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Wu Y, Zhang X. Examining Conversation Analysis in Palliative Care: A Systematic Review. HEALTH COMMUNICATION 2024:1-12. [PMID: 38166606 DOI: 10.1080/10410236.2023.2301202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.
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Affiliation(s)
- Yijin Wu
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| | - Xin Zhang
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
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Weiss CR, Baker C, Gillespie A, Jones J. Ambiguous loss in family caregivers of loved ones with cancer, a synthesis of qualitative studies. J Cancer Surviv 2023; 17:484-498. [PMID: 36396909 DOI: 10.1007/s11764-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory. METHODS We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation. RESULTS Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research. CONCLUSIONS The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency. IMPLICATIONS FOR CANCER SURVIVORS Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.
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Affiliation(s)
- Charlotte R Weiss
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA.
- , Wilmington, USA.
| | - Christina Baker
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Anne Gillespie
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
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Hanson LC, Wessell KL, Hanspal J, Lin FC, Collichio FA, DeWalt D, Milowsky MI, Rosenstein DL, Winzelberg GS, Wood WA, Ernecoff NC. Pre-Post Evaluation of Collaborative Oncology Palliative Care for Patients With Stage IV Cancer. J Pain Symptom Manage 2021; 62:e56-e64. [PMID: 33652096 PMCID: PMC8390587 DOI: 10.1016/j.jpainsymman.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT The Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care. OBJECTIVES To develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer. METHODS We conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization. CO-Pal has 4 components: 1) oncologist communication skills training; 2) patient tracking; 3) palliative care needs assessment; and 4) care coordination stratified by high vs. low palliative care need. Health record reviews from hospital admission through 60 days provided data on outcomes - goals-of-care discussions (primary outcome), advance care planning, symptom treatment, specialty palliative care and hospice use, and hospital transfers. RESULTS We enrolled 256 patients (n = 114 pre and n = 142 post-intervention); 60-day mortality was 32%. Comparing patients pre vs post-intervention, CO-Pal did not increase overall goals-of-care discussions, but did increase advance care planning (48% vs 63%, P = 0.021) and hospice use (19% vs 31%, P = 0.034). CO-Pal did not impact symptom treatment, overall treatment plans, or 60-day hospital transfers. During the intervention phase, high-need vs low-need patients had more goals-of-care discussions (60% vs. 15%, P < 0.001) and more use of specialty palliative care (64% vs 22%, P < 0.001) and hospice (44% vs 16%, P < 0.001). CONCLUSION Collaborative oncology palliative care is efficient and feasible. While it did not increase overall goals-of-care discussions, it was effective to increase overall advance care planning and hospice use for patients with Stage IV cancer.
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Affiliation(s)
- Laura C Hanson
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill (L.C.H., G.S.W.), Chapel Hill, North Carolina, USA; Palliative Care Program, University of North Carolina at Chapel Hill (L.C.H., J.H., G.S.W.), Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (L.C.H., K.L.W.), Chapel Hill, North Carolina, USA.
| | - Kathryn L Wessell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (L.C.H., K.L.W.), Chapel Hill, North Carolina, USA
| | - Jenny Hanspal
- Palliative Care Program, University of North Carolina at Chapel Hill (L.C.H., J.H., G.S.W.), Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (F.-C.L.), Chapel Hill, North Carolina, USA
| | - Frances A Collichio
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill (F.A.C., M.I.M., W.A.W.), Chapel Hill, North Carolina, USA
| | - Darren DeWalt
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill (D.D.), Chapel Hill, North Carolina, USA
| | - Matthew I Milowsky
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill (F.A.C., M.I.M., W.A.W.), Chapel Hill, North Carolina, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill (D.L.R.), Chapel Hill, North Carolina, USA
| | - Gary S Winzelberg
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill (L.C.H., G.S.W.), Chapel Hill, North Carolina, USA; Palliative Care Program, University of North Carolina at Chapel Hill (L.C.H., J.H., G.S.W.), Chapel Hill, North Carolina, USA
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill (F.A.C., M.I.M., W.A.W.), Chapel Hill, North Carolina, USA
| | - Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine (N.C.E.), Pittsburgh, Pennsylvania, USA
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Hanson LC, Ernecoff NC, Wessell KL, Lin FC, Milowsky MI, Collichio FA, Wood WA, Rosenstein DL. Mortality Risk for Patients With Stage IV Cancer and Acute Illness Hospitalization. J Pain Symptom Manage 2021; 61:797-804. [PMID: 33096216 PMCID: PMC8075274 DOI: 10.1016/j.jpainsymman.