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Bergerot CD, Philip EJ, Govindarajan A, Castro D, Malhotra J, Bergerot P, Salgia S, Salgia M, Salgia N, Hsu J, Meza L, Zengin ZB, Liu S, Chehrazi-Raffle A, Tripathi A, Dorff T, Pal S. Changes in Perception of Cure Among Patients With Genitourinary Cancers Initiating Immune Checkpoint Inhibitors: A Longitudinal Study. Clin Genitourin Cancer 2023; 21:626-630.e3. [PMID: 37391301 PMCID: PMC11225089 DOI: 10.1016/j.clgc.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND We explored changes in perceptions of cure among patients with genitourinary (GU) cancers starting Immune checkpoint inhibitors (ICIs) therapy. MATERIALS AND METHODS This longitudinal study assessed patients before starting therapy and 3-months later with a questionnaire that included patient perceptions of ICIs and the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale. General linear modeling was used to investigate changes in expectation of cure over time, and chi-square tests were used to determine the association between expectation of cure and perceptions of ICIs and anxiety. RESULTS A total of 45 patients were recruited (73% male, 84% diagnosed with renal cell carcinoma). The proportion of patients who possessed an accurate expectation of cure increased over time (55.6%-66.7%, P = .001). An accurate expectation of cure was associated with lower rates of anxiety over time. Patients with inaccurate expectation of cure reported more severe side effects and worse self-reported ECOG score at the follow-up assessment (P = .04). CONCLUSION We found that patients with GU metastatic cancer treated with ICI therapy have increasingly accurate expectations of cure over time. Accurate expectation of cure is associated with decreased anxiety. Further research is needed to fully explore this dynamic over time and help inform interventions that can help patients develop accurate expectations.
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Affiliation(s)
- Cristiane Decat Bergerot
- Centro de Cancer de Brasilia, Instituto Unity de Ensino e Pesquisa, Oncoclinicas, Brasília, DF, Brazil
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Daniela Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jasnoor Malhotra
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paulo Bergerot
- Centro de Cancer de Brasilia, Instituto Unity de Ensino e Pesquisa, Oncoclinicas, Brasília, DF, Brazil
| | | | | | - Nicholas Salgia
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Zeynep B Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sandy Liu
- Department of Medical Oncology, City of Hope Orange County Medical Center, Irvine, CA
| | - Alex Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanya Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA.
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2
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Ngo J, Le J, Gandhi CH, Mariano JD, Viveros LA, Wang SE. Evolving Advance Care Planning in a Health Ecosystem: The Kaiser Permanente Experience. J Pain Symptom Manage 2023; 66:e245-e253. [PMID: 37054957 DOI: 10.1016/j.jpainsymman.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Advance care planning is an integral part of supporting patients through serious illness and end-of-life care. PROBLEM Several components of advance care planning may be too inflexible to account for patients' changing disease and evolving goals as serious illness progresses. Health systems are starting to implement processes to address these barriers, though implementation has varied. PROPOSED SOLUTION In 2017, Kaiser Permanente introduced Life Care Planning (LCP), incorporating advance care planning dynamically into concurrent disease management. LCP provides a framework for identifying surrogates, documenting goals, and eliciting patient values across disease progression. LCP provides standardized training to facilitate communication and utilizes a centralized section within the electronic health record for longitudinal documentation of goals. OUTCOMES More than 6000 physicians, nurses, and social workers have been trained in LCP. Over one million patients have engaged in LCP since its inception, with over 52% of patients age 55+ having a surrogate designated. There is evidence of high treatment concordance with patients' desired wishes (88.9%), with high rates of advance directive completion as well (84.1%).
