111-2118. [PMID: 33174303 PMCID: PMC9305590 DOI: 10.1111/imj.14958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022]
Abstract
Background Progress in advance care planning (ACP) in China has been hindered for decades compared with other countries. Aims To describe knowledge of ACP, end‐of‐life (EOL) care preferences and the predictors of patients' preference for ACP, as well as who should mention ACP among Chinese lung cancer patients. Methods Questionnaire‐based interviews were carried out. Two hundred and fifty‐eight lung cancer patients were recruited when first admitted to Tongji Hospital from October 2017 to November 2018. Social‐demographic factors, which might influence patients' preference on ACP decisions and who should mention ACP, were evaluated using multivariate logistic regression analysis. Results A total of 91.1% (n = 235) of patients favoured ACP on EOL issues. One hundred and sixty (60%) patients wanted to make EOL decisions on their own. Only 10% of patients were familiar with advance directions. Eighty‐two (31.8%) patients were familiar with do not resuscitate/do not intubate (DNR/DNI) directions. ACP was not mentioned in 92.2% of patients. Gender (male, OR = 4.87 (2.16–5.83)), tumour stage (Stage III, OR = 0.108 (0.06–0.51); Stage IV, OR = 1.780 (1.02–2.11)) and number of children (every increase in the number of children, OR = 0.267 (0.09–0.93)) were the significant predictors of preference for autonomous ACP. Female patients and patients currently receiving treatment are 2.743 and 1.8 times, respectively, more willing to need ACP initiated by doctors. Conclusions Chinese patients showed preferences towards ACP, but with inadequate knowledge. More assistance is needed with ACP for those patients, especially for females, patients with one child and those with early stage lung cancer. For female patients and patients receiving treatment, doctors may initiate ACP dialogue first.
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Affiliation(s)
- Liya Hu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Qian Chu
- Department of Oncology, TongJi Hospital, TongJi Medical College, HuaZhong University of Science and Technology
| | - Zeng Fan
- Department of Oncology, TongJi Hospital, TongJi Medical College, HuaZhong University of Science and Technology
| | - Yuan Chen
- Department of Oncology, TongJi Hospital, TongJi Medical College, HuaZhong University of Science and Technology
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15
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Chan WCH, Chan SO, Wong ALY, Ng PKL. Communication with family concerning body donation in Hong Kong: what do we know? HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1817-1826. [PMID: 32337803 DOI: 10.1111/hsc.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to examine three major issues: (a) The extent to which registered donors have communicated with family about body donation; (b) The differences in demographics, life and death attitudes, and quality of relationship with family members between those who communicated their body donation decision and those who did not; (c) The factors associated with the act of communicating with family about body donation. A survey was conducted of people who registered in a body donation programme in Hong Kong. A total of 1,070 registered donors completed an online questionnaire between August and September 2016. The majority of participants (80.1%) reported that they communicated with family members about body donation. About one-third only informed family members of their decisions after registration, and around 15.6% did not communicate with family members. Those who communicated with family were significantly older and married; they also indicated more positive life and death attitudes and a better quality of relationship with family members. Three factors were found to have significant associations with the act of communicating with family members about the decision to donate the body: (a) Age, (b) Quality of life, (c) Quality of relationship with family members. Communication with family members about body donation is still inadequate. Future body donation programmes may focus more on the way body donation decisions can be better communicated with family members. Special attention can be given to younger registered donors who find it difficult to communicate with the older generation, those who indicate more negative life and death attitudes, and who experienced a poorer quality of relationship with family members.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sun On Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Pasu Kwai Lun Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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16
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Pun JKH, Cheung KM, Chow JCH, Chan WL. Chinese perspective on end-of-life communication: a systematic review. BMJ Support Palliat Care 2020:bmjspcare-2019-002166. [PMID: 32647031 DOI: 10.1136/bmjspcare-2019-002166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Palliative care providers serving Chinese patients lack a culture-specific model of communication, a strong evidence base for this and clear guidance on its application. Thus, providers find it challenging to address patients' dignity, and determine their priorities and preferences for treatments and care, at the patients' final stage of life. AIM This study explores the culture-specific influences and current understanding of end-of-life (EOL) communication in the Chinese context. METHODS A qualitative systematic review of qualitative studies was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, PubMed and ERIC databases were searched for studies between January 1994 and July 2019, using keywords 'end of life', 'terminal care', 'communication' and 'Chinese'. Included studies were appraised with Critical Appraisal Skills Programme criteria. RESULTS The search strategy yielded 982 entries and 13 studies were included. Six themes were identified in EOL communication in the Chinese context: (1) Chinese philosophies on the meaning of 'good death'. (2) Negative attitudes towards communication on dying. (3) EOL communication as a taboo topic. (4) Clinician-centred approaches to treatment-decision making. (5) Family expectations being prioritised over patient self-autonomy in prognosis disclosure. (6) Care-providers expressing puzzlement over cultural preferences regarding EOL communication. CONCLUSIONS The review detailed the complexity of EOL communication in the Chinese context, urging for a communication model distinct from Western-based practices. Future research could explore a validated communication framework that addresses the local culture, thus enabling an understanding of patients' priorities and interpreting EOL encounters from a cross-cultural perspective.