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT Cancer prognosis data often come from clinical trials which exclude patients with acute illness. OBJECTIVES For patients with Stage IV cancer and acute illness hospitalization to 1) describe predictors of 60-day mortality and 2) compare documented decision-making for survivors and decedents. METHODS Investigators studied a consecutive prospective cohort of patients with Stage IV cancer and acute illness hospitalization. Structured health record and obituary reviews provided data on 60-day mortality (outcome), demographics, health status, and treatment; logistic regression models identified mortality predictors. RESULTS Four hundred ninety-two patients with Stage IV cancer and acute illness hospitalization had median age of 60.2 (51% female, 38% minority race/ethnicity); 156 (32%) died within 60 days, and median survival for decedents was 28 days. Nutritional insufficiency (odds rato [OR] 1.83), serum albumin (OR 2.15 per 1.0 g/dL), and hospital days (OR 1.04) were associated with mortality; age, gender, race, cancer, and acute illness type were not predictive. On admission, 79% of patients had orders indicating Full Code. During 60-day follow-up, 42% of patients discussed goals of care. Documented goals of care discussions were more common for decedents than survivors (70% vs. 28%, P < 0.001), as were orders for do not resuscitate/do not intubate (68% vs. 24%, P < 0.001), stopping cancer-directed therapy (29% vs. 10%, P < 0.001), specialty Palliative Care (79% vs. 44%, P < 0.001), and Hospice (68% vs. 14%, P < 0.001). CONCLUSION Acute illness hospitalization is a sentinel event in Stage IV cancer. Short-term mortality is high; nutritional decline increases risk. For patients with Stage IV cancer, acute illness hospitalization should trigger goals of care discussions.
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Affiliation(s)
- Laura C Hanson
- Division of Geriatric Medicine & Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kathryn L Wessell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew I Milowsky
- Division of Hematology and Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Frances A Collichio
- Division of Hematology and Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Wood
- Division of Hematology and Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ferrell B, Buller H, Paice J, Anderson W, Donesky D. End-of-Life Nursing and Education Consortium Communication Curriculum for Interdisciplinary Palliative Care Teams. J Palliat Med 2019; 22:1082-1091. [DOI: 10.1089/jpm.2018.0645] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Judith Paice
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wendy Anderson
- Division of Palliative Medicine, University of California San Francisco, San Francisco, California
| | - DorAnne Donesky
- School of Nursing, Touro University of California, Vallejo, California
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End-of-Life Nursing and Education Consortium Communication Curriculum for Nurses. J Hosp Palliat Nurs 2019; 21:E5-E12. [DOI: 10.1097/njh.0000000000000540] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chou WS, Hamel LM, Thai CL, Debono D, Chapman RA, Albrecht TL, Penner LA, Eggly S. Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists' language. Health Expect 2017; 20:1073-1080. [PMID: 28261901 PMCID: PMC5600249 DOI: 10.1111/hex.12549] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information. OBJECTIVE This qualitative study describes oncologists' language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer. DESIGN We analysed transcripts from video recordings of clinical interactions between patients with Stage III or IV cancer (n=26) and their oncologists (n=9). In-depth discourse analysis was conducted to describe and interpret oncologists' communication behaviours and common linguistic features in the interactions. SETTING AND PARTICIPANTS Data were from a larger study of patient-provider communication between African Americans and oncologists at two cancer hospitals in Detroit. RESULTS Prognosis was discussed in 73.1% (n=19) of the interactions; treatment goals were discussed in 92.3% (n=24). However, analysis revealed that oncologists' description of prognosis was vague (e.g. "prognosis is a bit worse in your case") and rarely included a survival estimate. Oncologists often used ambiguous terminology, including euphemisms and jargon, and emphasized uncertainty (e.g. "lesions are suspicious for the disease"). Conversation about prognosis was frequently brief, moving quickly to the urgency and details of treatment. DISCUSSION This study demonstrates how oncologists' language may obscure discussion of prognosis and treatment goals. The identified behaviours may lead to missed opportunities in eliciting and discussing patients' knowledge about and preferences for their care. Patient-, provider- and system-oriented interventions are needed to improve clinical communication, especially among minority patients with advanced cancer.
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Affiliation(s)
| | - Lauren M. Hamel
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | | | - David Debono
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | | | | | - Louis A. Penner
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | - Susan Eggly
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
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Davison J, Schenker Y, Donovan H, Rosenzweig M. A Work Sampling Assessment of the Nursing Delivery of Palliative Care in Ambulatory Cancer Centers. Clin J Oncol Nurs 2017; 20:421-6. [PMID: 27441515 DOI: 10.1188/16.cjon.421-426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most cancer care occurs within infusion rooms at ambulatory cancer centers, which are staffed by RNs administering chemotherapies and other cancer care medications. Many patients receiving these therapies have basic palliative care needs that could be addressed by the RNs. However, the extent to which these RNs spend their time on basic, or "primary," palliative care is unknown. OBJECTIVES The aim of this project was to conduct a work sampling assessment of infusion room RNs' work activities and provision of primary palliative care. METHODS A single observer conducted direct observation work sampling at three academic cancer center infusion rooms. Nursing tasks were recorded via freehand text and later assigned an appropriate task code. FINDINGS Observed infusion room RNs spent about 1% of their time on direct care palliative care tasks, primarily symptom assessment. The remainder of their time was divided among direct (28%) and indirect (56%) nonpalliative care activities, unit-related activities (7%), and personal time (9%). Infusion room RNs spent less than a third of their time on administering direct patient care and very minimal time on performing palliative care activities.