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Affiliation(s)
- Jason Ngo
- Department of Geriatrics, Palliative, and Continuing Care (J.N., C.H.G.), Kaiser Permanente Southern California, Fontana Medical Center, Fontana, California, USA.
| | - John Le
- Department of Internal Medicine (J.L.), Kaiser Permanente Southern California, Fontana Medical Center, Fontana, California, USA
| | - Chirag H Gandhi
- Department of Geriatrics, Palliative, and Continuing Care (J.N., C.H.G.), Kaiser Permanente Southern California, Fontana Medical Center, Fontana, California, USA
| | - Jeffrey D Mariano
- Department of Geriatrics, Palliative, and Continuing Care (J.D.M., S.E.W.), Kaiser Permanente Southern California, West Los Angeles Medical Center, Los Angeles, California, USA
| | - Lori A Viveros
- Kaiser Permanente Southern California (L.A.V.), Pasadena, California, USA
| | - Susan E Wang
- Department of Geriatrics, Palliative, and Continuing Care (J.D.M., S.E.W.), Kaiser Permanente Southern California, West Los Angeles Medical Center, Los Angeles, California, USA
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3
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Elbaum A, Kinsey L, Mariano J. Decision-Making Across Cultures. Cancer Treat Res 2023; 187:85-104. [PMID: 37851221 DOI: 10.1007/978-3-031-29923-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
This chapter surveys the range of different orientations toward decision-making, common clinical scenarios, and considerations to bear in mind when caring for culturally diverse patients at the end of life. While this chapter draws on the cultural competency literature, its primary goal is to articulate an approach to end-of-life care that is rooted in cultural humility and structural competency. Medical providers, as representatives of the social institution of medicine, have their own cultural values that often come into conflict with patients' cultural values, especially when patients and providers have different unspoken visions of the "good death," or when patients wish to receive interventions that their providers deem futile. In the final section of the chapter, we seek to move away from this confrontational paradigm by analyzing two case studies of decision-making across cultures in order to empower providers to engage in value-based shared decision-making and thereby achieve goal-concordant care.
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Affiliation(s)
- Alan Elbaum
- University of California San Francisco, San Francisco, USA.
| | | | - Jeffrey Mariano
- Department of Geriatrics, Palliative Medicine and Continuing Care, Kaiser Permanente Bernard J. Tyson School of Medicine, Southern California Permanente Medical Group, Kaiser Permanente West Los Angeles, Pasadena, USA
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4
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Bodschwinna D, Weissflog G, Döhner H, Niederwieser D, Mehnert-Theuerkauf A, Gündel H, Ernst J, Goerling U, Hönig K. Couples Coping With Hematological Cancer: Support Within and Outside the Couple - Findings From a Qualitative Analysis of Dyadic Interviews. Front Psychol 2022; 13:855638. [PMID: 35664207 PMCID: PMC9161167 DOI: 10.3389/fpsyg.2022.855638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Cancer affects the patients as well as their partners. Couples use different strategies to cope with cancer and the associated burden: individual coping, dyadic coping, and support from the social network and from professional health care. The aim of this qualitative dyadic interviews is to gain a deeper and more differentiated understanding of the support system inside and outside of the couple. Methods Ten heterosexual couples (patients: seven men and three women) with different ages (patients: range = 22-75; spouses: range = 22-74), different hematological cancer (e.g., acute myeloid leukemia, non-Hodgkin's lymphoma) and cancer stages (initial diagnosis or relapse) participated in the study. Semi-structured dyadic interviews were conducted. Data of the verbatim transcripts were systematically coded and analyzed following structuring content analysis. Results Three main categories (individual coping, dyadic coping, and outside support) and ten subcategories about coping and support strategies in hematological cancer patients and their spouses could be identified. All couples described cohesion in relationship as an essential common dyadic coping strategy. Most strategies were focused on the patient's wellbeing. Furthermore, couples reported different common plans for the future: while some wanted to return to normality, others were reaching out for new goals. Conclusion Couples used various coping and support strategies, that differed in type and frequency between patients and spouses. Most of the strategies were perceived as beneficial, but some also triggered pressure. Overall, spouses seem to need more psychological support to improve their own wellbeing.