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Affiliation(s)
- Jack K H Pun
- Department of English, City University of Hong Kong, Kowloon, Hong Kong
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Wing Lok Chan
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
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17
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Cheung JTK, Au D, Ip AHF, Chan J, Ng K, Cheung L, Yuen J, Hui E, Lee J, Lo R, Woo J. Barriers to advance care planning: a qualitative study of seriously ill Chinese patients and their families. BMC Palliat Care 2020; 19:80. [PMID: 32513166 PMCID: PMC7282137 DOI: 10.1186/s12904-020-00587-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) facilitates identification and documentation of patients' treatment preferences. Its goal aligns with that of palliative care - optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barriers to ACP from perspective of seriously ill patients and their family caregivers. METHODS This is a qualitative study conducted in a Palliative Day Care Centre of Hong Kong between October 2016 and July 2017. We carried out focus groups and individual interviews for the seriously ill patients and their family caregivers. A semi-structured interview guide was used to explore participants' experiences and attitudes about ACP. Qualitative content analysis was adopted to analyze both manifest content and latent content. RESULTS A total of 17 patients and 13 family caregivers participated in our study. The qualitative analysis identified four barriers to ACP: 1) limited patients' participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system. CONCLUSIONS Participations of seriously ill patients, family caregivers and healthcare workers in ACP initiation are lacking respectively. A series of interventions are necessary to resolve the barriers.
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Affiliation(s)
- Johnny T K Cheung
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Doreen Au
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony H F Ip
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jenny Chan
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kenway Ng
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lok Cheung
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Yuen
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Elsie Hui
- Department of Medicine & Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | - Jenny Lee
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
| | - Raymond Lo
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean Woo
- Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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18
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Abstract
Prognostication is a vital aspect of decision making because it provides patients and families with information to establish realistic and achievable goals of care, is used in determining eligibility for certain benefits, and helps in targeting interventions to those likely to benefit. Prognostication consists of 3 components: clinicians use their clinical judgment or other tools to estimate the probability of an individual developing a particular outcome over a specific period of time; this prognostic estimate is communicated in accordance with the patient's information preferences; the prognostic estimate is interpreted by the patient or surrogate and used in clinical decision making.
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Affiliation(s)
- Emily J Martin
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, 757 Westwood Plaza Suite 7501, Los Angeles, CA 90095, USA.
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, Box 181G, San Francisco, CA 94121, USA. https://twitter.com/EWidera
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19
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Kremeike K, Frerich G, Romotzky V, Boström K, Dojan T, Galushko M, Shah-Hosseini K, Jünger S, Rodin G, Pfaff H, Perrar KM, Voltz R. The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach. BMC Palliat Care 2020; 19:49. [PMID: 32299415 PMCID: PMC7164236 DOI: 10.1186/s12904-020-00548-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. METHODS Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. RESULTS 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die". CONCLUSIONS We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maren Galushko
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Medical Faculty, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS), University of Cologne, Cologne, Germany
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20
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Vlckova K, Tuckova A, Polakova K, Loucka M. Factors associated with prognostic awareness in patients with cancer: A systematic review. Psychooncology 2020; 29:990-1003. [DOI: 10.1002/pon.5385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care Prague Czech Republic
- First Faculty of MedicineCharles University Prague Czech Republic
| | - Anna Tuckova
- Center for Palliative Care Prague Czech Republic
- Faculty of Social SciencesCharles University Prague Czech Republic
| | | | - Martin Loucka
- Center for Palliative Care Prague Czech Republic
- Third Faculty of MedicineCharles University Prague Czech Republic
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21
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Gray TF, Temel JS, El-Jawahri A. Illness and prognostic understanding in patients with hematologic malignancies. Blood Rev 2020; 45:100692. [PMID: 32284227 DOI: 10.1016/j.blre.2020.100692] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/04/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
It is critical for patients with hematologic malignancies to have an accurate understanding of their illness and prognosis to make informed treatment decisions. Illness and prognostic understanding have primarily been studied in patients with solid tumors, however, data in patients with hematologic malignancies are rapidly growing. Patients with hematologic malignancies often face a unique and unpredictable illness trajectory with the possibility of cure persisting even in relapsed and refractory settings. These patients often require intensive therapies such as high-dose chemotherapy, hematopoietic stem cell transplantation (HCT), or CAR T-cell therapy, which carry with them significant risk of morbidity, mortality, and prognostic uncertainty. In this review article, we first described the current literature on illness and prognostic understanding in patients with hematologic malignancies including 1) patients' varying desire for prognostic information; (2) patients' prognostic misperceptions, (3) the association between patients' prognostic understanding and their psychological outcomes; and (4) barriers to prognostic understanding. Next, we examined insights gained from the literature about illness and prognostic understanding in patients with solid tumors to guide our understanding of the research gaps in hematologic malignancies. Future studies are needed to better delineate the longitudinal relationship between prognostic understanding, psychological distress, and coping in patients with hematologic malignancies. Strategies such as communicating effectively about prognosis, cultivating adaptive coping in the face of a terminal prognosis, and integrating specialty palliative care for patients with hematologic malignancies have the potential to improve patients' prognostic understanding and their quality of life and care.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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22