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Hanson LC, Collichio F, Bernard SA, Wood WA, Milowsky M, Burgess E, Creedle CJ, Cheek S, Chang L, Chera B, Fox A, Lin FC. Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention. J Palliat Med 2017; 20:1366-1371. [PMID: 28737996 DOI: 10.1089/jpm.2017.0100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Practice guidelines recommend palliative care for patients with advanced cancer, but gaps in access and quality of care persist. OBJECTIVE To increase goals-of-care (GOC) communication for hospitalized patients with Stage IV cancer. METHODS An interdisciplinary team designed a quality improvement intervention to enhance oncology palliative care, including training in communication skills and triggers for palliative care consults. SETTING/SUBJECTS All adult inpatients with Stage IV cancer and unplanned admission at an 804-bed hospital affiliated with a National Cancer Institute (NCI) Comprehensive Cancer Center. MEASUREMENTS The primary quality measure was the percentage of patients with Stage IV cancer who had a GOC discussion during hospitalization; secondary measures included screening for pain, dyspnea, spiritual needs, and outcomes of intensive care, hospice, and 30-day readmission. RESULTS In the 11-month study period, n = 330, Stage IV cancer patients were hospitalized. Comparing the first three months with the final three months, rates of GOC discussion increased from 29% to 48% (p = 0.013), and specialty palliative care consultation increased from 18% to 33%, (p = 0.026). Rates of symptom screening, intensive care unit transfer, hospice, and 30-day re-admission did not change overall. However, patients with specialty palliative care more frequently had pain screening (91% vs. 81%, p = 0.020), spiritual assessment (48% vs. 10%, p < 0.001), and hospice referral (39% vs. 9%, p < 0.001), and they were less likely to be re-admitted within 30 days (12% vs. 21%, p = 0.059). DISCUSSION Interdisciplinary quality improvement was effective to increase GOC discussions and palliative care consults for patients with Stage IV cancer.
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Affiliation(s)
- Laura C Hanson
- 1 Division of Geriatric Medicine, The University of North Carolina , Chapel Hill, North Carolina.,2 Palliative Care Program, The University of North Carolina , Chapel Hill, North Carolina.,3 Cecil Sheps Center for Health Services Research, The University of North Carolina , Chapel Hill, North Carolina
| | - Frances Collichio
- 4 Division of Hematology and Oncology, The University of North Carolina , Chapel Hill, North Carolina
| | - Stephen A Bernard
- 2 Palliative Care Program, The University of North Carolina , Chapel Hill, North Carolina.,4 Division of Hematology and Oncology, The University of North Carolina , Chapel Hill, North Carolina
| | - William A Wood
- 4 Division of Hematology and Oncology, The University of North Carolina , Chapel Hill, North Carolina
| | - Matt Milowsky
- 4 Division of Hematology and Oncology, The University of North Carolina , Chapel Hill, North Carolina
| | - Erin Burgess
- 5 Performance Improvement & Patient Safety, UNC Hospitals , Chapel Hill, North Carolina
| | - Crista J Creedle
- 6 Hematology Oncology Nursing, UNC Hospitals , Chapel Hill, North Carolina
| | - Summer Cheek
- 6 Hematology Oncology Nursing, UNC Hospitals , Chapel Hill, North Carolina
| | - Lydia Chang
- 7 Division of Pulmonology and Critical Care Medicine, The University of North Carolina , Chapel Hill, North Carolina
| | - Bhisham Chera
- 8 Patient Safety and Quality, Department of Radiation Oncology, The University of North Carolina , Chapel Hill, North Carolina
| | - Alexandra Fox
- 3 Cecil Sheps Center for Health Services Research, The University of North Carolina , Chapel Hill, North Carolina
| | - Feng-Chang Lin
- 9 Department of Biostatistics, School of Public Health, The University of North Carolina , Chapel Hill, North Carolina
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Rabow MW, Dahlin C, Calton B, Bischoff K, Ritchie C. New Frontiers in Outpatient Palliative Care for Patients With Cancer. Cancer Control 2016; 22:465-74. [PMID: 26678973 DOI: 10.1177/107327481502200412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although much evidence has accumulated demonstrating its benefit, relatively little is known about outpatient palliative care in patients with cancer. METHODS This paper reviews the literature and perspectives from content experts to describe the current state of outpatient palliative care in the oncology setting and current areas of innovation and promise in the field. RESULTS Evidence, including from controlled trials, documents the benefits of outpatient palliative care in the oncology setting. As a result, professional medical organizations have guidelines and recommendations based on the key role of palliative care in oncology. Six elements of the practice sit at the frontier of outpatient oncology palliative care, including the setting and timing of palliative care integration into outpatient oncology, the relationships between primary and specialty palliative care, quality and measurement, research, electronic and technical innovations, and finances. CONCLUSIONS Evidence of clinical and health care system benefits supports the recommendations of professional organizations to integrate palliative care into the routine treatment of patients with advanced cancer.