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Affiliation(s)
- Daniela Bodschwinna
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Ulm, Germany
- Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
| | - Gregor Weissflog
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Hartmut Döhner
- Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Dietger Niederwieser
- Medical Clinic and Policlinic, Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Ulm, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Ute Goerling
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Klaus Hönig
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Ulm, Germany
- Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
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Horowitz RK, Hogan LA, Carroll T. MVP-Medical Situation, Values, and Plan: A Memorable and Useful Model for All Serious Illness Conversations. J Pain Symptom Manage 2020; 60:1059-1065. [PMID: 32738279 PMCID: PMC7390732 DOI: 10.1016/j.jpainsymman.2020.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Robert K Horowitz
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA.
| | - Laura A Hogan
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
| | - Thomas Carroll
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
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6
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Geerse OP, Lamas DJ, Bernacki RE, Sanders JJ, Paladino J, Berendsen AJ, Hiltermann TJN, Lindvall C, Fromme EK, Block SD. Adherence and Concordance between Serious Illness Care Planning Conversations and Oncology Clinician Documentation among Patients with Advanced Cancer. J Palliat Med 2020; 24:53-62. [PMID: 32580676 DOI: 10.1089/jpm.2019.0615] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Serious illness conversations are part of advance care planning (ACP) and focus on prognosis, values, and goals in patients who are seriously ill. To be maximally effective, such conversations must be documented accurately and be easily accessible. Objectives: The two coprimary objectives of the study were to assess concordance between written documentation and recorded audiotaped conversations, and to evaluate adherence to the Serious Illness Conversation Guide questions. Methods: Data were obtained as part of a trial in patients with advanced cancer. Clinicians were trained to use a guide to conduct and document serious illness conversations. Conversations were audiotaped. Two researchers independently compared audiorecordings with the corresponding documentation in an electronic health record (EHR) template and free-text progress notes, and rated the degree of concordance and adherence. Results: We reviewed a total of 25 audiorecordings. Clinicians addressed 87% of the conversation guide elements. Prognosis was discussed least frequently, only in 55% of the patients who wanted that information. Documentation was fully concordant with the conversation 43% of the time. Concordance was best when documenting family matters and goals, and least frequently concordant when documenting prognostic communication. Most conversations (64%) were documented in the template, a minority (28%) only in progress notes and two conversations (8%) were not documented. Concordance was better when the template was used (62% vs. 28%). Conclusion: Clinicians adhered well to the conversation guide. However, key information elicited was documented and fully concordant less than half the time. Greater concordance was observed when clinicians used a prespecified template. The combined use of a guide and EHR template holds promise for ACP conversations.
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Affiliation(s)
- Olaf P Geerse
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Daniela J Lamas
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Justin J Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanna Paladino
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Thijo J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Erik K Fromme
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan D Block
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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7
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Edmonds KP, Ajayi TA. Do We Know What We Mean? An Examination of the Use of the Phrase “Goals of Care” in the Literature. J Palliat Med 2019; 22:1546-1552. [DOI: 10.1089/jpm.2019.0059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Kyle P. Edmonds
- Doris A. Howell Palliative Care, UC San Diego Health, San Diego, California
| | - Toluwalase A. Ajayi
- Scripps Research, San Diego, California
- Scripps Health, San Diego, California
- Department of Pediatrics, UC San Diego Health, San Diego, California
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8