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Butow PN, Clayton JM, Epstein RM. Prognostic Awareness in Adult Oncology and Palliative Care. J Clin Oncol 2020; 38:877-884. [PMID: 32023158 DOI: 10.1200/jco.18.02112] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Communicating prognosis clearly and empathically can foster accurate prognostic awareness in patients with advanced cancer and their family members. Whereas patients and doctors desire clear prognostic communication, it presents many challenges in oncologic and palliative care settings. Patients with advanced cancer often have poor prognostic awareness as a result of deficiencies in doctor communication and understandable-and potentially adaptive-attempts by patients and families to reduce the threat of death and maintain hope. Interventions to promote prognostic discussion have largely succeeded in increasing the frequency, but not necessarily the quality, of such discussions, yet have failed to improve prognostic awareness. Because clear communication of prognosis is an ethical mandate, more research is needed to provide an evidence base for teaching and practice in this area.
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Affiliation(s)
| | - Josephine M Clayton
- The University of Sydney, Sydney, NSW, Australia.,Greenwich Hospital, Greenwich, Sydney, NSW, Australia
| | - Ronald M Epstein
- University of Rochester School of Medicine and Dentistry, New York, NY
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23
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Chan WCH, Chan SO, Wong ALY, Ng PKL. Understanding family involvement in body donation in Hong Kong: A qualitative study of registered donors and bereaved family members. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:270-278. [PMID: 31566842 DOI: 10.1111/hsc.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/18/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
Encouraging the public to donate their bodies after death is crucial for anatomy teaching in medical education. In Hong Kong, success may be affected if family members override the registered donors' wish after death, and thus the role of family in body donation is worth more attention. This study aims to examine how family is involved in the process of body donation. A qualitative study was conducted in Hong Kong. Registered donors and bereaved family members were recruited from a body donation scheme organised by a medical school. In-depth interviews were done and thematic analysis was conducted. Five themes were found: (a) decision-making: individual versus family; (b) family conflicts: avoidance versus confrontation; (c) trust in family members: discuss versus do not discuss; (d) family members' struggles in implementation; (e) informed end-of-life planning. Findings revealed that donors may not necessarily discuss their decisions about body donation with family members directly. Instead, it was found that family was involved in the body donation process in different ways and to different extents. For example, donors considered family members' views about body donation, but they chose not to involve them in the discussions if they expected objections, in order to avoid conflicts. Bereaved family members considered understanding family members' body donation decisions prior to death important, and they shared the implications of body donation for funeral arrangements and the grieving process. Findings help to understand the role of the family in body donation, especially in the Hong Kong Chinese context, and may give insights into how the body donation scheme could be enhanced to facilitate better communication between registered donors and family members as well as to support bereaved family members in implementing the decision to donate.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sun On Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Pasu Kwai Lun Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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24
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Sato T, Soejima K, Fujisawa D, Takeuchi M, Arai D, Nakachi I, Naoki K, Kawada I, Yasuda H, Ishioka K, Nukaga S, Kobayashi K, Masaki K, Inoue T, Hikima K, Nakamura M, Ohgino K, Oyamada Y, Funatsu Y, Terashima T, Miyao N, Sayama K, Saito F, Sakamaki F, Betsuyaku T. Prognostic Understanding at Diagnosis and Associated Factors in Patients with Advanced Lung Cancer and Their Caregivers. Oncologist 2018; 23:1218-1229. [PMID: 30120158 DOI: 10.1634/theoncologist.2017-0329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prognostic understanding in advanced cancer patients and their caregivers may have an impact on the delivery of effective care. The aims of this study were to explore prognostic understanding at diagnosis in both patients with advanced lung cancer and their caregivers and to investigate correlates of their understanding. SUBJECTS, MATERIALS, AND METHODS A total of 193 patients with newly diagnosed advanced lung cancer and their 167 caregivers were enrolled at 16 hospitals in Japan. We assessed their perceptions of prognosis and goals of therapy and examined their associations with their sociodemographic characteristics, clinical status, quality of life, mood symptoms, and the status of disclosure of information by their treating physicians. RESULTS One fifth of patients and caregivers (21.7% and 17.6%, respectively) mistakenly believed that the patients' cancer was "completely curable." Substantial proportions of them (16.9% and 10.3%, respectively) mistakenly believed that the primary goal of therapy was to remove all the cancer. Levels of anxiety and depression in both patients and caregivers were significantly higher among those who had accurate understanding of prognosis. In multivariate analyses, inaccurate perceptions of prognosis in patients were associated with sex, better emotional