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Michael N, O'Callaghan C, Baird A, Gough K, Krishnasamy M, Hiscock N, Clayton J. A mixed method feasibility study of a patient- and family-centred advance care planning intervention for cancer patients. BMC Palliat Care 2015; 14:27. [PMID: 25981642 PMCID: PMC4456060 DOI: 10.1186/s12904-015-0023-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/23/2015] [Indexed: 12/16/2022] Open
Abstract
Background Advance care planning (ACP) is a process whereby values and goals are sensitively explored and documented to uphold patients’ wishes should they become incompetent to make decisions in the future. Evidenced-based, effective approaches are needed. This study sought to assess the feasibility and acceptability of an ACP intervention informed by phase 1 findings and assessed the suitability of measures for a phase 3 trial. Methods Prospective, longitudinal, mixed methods study with convenience sampling. A skilled facilitator conducted an ACP intervention with stage III/IV cancer patients and invited caregivers. It incorporated the vignette technique and optional completion/integration of ACP documents into electronic medical records (EMR). Quantitative and qualitative data were collected concurrently, analysed separately, and the two sets of findings converged. Results Forty-seven percent consent rate with 30 patients and 26 caregivers completing the intervention. Ninety percent of patient participants had not or probably not written future care plans. Compliance with assessments was high and missing responses to items low. Small- to medium-sized changes were observed on a number of patients and caregiver completed measures, but confidence intervals were typically wide and most included zero. An increase in distress was reported; however, all believed the intervention should be made available. Eleven documents from nine patients were incorporated into EMR. ACP may not be furthered because of intervention inadequacies, busy lives, and reluctance to plan ahead. Conclusions In this phase 2 study we demonstrated feasibility of recruitment and acceptability of the ACP intervention and most outcome measures. However, patient/family preferences about when and whether to document ACP components need to be respected. Thus flexibility to accommodate variability in intervention delivery, tailored to individual patient/family preferences, may be required for phase 3 research. Electronic supplementary material The online version of this article (doi:10.1186/s12904-015-0023-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natasha Michael
- Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, 3800, Australia.
| | - Clare O'Callaghan
- Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia. .,Caritas Christi Hospice, St Vincent's Hospital, 104 Studley Park Rd Kew, Victoria, 3101, Australia. .,Department of Medicine, St Vincent's Hospital, Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia. .,Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia.
| | - Angela Baird
- Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia.
| | - Karla Gough
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia.
| | - Mei Krishnasamy
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia. .,Department of Nursing, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Nathaniel Hiscock
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, 3800, Australia.
| | - Josephine Clayton
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, 97-115 River Road, Greenwich, NSW, 2065, Australia. .,Sydney Medical School, University of Sydney, New South Wales, 2006, Australia.
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Humphrey L, Kang TI. Palliative care in pediatric patients with hematologic malignancies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:490-495. [PMID: 26637763 DOI: 10.1182/asheducation-2015.1.490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Children with advanced cancer, including those with hematologic malignancies, can benefit from interdisciplinary palliative care services. Palliative care includes management of distressing symptoms, attention to psychosocial and spiritual needs, and assistance with navigating complex medical decisions with the ultimate goal of maximizing the quality-of-life of the child and family. Palliative care is distinct from hospice care and can assist with the care of patients throughout the cancer continuum, irrespective of prognosis. While key healthcare organizations, including the Institute of Medicine, the American Academy of Pediatrics and the American Society of Clinical Oncology among many others endorse palliative care for children with advanced illness, barriers to integration of palliative care into cancer care still exist. Providing assistance with advance care planning, guiding patients and families through prognostic uncertainty, and managing transitions of care are also included in goals of palliative care involvement. For patients with advanced malignancy, legislation, included in the Patient Protection and Affordable Health Care Act allows patients and families more options as they make the difficult transition from disease directed therapy to care focused on comfort and quality-of-life.
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Affiliation(s)
| | - Tammy I Kang
- The Children's Hospital of Philadelphia, Philadelphia, PA
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