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O'Hare AM, Kurella Tamura M, Lavallee DC, Vig EK, Taylor JS, Hall YN, Katz R, Curtis JR, Engelberg RA. Assessment of Self-reported Prognostic Expectations of People Undergoing Dialysis: United States Renal Data System Study of Treatment Preferences (USTATE). JAMA Intern Med 2019; 179:1325-1333. [PMID: 31282920 PMCID: PMC6618699 DOI: 10.1001/jamainternmed.2019.2879] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Prognostic understanding can shape patients' treatment goals and preferences. Patients undergoing dialysis in the United States have limited life expectancy and may receive end-of-life care directed at life extension. Little is known about their prognostic expectations. OBJECTIVE To understand the prognostic expectations of patients undergoing dialysis and how these relate to care planning, goals, and preferences. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey study of 996 eligible patients treated with regular dialysis at 31 nonprofit dialysis facilities in 2 metropolitan areas (Seattle, Washington, and Nashville, Tennessee) between April 2015 and October 2018. After a pilot phase, 1434 eligible patients were invited to participate (response rate, 69.5%). To provide a context for interpreting survey participants' prognostic estimates, United States Renal Data System standard analysis files were used to construct a comparison cohort of 307 602 patients undergoing in-center hemodialysis on January 1, 2006, and followed for death through July 31, 2017. Final analyses for this study were conducted between November 2018 and March 2019. EXPOSURES Responses to the question "How long would you guess people your age with similar health conditions usually live?" (<5 years, 5-10 years, >10 years, or not sure). MAIN OUTCOMES AND MEASURES Self-reported (1) documentation of a surrogate decision-maker, (2) documentation of treatment preferences, (3) values around life prolongation, (4) preferences for receipt of cardiopulmonary resuscitation and mechanical ventilation, and (5) desired place of death. RESULTS Of the 996 survey respondents, the mean (SD) age was 62.7 (13.9) years, and 438 (44.0%) were women. Overall, 112 (11.2%) survey respondents selected a prognosis of fewer than 5 years, 150 (15.1%) respondents selected 5 to 10 years, 330 (33.1%) respondents selected more than 10 years, and 404 (40.6%) were not sure. By comparison, 185 427 (60.3%) prevalent US in-center patients undergoing hemodialysis died within 5 years, 58 437 (19.0%) died within 5 to 10 years, and 63 738 (20.7%) lived more than 10 years. In analyses adjusted for participant characteristics, survey respondents with a prognostic expectation of more than 10 years (vs <5 years) were less likely to report documentation of a surrogate decision-maker (adjusted odds ratio [aOR], 0.6; 95% CI, 0.4-0.9) and treatment preferences (aOR, 0.4; 95% CI, 0.2-0.6) and to value comfort over life extension (aOR, 0.1; 95% CI, 0.04-0.3), and were more likely to want cardiopulmonary resuscitation (aOR, 5.3; 95% CI, 3.2-8.7) and mechanical ventilation (aOR, 2.2; 95% CI, 1.2-3.7). The respondents who reported that they were not sure about prognosis had similar associations. CONCLUSIONS AND RELEVANCE Uncertain and overly optimistic prognostic expectations may limit the benefit of advance care planning and contribute to high-intensity end-of-life care in patients undergoing dialysis.
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Affiliation(s)
- Ann M O'Hare
- Department of Medicine, University of Washington, Seattle.,Kidney Research Institute, University of Washington, Seattle.,VA Puget Sound Health Care System, Seattle, Washington
| | - Manjula Kurella Tamura
- Stanford University Medical Center, Palo Alto, California.,Division of Nephrology, Geriatric Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | | | - Elizabeth K Vig
- Department of Medicine, University of Washington, Seattle.,VA Puget Sound Health Care System, Seattle, Washington
| | | | - Yoshio N Hall
- Department of Medicine, University of Washington, Seattle.,Kidney Research Institute, University of Washington, Seattle
| | - Ronit Katz
- Department of Medicine, University of Washington, Seattle.,Kidney Research Institute, University of Washington, Seattle
| | - J Randall Curtis
- Department of Medicine, University of Washington, Seattle.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Ruth A Engelberg
- Department of Medicine, University of Washington, Seattle.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle
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9
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Huo J, Hong YR, Turner K, Bian J, Grewal R, Wilkie DJ. Utilization pattern and service settings of palliative care for patients with metastatic non-small cell lung cancer. Cancer 2019; 125:4481-4489. [PMID: 31449674 DOI: 10.1002/cncr.32478] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the benefits of palliative care for patients with cancer has been well established, the current utilization pattern remains largely unknown. The authors investigated the temporal trends and service settings of palliative care among Medicare beneficiaries with newly diagnosed, metastatic non-small cell lung cancer (NSCLC). METHODS In total, 69,414 patients with NSCLC were identified between January 1, 2001 and December 31, 2013 from the Surveillance, Epidemiology, and End Results-Medicare-linked database. Temporal trends in palliative care use and the temporal shift in palliative care service settings were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for the receipt of palliative care, controlling for patients' sociodemographic and clinical characteristics. RESULTS Fifteen percent (10,359) of patients with NSCLC received palliative care within 1 year of a diagnosis of metastatic NSCLC. The proportion of beneficiaries receiving palliative care increased from 3.6% in 2001 to 31.9% in 2013 (P for trend <.001). Multivariable analyses demonstrated that receipt of palliative care varied significantly by sex, race, and region. Most patients (53.5%) had their first receipt of palliative care in a hospital. Less than one-third of patients (27.6%) received palliative care in an outpatient setting or received palliative care in more than 1 service setting (26.3%) in 2013. CONCLUSIONS The number of patients with metastatic NSCLC receiving palliative care has increased substantially. Although the hospital-based program is still the main form of palliative care delivery, more patients in recent years have received palliative care services in multiple locations.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Kea Turner