well-being, and lower lung cancer-specific symptom burden. Caregivers' inaccurate perceptions of patients' prognoses were associated with better performance status and better emotional well-being of patients. CONCLUSION Substantial proportions of advanced lung cancer patients and their caregivers misunderstood their prognosis. Interventions to improve their accurate prognostic understanding should be developed with careful attention paid to its associated factors. IMPLICATIONS FOR PRACTICE This study demonstrated that substantial proportions of patients with newly diagnosed advanced lung cancer and their caregivers had misunderstandings about their prognosis. Accurate perceptions of prognosis, which are indispensable in the delivery of effective care, were associated with elevated levels of anxiety and depression in both patients and caregivers, warranting psychosocial care and support for them immediately after diagnosis. Inaccurate perceptions of prognosis in patients were associated with better emotional well-being and lower lung cancer-specific symptom burden. Illness understanding in caregivers was associated with patients' physical and mental status. Those findings provide insight into how they obtain accurate illness understanding.
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Affiliation(s)
- Takashi Sato
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Mari Takeuchi
- Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Arai
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Katsuhiko Naoki
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kota Ishioka
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigenari Nukaga
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Takashi Inoue
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
| | - Kota Hikima
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
| | - Morio Nakamura
- Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Keiko Ohgino
- Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yohei Funatsu
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College, Chiba, Japan
| | - Naoki Miyao
- Department of Respiratory Medicine, Nippon Kokan Hospital, Kanagawa, Japan
| | | | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Fumio Sakamaki
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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25
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Communication with children about a parent's advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study. Support Care Cancer 2017; 26:287-295. [PMID: 28785863 DOI: 10.1007/s00520-017-3847-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Parents with advanced cancer are faced with difficult decision-making about communication about their illness with their children. The objectives of this study were to describe how parents communicated with their children about advanced cancer and to explore associations between communication and parental depression and anxiety. METHODS This was a cross-sectional, mixed-methods study of 42 patients with stage IV solid tumor malignancies who had at least one child less than 18 years of age. Participants completed a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS). We used multiple linear regression to evaluate the association between extent of communication and HADS Anxiety and Depression scores. Interview data were analyzed using standard qualitative content and thematic techniques and triangulated with survey data. RESULTS Higher HADS Anxiety scores, but not HADS Depression scores, were cross-sectionally associated with greater extent of parental communication (p = 0.003), even when controlling for performance status and children's ages. In qualitative analyses, parents who acknowledged the terminal nature of their illness or experienced higher symptom burden were more likely to report that they also communicated more extensively with children. A third of parents (n = 14, 33%) described difficulty with illness-related communication with their children. CONCLUSIONS In this pilot study, parents with advanced cancer who reported more illness-related communication with their children also reported more symptoms of general anxiety. Future interventions should address psychological distress relevant to parenting and further assess how parental communication may be linked to parental mood symptoms.
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Hsiu Chen C, Wen FH, Hou MM, Hsieh CH, Chou WC, Chen JS, Chang WC, Tang ST. Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling. Oncologist 2017; 22:1135-1142. [PMID: 28684551 DOI: 10.1634/theoncologist.2017-0068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients' last 6 months and estimated the time spent in each state. METHODS Prognostic awareness was categorized into four states: (a) unknown and not wanting to know, state 1; (b) unknown but wanting to know, state 2; (c) inaccurate awareness, state 3; and (d) accurate awareness, state 4. Transitional probabilities were examined by multistate Markov modeling. RESULTS Initially, 59.5% of patients had accurate prognostic awareness, whereas the probabilities of being in states 1-3 were 8.1%, 17.4%, and 15.0%, respectively. Patients' prognostic awareness generally remained unchanged (probabilities of remaining in the same state: 45.5%-92.9%). If prognostic awareness changed, it tended to shift toward higher prognostic-awareness states (probabilities of shifting to state 4 were 23.2%-36.6% for patients initially in states 1-3, followed by probabilities of shifting to state 3 for those in states 1 and 2 [9.8%-10.1%]). Patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in states 1-4, respectively, in their last 6 months. CONCLUSION Terminally ill cancer patients' prognostic awareness generally remained unchanged, with a tendency to become more aware of their prognosis. Health care professionals should facilitate patients' transitions toward accurate prognostic awareness in a timely manner to promote preference-based EOL decisions. IMPLICATIONS FOR PRACTICE Terminally ill Taiwanese cancer patients' prognostic awareness generally remained stable, with a tendency toward developing higher states of awareness. Health care professionals should appropriately assess patients' readiness for prognostic information and respect patients' reluctance to confront their poor prognosis if they are not ready to know, but sensitively coach them to cultivate their accurate prognostic awareness, provide desired and understandable prognostic information for those who are ready to know, and give direct and honest prognostic information to clarify any misunderstandings for those with inaccurate awareness, thus ensuring that they develop accurate and realistic prognostic knowledge in time to make end-of-life care decisions.