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Reetu Grewal
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Jacksonville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
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10
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Toward an Understanding of Patients’ and Their Partners’ Experiences of Bladder Cancer. Cancer Nurs 2019; 43:E254-E263. [DOI: 10.1097/ncc.0000000000000718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Nipp RD, Greer JA, El-Jawahri A, Moran SM, Traeger L, Jacobs JM, Jacobsen JC, Gallagher ER, Park ER, Ryan DP, Jackson VA, Pirl WF, Temel JS. Coping and Prognostic Awareness in Patients With Advanced Cancer. J Clin Oncol 2017; 35:2551-2557. [PMID: 28574777 DOI: 10.1200/jco.2016.71.3404] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients' understanding of their illness is key for making informed treatment decisions, yet studies suggest an association between prognostic awareness and worse quality of life (QOL) and mood among patients with advanced cancer. We sought to explore the relationships among prognostic awareness, coping, QOL, and mood in patients with newly diagnosed, incurable cancer. Methods We assessed patients' self-reported health status and treatment goal (Prognosis and Treatment Perceptions Questionnaire), coping (Brief COPE), QOL (Functional Assessment of Cancer Therapy-General), and mood (Hospital Anxiety and Depression Scale) within 8 weeks of incurable lung or GI cancer diagnosis. We used linear regression to examine associations and interaction effects among patients' health status and treatment goal, coping strategies, QOL, and mood. Results Patients who reported a terminally ill health status had worse QOL (unstandardized coefficient [B] = -6.88; P < .001), depression (B = 1.60; P < .001), and anxiety (B = 1.17; P = .007). Patients who reported their oncologist's treatment goal was "to cure my cancer" had better QOL (B = 4.33; P = .03) and less anxiety (B = -1.39; P = .007). We observed interaction effects between self-reported health status and treatment goal and certain coping strategies. Specifically, subgroup analyses showed that greater use of positive reframing was related to better QOL (B = 2.61; P < .001) and less depression (B = -0.78; P < .001) among patients who reported a terminally ill health status. Active coping was associated with better QOL (B = 3.50; P < .001) and less depression (B = -1.01; P < .001) among patients who acknowledged their oncologist's treatment goal was not "to cure my cancer." Conclusion Prognostic awareness is related to worse QOL and mood in patients with newly diagnosed, incurable cancer; however, the use of certain coping strategies may buffer these relationships. Interventions to improve patients' prognostic awareness should seek to cultivate more adaptive coping strategies in order to enhance QOL and mood.
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Affiliation(s)
- Ryan D Nipp
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Joseph A Greer
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Areej El-Jawahri
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Samantha M Moran
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Lara Traeger
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jamie M Jacobs
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Juliet C Jacobsen
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Emily R Gallagher
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Elyse R Park
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - David P Ryan
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Vicki A Jackson
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - William F Pirl
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Temel
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
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12
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Patients' perspectives on information from physicians during palliative chemotherapy: A qualitative study. Palliat Support Care 2015; 14:495-502. [DOI: 10.1017/s1478951515001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:During the course of their disease, patients with cancer receiving palliative chemotherapy receive extensive amounts of information from physicians. The objective of our study was to describe patients' perspectives on the information they received from physicians during palliative chemotherapy with regard to their cancer diagnosis, treatments, prognosis, and future planning.Method:A total of 15 semistructured face-to-face interviews with patients who had incurable cancer were conducted, transcribed verbatim, and analyzed with qualitative content analysis.Results:Three categories were defined during the analytical process: “having a chronic disease,” “depending on chemotherapy,” and “living with an unpredictable future.”Significance of results:Our study demonstrated that patients undergoing palliative chemotherapy perceived that their disease was incurable and chronic, that they were dependent on chemotherapy, and that their future was uncertain. Compared with other studies, the patients in our study seemed to be more aware of their prognosis and the goals of care.
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Johnston B, Pringle J, Buchanan D. Operationalizing reflexivity to improve the rigor of palliative care research. Appl Nurs Res 2015; 31:e1-5. [PMID: 26620579 DOI: 10.1016/j.apnr.2015.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research.
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Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, The University of Nottingham, Queen's Medical Centre, Nottingham NG7 2HA.
| | - Jan Pringle
- University of Dundee and University of Nottingham, School of Nursing and Midwifery, Airlie Place, Dundee
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15
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Postma-Nilsenová M, Postma E, Tates K. Automatic detection of confusion in elderly users of a web-based health instruction video. Telemed J E Health 2015; 21:514-9. [PMID: 25844904 DOI: 10.1089/tmj.2014.0061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because of cognitive limitations and lower health literacy, many elderly patients have difficulty understanding verbal medical instructions. Automatic detection of facial movements provides a nonintrusive basis for building technological tools supporting confusion detection in healthcare delivery applications on the Internet. MATERIALS AND METHODS Twenty-four elderly participants (70-90 years old) were recorded while watching Web-based health instruction videos involving easy and complex medical terminology. Relevant fragments of the participants' facial expressions were rated by 40 medical students for perceived level of confusion and analyzed with automatic software for facial movement recognition. RESULTS A computer classification of the automatically detected facial features performed more accurately and with a higher sensitivity than the human observers (automatic detection and classification, 64% accuracy, 0.64 sensitivity; human observers, 41% accuracy, 0.43 sensitivity). A drill-down analysis of cues to confusion indicated the importance of the eye and eyebrow region. CONCLUSIONS Confusion caused by misunderstanding of medical terminology is signaled by facial cues that can be automatically detected with currently available facial expression detection technology. The findings are relevant for the development of Web-based services for healthcare consumers.
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Affiliation(s)
- Marie Postma-Nilsenová
- Department of Communication and Information Sciences, Tilburg University, Tilburg, The Netherlands
| | - Eric Postma
- Department of Communication and Information Sciences, Tilburg University, Tilburg, The Netherlands
| | - Kiek Tates
- Department of Communication and Information Sciences, Tilburg University, Tilburg, The Netherlands
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Goldzweig G, Abramovitch A, Brenner B, Perry S, Peretz T, Baider L. Expectations and Level of Satisfaction of Patients and Their Physicians: Concordance and Discrepancies. PSYCHOSOMATICS 2014; 56:521-9. [PMID: 25596021 DOI: 10.1016/j.psym.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying discrepancies between patients׳ expectations for support provided by their physicians, and physicians׳ appraisal of the support they provide to their patients, is a key factor in constructing effective doctor-patient communication. OBJECTIVE The current study proposes and explores a paradigm for assessing possible gaps and overlaps between perceptions of patients with cancer and physicians about the "actual" and the "ideal" (desired) emotional and cognitive support oncologists provide to patients. METHODS Participants included 1027 patients with cancer and 47 senior oncologists. Patients׳ and physicians׳ levels of expectations and satisfaction with the emotional and cognitive support offered by physicians were assessed using a quantitative measure of discrepancy between the actual and the ideal situation. The measure was developed for this study and tested on a random sample of 200 patients and 17 oncologists. RESULTS The results indicated consistency between physicians׳ and patients׳ perceptions of the needs and support that the patients received. Nevertheless, oncologists did not feel highly trusted by their patients, oncologists desired less involvement of patients in the treatment plan than the patients expected. Oncologists thought that they actually provided the desired levels of explanation to patients׳ families, whereas patients thought their families got less explanations than expected. CONCLUSION Actual and ideal levels of communication should be described from the points of view of both physicians and patients to better understand the complex picture of patient satisfaction. Oncologists should consider patients׳ expectations for support vs their own expectations to effectively address patients׳ needs.