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Affiliation(s)
- Chen Hsiu Chen
- Department of Nursing, University of Kang Ning, Taipei and Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, and Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou
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Chan WCH, Tin AF, Wong KLY. Effectiveness of an experiential workshop for enhancing helping professionals' self-competence in death work in Hong Kong: a randomised controlled trial. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1070-1079. [PMID: 27868259 DOI: 10.1111/hsc.12407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
Helping professionals require self-competence in coping with the existential and emotional challenges of death work. Previous training often focused on knowledge and skills rather than on this competence. This study aimed to examine the effectiveness of a 3-day workshop in Hong Kong to enhance helping professionals' self-competence in death work. A randomised controlled trial was conducted to examine the effects of the training between January and May 2014. Targeted participants were helping professionals who had been doing death work for at least 6 months. The 112 participants were openly recruited from hospitals and NGOs and were assigned to an intervention group or a waitlist control group. Data were collected at pre-intervention and post-intervention. Primary outcome was self-competence in death work. All participants were grouped for analysing the changes in outcomes at pre-intervention, post-intervention and 3-month follow-up. Participants in the intervention group experienced a significant increase in the total score of the Self-competence in Death Work Scale (SC-DWS) and in scores of the Existential and Emotional subscales of SC-DWS. The positive effects of training on self-competence in death work were maintained at the 3-month follow-up. This study provides evidence of the effectiveness of training in enhancing helping professionals' self-competence in death work. Further research is required to examine the long-term effects of training.
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Affiliation(s)
| | - Agnes Fong Tin
- Center on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Karen Lok Yi Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong
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Shaku F, Tsutsumi M. The Effect of Providing Life Support on Nurses’ Decision Making Regarding Life Support for Themselves and Family Members in Japan. Am J Hosp Palliat Care 2016; 33:917-923. [DOI: 10.1177/1049909115624655] [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] Open
Abstract
Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care.
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Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Madoka Tsutsumi
- Primary Care and Medical Education, University of Tsukuba, Ibaraki, Japan
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Tsai HH, Tsai YF, Huang HL. Nursing home nurses’ experiences of resident transfers to the emergency department: no empathy for our work environment difficulties. J Clin Nurs 2016; 25:610-8. [DOI: 10.1111/jocn.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Yun-Fang Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
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30
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Nie X, Ye D, Wang Q, Manyande A, Yang L, Qiu H, Chao T, Zhang P, Gong C, Zhuang L, Yu S, Xiong H. Poor-prognosis disclosure preference in cancer patient-caregiver dyads and its association with their quality of life and perceived stress: a cross-sectional survey in mainland China. Psychooncology 2015; 25:1099-105. [PMID: 26643744 DOI: 10.1002/pon.4055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 09/14/2015] [Accepted: 11/13/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study attempted to examine the discordance between family caregivers and cancer patients in their poor-prognosis disclosure preferences in mainland China and then ascertained the associations between quality of life (QoL), perceived stress, and poor-prognosis disclosure preferences. METHODS Six hundred fifty-one pairs of inpatients and their matched caregivers (participation rate = 92.2%) were recruited in this cross-sectional survey. A set of paired self-administered questionnaires were completed independently by patient-caregiver dyads. RESULTS Fewer family caregivers than cancer patients felt that poor prognosis should be disclosed to patients (61.2% vs. 90.0%, p < 0.001). Patients' positive poor-prognosis disclosure preference was associated with patients' better QoL (p < 0.05) and caregivers' reduced perceived stress levels (p = 0.013). However, caregivers' poor-prognosis disclosure preference correlated only with their own physical state (p = 0.028). Moreover, the caregivers who concurred with patients in positive poor-prognosis disclosure preference were more likely to experience a better QoL (p < 0.05) and lower perceived stress levels (p = 0.048) in the III-IV stage subgroup. CONCLUSIONS There was a significant discrepancy in poor-prognosis disclosure preference between cancer patients and caregivers in China. The caregivers' preference of concealing poor prognosis from patients was not related to cancer patients' QoL or perceived stress. In addition, caregivers had better QoL and lower stress levels when they held the same positive poor-prognosis disclosure preference as the patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xin Nie
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Dawei Ye
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qiming Wang
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, China
| | - Anne Manyande
- School of Psychology, Social Work and Human Sciences, University of West London, London, UK
| | - Lin Yang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hong Qiu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tengfei Chao
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chen Gong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Liang Zhuang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shiying Yu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huihua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Collins ES, Witt J, Bausewein C, Daveson BA, Higginson IJ, Murtagh FEM. A Systematic Review of the Use of the Palliative Care Outcome Scale and the Support Team Assessment Schedule in Palliative Care. J Pain Symptom Manage 2015; 50:842-53.e19. [PMID: 26335764 DOI: 10.1016/j.jpainsymman.2015.07.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/24/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT The Palliative care Outcome Scale (POS) and the Support Team Assessment Schedule (STAS) are two outcome measures used in palliative care settings to assess palliative concerns, needs, and quality of care. OBJECTIVES This systematic review builds on the findings of a previous review to appraise the use of the POS and STAS since 2010, particularly the context and nature of their use. METHODS MEDLINE, Embase, PsycINFO, British Nursing Index, and CINAHL were searched for studies published between February 2010 and June 2014. Relevant authors were contacted, and reference lists of included studies were searched. Studies reporting validation or the use of the POS or STAS were included, and data on sample population, how the outcome measure was being used, study design, study aim, and results of the study were extracted. RESULTS Forty-three studies were included (POS n = 35, STAS n = 8). There was an increase in the use of the POS and STAS in Europe and Africa with the publication of 13 new translations of the POS. Most studies focused on the use, rather than further validation, of the POS and STAS. There has been increasing use of these measures within non-cancer patient groups. CONCLUSION The POS and STAS are now used in a wide variety of settings and countries. These tools may be used in the future to compare palliative care needs and quality of care across diverse contexts and patient groups.
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Affiliation(s)
- Emily S Collins
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom; School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Jana Witt
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Munich, Germany
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
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Tang ST, Chang WC, Chen JS, Chou WC, Hsieh CH, Chen CH. Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life. Psychooncology 2015; 25:455-62. [DOI: 10.1002/pon.3943] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/01/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Siew Tzuh Tang
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Chen H. Chen
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Kang-Ning Junior College of Medical Care and Management; Taipei Taiwan
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End-of-life care research in Hong Kong: A systematic review of peer-reviewed publications. Palliat Support Care 2015; 13:1711-20. [DOI: 10.1017/s1478951515000802] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:This systematic review aimed to examine end-of-life (EoL) care research undertaken in an Eastern cultural context—Hong Kong—with the hope of better informing EoL care professionals and policy makers and providing lessons for other countries or areas that share similar EoL care challenges.Method:Eight databases were searched from their respective inception through to August of 2014. All of the resulting studies conducted in Hong Kong and relevant to EoL care or palliative care were examined. The included studies were assessed with respect to study design, care settings, participants, research themes, and major findings.Results:Some 107 publications published between 1991 and 2014 were identified. These studies were undertaken at a range of places by different professionals. Of the total, 44 were led by physicians, 36 by nurses, 17 by social workers, and 10 by other professionals. Participants included both inpatients and outpatients with different illnesses, nursing home residents, older community-dwelling adults, deceased individuals, care staff, and informal caregivers. A total of 13 research themes were identified: (1) attitudes to or perceptions of death and dying; (2) utilization of healthcare services, (3) physical symptoms or medical problems; (4) death anxiety or mental health issues; (5) quality of life; (6) advance directives or advance care planning; (7) supportive care needs, (8) decision making; (9) spirituality; (10) cost-effectiveness or utility studies; (11) care professionals' education and training; (12) informal caregivers' perceptions and experience; and (13) scale development or validation.Significance of results:While there has been a wide and diverse range of research activities in Hong Kong, EoL care services at primary care settings should be strengthened. Some priority areas for further research are recommended.
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Fisher K, Seow H, Cohen J, Declercq A, Freeman S, Guthrie DM. Patient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument. J Pain Symptom Manage 2015; 49:716-25. [PMID: 25220047 DOI: 10.1016/j.jpainsymman.2014.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Abstract
CONTEXT Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it. OBJECTIVES To identify patient characteristics associated with PA in a PC population. METHODS The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis. RESULTS The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis. CONCLUSION Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.
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Affiliation(s)
- Kathryn Fisher
- Aging and Community Health Research Unit, McMaster University, Hamilton, Ontario, Canada.