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Affiliation(s)
- Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel (GG).
| | - Amitai Abramovitch
- OCD and Related Disorders Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA (AA)
| | - Baruch Brenner
- Institute of Oncology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel (BB, SP)
| | - Shlomit Perry
- Institute of Oncology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel (BB, SP)
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel (TP)
| | - Lea Baider
- Institute of Oncology, Assuta Medical Center, Tel-Aviv, Israel (LB)
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Jacobsen J, Kvale E, Rabow M, Rinaldi S, Cohen S, Weissman D, Jackson V. Helping patients with serious illness live well through the promotion of adaptive coping: a report from the improving outpatient palliative care (IPAL-OP) initiative. J Palliat Med 2014; 17:463-8. [PMID: 24579823 DOI: 10.1089/jpm.2013.0254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Continuity outpatient palliative care practice is characterized by long relationships between patients, families, and palliative care clinicians and by periods of relative stability when the disease and resultant symptoms are less active. Compared to inpatient palliative care, outpatient practice requires a greater focus on encouraging healthy coping and on helping patients to live well with serious illness. This paper discusses the opportunities to promote adaptive coping in the delivery of outpatient palliative care.
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Affiliation(s)
- Juliet Jacobsen
- 1 Department of Palliative Care, Massachusets General Hospital , Boston, Massachusetts
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Enguidanos S, Housen P, Penido M, Mejia B, Miller JA. Family members' perceptions of inpatient palliative care consult services: a qualitative study. Palliat Med 2014; 28:42-8. [PMID: 23744841 DOI: 10.1177/0269216313491620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family members are commonly involved in end-of-life decision making and typically involved in inpatient palliative care consultations. Although much research has documented patient outcomes following inpatient palliative care consultation, little is known about family member perceptions of the consultation. AIM The purpose of this study was to determine how inpatient palliative care consultations impacted family members' understanding of the patient's condition, knowledge of available care options, and decision-making ability. DESIGN An exploratory, qualitative study was conducted employing individual interviews among family members of seriously ill patients, recruited purposively. Interviews were conducted in person, at the hospital, or via telephone, using a semistructured protocol. SETTING/PARTICIPANTS Family members of seriously ill patients were recruited from a nonprofit, community hospital. RESULTS Interviews were conducted among 23 family members. Four themes were identified and included: perceived qualities of the inpatient palliative care consultation, family readiness, impact on decision-making process, and focus on comfort and quality of life. While most comments reflected positive aspects of the inpatient palliative care consult, such as improved pain control and communication, and increased access to medical professionals and time to discuss patient conditions, some themes reflected a lack of adequate preparation for the inpatient palliative care consultation and readiness for discussing prognosis. CONCLUSION Family members report discussion with the inpatient palliative care team results in improved communication and knowledge, which contributes to decision-making ability. However, palliative care consultation may be improved by developing stronger protocols for introducing palliative care and by including the attending physician in the process to preclude conflicting, inconsistent information and recommendations.
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Affiliation(s)
- Susan Enguidanos
- 1Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Jackson VA, Jacobsen J, Greer JA, Pirl WF, Temel JS, Back AL. The cultivation of prognostic awareness through the provision of early palliative care in the ambulatory setting: a communication guide. J Palliat Med 2013; 16:894-900. [PMID: 23786425 DOI: 10.1089/jpm.2012.0547] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Early, integrated palliative care delivered in the ambulatory setting has been associated with improved quality of life, lower rates of depression, and even prolonged survival. We outline an expert practice that provides a step-wise approach to cultivating prognostic awareness in patients cared for by a palliative care clinician early in the course of the patient's disease. This approach can be used by both novice and more experienced palliative care clinicians.
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Affiliation(s)
- Vicki A Jackson
- Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. @partners.org
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