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Anja Declercq
- LUCAS & Faculty of Social Sciences, University of Leuven, Leuven, Belgium
| | - Shannon Freeman
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Seyedrasooli A, Rahmani A, Howard F, Zamanzadeh V, Mohammadpoorasl A, Aliashrafi R, Pakpour V. Iranian Cancer Patient Perceptions of Prognosis and the Relationship to Hope. Asian Pac J Cancer Prev 2014; 15:6205-10. [DOI: 10.7314/apjcp.2014.15.15.6205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Seyedrasooly A, Rahmani A, Zamanzadeh V, Aliashrafi Z, Nikanfar AR, Jasemi M. Association between Perception of Prognosis and Spiritual Well-being among Cancer Patients. J Caring Sci 2014; 3:47-55. [PMID: 25276748 DOI: 10.5681/jcs.2014.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Disclosure of cancer prognosis is one of the most difficult challenges in caring of cancer patients. An exact effect of prognosis disclosure on spiritual well-being of cancer patient was not completely investigated. Therefore, the present study aimed to investigate the relationship between perception of prognosis and spiritual well-being among cancer patients. METHODS In this descriptive-correlational study, which conducted in 2013, two hundred cancer patients referred to Shahid Ghazi Hospital and private offices of two oncologists in Tabriz participated with convenience sampling method. Perception of prognosis was investigated by Perception of Prognosis Inventory and spiritual well-being of cancer patients was investigated by Paloutzian and Ellison Inventory. Data were analyzed using descriptive statistics and Pearson correlation test. RESULTS Participants reported positive perception about the prognosis of their disease (score 11 from 15) and rated their spiritual well-being as high (score 99 from 120). There was a positive correlation between the perception of prognosis and spiritual health among cancer patients. CONCLUSION Disclosure of cancer prognosis has negative effects on cancer patients. This result highlights the importance of considering cultural factors in disclosure of cancer prognosis. According to limitations of the present study approving these results need more studies.
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Affiliation(s)
- Alehe Seyedrasooly
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Nursing, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zoliekha Aliashrafi
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Reza Nikanfar
- Department of Hematology and Oncology, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Madine Jasemi
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Tang ST, Liu TW, Chow JM, Chiu CF, Hsieh RK, Chen CH, Liu LN, Feng WL. Associations between accurate prognostic understanding and end-of-life care preferences and its correlates among Taiwanese terminally ill cancer patients surveyed in 2011-2012. Psychooncology 2014; 23:780-7. [DOI: 10.1002/pon.3482] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/15/2013] [Accepted: 12/17/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Siew Tzuh Tang
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
| | - Tsang-Wu Liu
- National Health Research Institutes; National Institute of Cancer Research; Taipei Taiwan
| | - Jyh-Ming Chow
- Section of Hematology and Medical Oncology; Wan-Fang Hospital; Taipei Taiwan
| | - Chang-Fang Chiu
- Division of Hematology-Oncology and Comprehensive Cancer Center; China Medical University Hospital; Taichung Taiwan
| | - Ruey-Kuen Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine; Mackay Memorial Hospital; Taipei Taiwan
| | - Chen H. Chen
- School of Nursing; Kang-Ning Junior College of Medical Care and Management; Taipei Taiwan
| | - Li Ni Liu
- Department of Nursing; Fu Jen Catholic University; Taipei Taiwan
| | - Wei-Lien Feng
- National Health Research Institutes; National Institute of Cancer Research; Taipei Taiwan
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Chan WCH, Chan CLF, Suen M. Validation of the Chinese version of the Modified Caregivers Strain Index among Hong Kong caregivers: an initiative of medical social workers. HEALTH & SOCIAL WORK 2013; 38:214-221. [PMID: 24432488 DOI: 10.1093/hsw/hlt021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Family caregivers may often experience caregiving stress and burden. To systematically assess this issue, medical social workers may need to use a brief and valid measurement in their practice. In the Hong Kong Chinese context, one additional challenge is to examine whether a measurement developed in the West is valid for Hong Kong Chinese caregivers. Thus, medical social workers in Hong Kong initiated this research study to validate the Chinese version of the Modified Caregiver Strain Index (C-M-CSI). A total of 223 Chinese caregivers of patients with various chronic illnesses were recruited for this validation study. C-M-CSI demonstrated good reliability (Cronbach's alpha coefficient = .91), concurrent validity with the Chinese version of the Caregiver Burden Inventory, and discriminant validity with the Chinese version of the Meaning in Life Questionnaire. Factor analysis yielded a single factor as the original M-CSI, which explained 49 percent of variance. Construct validity was shown by differentiating spousal and nonspousal caregivers, as well as caregivers of patients with and without behavioral problems. C-M-CSI is recommended as a brief and valid measurement that can be used by medical social workers in assessing the caregiving strain of Chinese caregivers of patients in Hong Kong.
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Affiliation(s)
| | | | - Margaret Suen
- Department of Medical Social Work, Caritas Medical Centre, Hospital Authority, Shamshuipo, Kowloon
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Applebaum AJ, Kolva EA, Kulikowski JR, Jacobs JD, DeRosa A, Lichtenthal WG, Olden ME, Rosenfeld B, Breitbart W. Conceptualizing prognostic awareness in advanced cancer: a systematic review. J Health Psychol 2013; 19:1103-19. [PMID: 24157936 DOI: 10.1177/1359105313484782] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review synthesizes the complex literature on prognostic awareness in cancer. A total of 37 studies examining cancer patients' understanding of their prognosis were included. Prognostic awareness definitions and assessment methods were inconsistent across studies. A surprisingly high percentage of patients (up to 75%) were unaware of their poor prognosis, and in several studies, even their cancer diagnosis (up to 96%), particularly in studies conducted outside of North America. This review highlights surprisingly low rates of prognostic awareness in patients with advanced cancer as well as discrepancies in prognostic awareness assessment, suggesting the need for empirically validated measures of prognostic awareness.
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Development and validation of a prognostic scale for hospitalized patients with terminally ill cancer in China. Support Care Cancer 2013; 22:145-52. [DOI: 10.1007/s00520-013-1970-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Lee PC, Lo C, Ko WJ, Huang SJ, Lee PH. When and how should physicians determine the need for palliative and hospice care for patients with end-stage liver disease?: an experience in Taiwan. Am J Hosp Palliat Care 2013; 31:454-8. [PMID: 23861543 DOI: 10.1177/1049909113495707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We analyzed one case of end-stage liver disease and discussed whether the palliative care should be considered for this case. The medical record of a 56-year-old woman with alcoholic liver cirrhosis admitted to our hospital due to hypovolemic shock and esophageal varices (EV) was reviewed. The EV with active bleeding were arrested by panendoscopic intervention. However, repeat surgery revealed transmural laceration over the cardia, and immediate surgery and splenectomy were needed. The patient died postoperatively in the surgical intensive care unit due to bleeding tendency and hypovolemic shock. We suggest that palliative care and/or hospice care should have been considered for this patient before the crisis developed and that physicians require education about timely palliative and hospice care for patients with end-stage nonmalignant disease.
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Affiliation(s)
- Po-Chu Lee
- 1Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
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Ahn E, Shin DW, Choi JY, Kang J, Kim DK, Kim H, Lee E, Hwang KO, Oh B, Cho B. The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients. Psychooncology 2013; 22:2771-8. [PMID: 23839783 DOI: 10.1002/pon.3346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 11/07/2022]
Abstract
OBJECTS We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. METHODS Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. RESULTS Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p < 0.001), 'maintaining hope and pleasure' (4.55 vs. 3.92; p = 0.002), and 'unawareness of death' (4.41 vs. 4.26; p = 0.024). CONCLUSION Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged.
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Affiliation(s)
- Eunmi Ahn
- Department of Family Medicine, Family Medicine, Seoul National University Hospital, Seoul, Korea
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Jacobsen J, Thomas JD, Jackson VA. Misunderstandings about Prognosis: An Approach for Palliative Care Consultants When the Patient Does Not Seem To Understand What Was Said. J Palliat Med 2013; 16:91-5. [DOI: 10.1089/jpm.2012.0142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juliet Jacobsen
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jane deLima Thomas
- Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Vicki A. Jackson
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Chen YY, Tsai SL, Yang CW, Ni YH, Chang SC. The ongoing westernization of East Asian biomedical ethics in Taiwan. Soc Sci Med 2012; 78:125-9. [PMID: 23273761 DOI: 10.1016/j.socscimed.2012.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 11/05/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
Family autonomy/family-determination (FA/FD) is deeply rooted in Confucianism, and is an important core value in East Asian biomedical ethics. Individual autonomy/self-determination (IA/SD) did not originate in East Asia, and is the most important core value of Western biomedical ethics. IA/SD and FA/FD are different from each other not only because of where they originated but also in their general sense and moral foundations. We investigated the influence of Western biomedical ethics on the Eastern hemisphere. We examined the secular trends of IA/SD use in ethics and biomedical ethics articles published in Taiwan from 1991 to 2010. The published articles were collected from a popular online library called the Chinese Electronic Periodical Services. A total of 1737 articles were associated with ethics, and 300 of them were associated with biomedical ethics. The total number of times IA/SD was used in each ethics and biomedical ethics article was calculated. The secular trends were plotted graphically and analyzed by time series linear regression analysis. The results showed that the secular trend of the proportion of the yearly total of biomedical ethics articles to the yearly total of ethics articles was significantly increasing (p = 0.007). The secular trends of the average of times IA/SD showed that one unit of yearly increase was associated with an increment of 0.056 IA/SD use per ethics article (p < 0.001), and 0.331 IA/SD use per biomedical ethics article (p = 0.027), respectively. These findings suggest that Western biomedical ethics have become increasingly influential in Taiwan over the past two decades. Thus, assuming that FA/FD takes priority over IA/SD in an East Asian medical encounter is too simplistic. Whether FA/FD or IA/SD takes priority in a medical encounter should be carefully evaluated.
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Affiliation(s)
- Yen-Yuan Chen
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan, ROC
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