1
|
Jia N, Wu Y. Discourse Analysis in End-of-Life Communication: A Systematic Review. HEALTH COMMUNICATION 2024:1-16. [PMID: 39246016 DOI: 10.1080/10410236.2024.2400815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Discourse analysis (DA) has emerged as a valuable method for examining communication between participants in end-of-life (EOL) care. However, there remains a gap in synthesizing the findings of discourse analytic studies focused on communication within EOL care settings. The aim of this study was to synthesize DA studies in EOL care. A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (Prisma) guidelines. An electronic database of Web of Science (WOS), MEDLINE, PubMed, and Embase was performed. 14 peer-reviewed studies published in English before January 10 2024, were included. Thematic analysis identified three overarching themes: (1) caregivers' discursive stances on EOL care, (2) discursive practices of participants in shared decision-making conversations, and (3) discursive resources in talking illness trajectories. Findings suggest that DA has the potential to provide insights into understanding communication practices in EOL care and examining an individual's stance on issues about EOL care, thus informing clinical practice and improving patient-centered care.
Collapse
Affiliation(s)
- Nan Jia
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| | - Yijin Wu
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| |
Collapse
|
2
|
Sørensen RW, Andersen NI, Dieperink KB. NADA Acupuncture in Specialized Palliative Care: Patients' and Family Caregivers' Experiences. J Pain Symptom Manage 2024; 68:1-9. [PMID: 38522805 DOI: 10.1016/j.jpainsymman.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
CONTEXT Over the last 30 years, non-pharmacological treatment with ear acupuncture, including National Acupuncture Detoxification Association (NADA) acupuncture, has become popular in Western society to relieve cancer-related symptoms. OBJECTIVES This study aim is to explore whether NADA acupuncture plays a role in relieving suffering experienced by patients hospitalized in a specialized palliative care ward and their family caregivers and whether it contributes to their coping skills. METHODS A qualitative study with a hermeneutic approach utilizing inductive thematic content analysis. Purposeful sampling took place in a specialized palliative care ward in Denmark and all data were collected through semi-structured interviews with patients and family caregivers as either individual or family interviews. RESULTS A total of 10 patients and 15 family caregivers participated in interviews. Four themes emerged: (1) communication about treatment with NADA acupuncture, (2) relief of suffering generates extra energy and inner strength, (3) sharing the experience with the family is beneficial, and (4) physical and psychological effects after receiving NADA acupuncture. CONCLUSION Patients in palliative care and their family caregivers experienced relief of suffering after receiving NADA acupuncture, as well as improved well-being, and extra energy and inner strength to cope with their life situation. The ability to share NADA acupuncture gave family caregivers the feeling of being cared for and contributed to feelings of fellowship and togetherness within the family, strengthening their ability to communicate and cope.
Collapse
Affiliation(s)
| | - Nina Ingerslev Andersen
- Department of Oncology (R.W.S., N.I.A., K.B.D.), Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
3
|
Lochmann M, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, Vanacker H, Vinceneux A, Brahmi M, Renard O, Verlingue L, Amini-Adle M, Swalduz A, Gautier J, Ducimetière F, Anota A, Cassier PA, Chvetzoff G, Christophe V. Qualitative evaluation of motives for acceptance or refusal of early palliative care in patients included in early-phase clinical trials in a French comprehensive cancer center: the PALPHA study. Support Care Cancer 2024; 32:353. [PMID: 38748187 DOI: 10.1007/s00520-024-08535-x] [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: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The integration of palliative care (PC) into oncological management is recommended well before the end of life. It improves quality of life and symptom control and reduces the aggressiveness of end-of-life care. However, its appropriate timing is still debated. Entry into an early-phase clinical trial (ECT) represents hopes for the patient when standard treatments have failed. It is an opportune moment to integrate PC to preserve the patient's general health status. The objective of this study was to evaluate the motives for acceptance or refusal of early PC management in patients included in an ECT. METHODS Patients eligible to enter an ECT were identified and concomitant PC was proposed. All patients received exploratory interviews conducted by a researcher. Their contents were analyzed in a double-blind thematic analysis with a self-determination model. RESULTS Motives for acceptance (PC acceptors: n = 27) were both intrinsic (e.g., pain relief, psychological support, anticipation of the future) and extrinsic (e.g., trust in the medical profession, for a relative, to support the advance of research). Motives for refusal (PC refusers: n = 3) were solely intrinsic (e.g., PC associated with death, negative representation of psychological support, no need for additional care, claim of independence). CONCLUSIONS The motives of acceptors and refusers are not internalized in the same way and call for different autonomy needs. Acceptors and refusers are influenced by opposite representations of PC and a different perception of mixed management.
Collapse
Affiliation(s)
- Mathilde Lochmann
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France.
| | - Magali Girodet
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Johanna Despax
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Valentine Baudry
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julie Duranti
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Bénédicte Mastroianni
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Hélène Vanacker
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Armelle Vinceneux
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mehdi Brahmi
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Olivier Renard
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Loïc Verlingue
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mona Amini-Adle
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Aurélie Swalduz
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julien Gautier
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Françoise Ducimetière
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Amélie Anota
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Philippe A Cassier
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Gisèle Chvetzoff
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Véronique Christophe
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Centre de Recherche sur le Cancer de Lyon (CRCL), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Université Claude Bernard Lyon 1 (UCBL), 43 Bd du 11 Novembre 1918, 69100, Villeurbanne, France
| |
Collapse
|
4
|
Singh N, Giannitrapani KF, Gamboa RC, O’Hanlon CE, Fereydooni S, Holdsworth LM, Lindvall C, Walling AM, Lorenz KA. What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic. Am J Hosp Palliat Care 2024; 41:558-567. [PMID: 37390466 PMCID: PMC10315453 DOI: 10.1177/10499091231187351] [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] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis. METHODS We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes. RESULTS Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time. CONCLUSION Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.
Collapse
Affiliation(s)
- Nainwant Singh
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Karleen F. Giannitrapani
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Raziel C. Gamboa
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | | | | | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne M. Walling
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| |
Collapse
|
5
|
Xuan X, Duan X, Feng Z, Zheng Y. Differences in Nurses' Satisfaction and Demand for Spatial Design Among Different Departments of Nursing Units: A Case Study in China. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:129-145. [PMID: 38087872 DOI: 10.1177/19375867231213955] [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: 05/09/2024]
Abstract
OBJECTIVES The study aimed to extend original research and identify operational and space-related requirements for specialization from the perspectives of nursing behavior and process. BACKGROUND Studies related to the specialty of different nursing units have been widely conducted in nursing science, while few studies have explored the specialized requirements for the physical environments of nursing units in different departments. METHOD Questionnaire survey data were collected from 125 nurses in 11 clinical departments, and nurse shadowing (approximately 68 hr) was conducted in four clinical departments. RESULTS The questionnaire survey showed that satisfaction with care activity, visibility, and physical environment within the existing nursing unit environment was rated differently among different departments of nursing units. However, nurses in different groups of age, education, work experience, and position indicated no statistically significant difference. Behavioral observations demonstrated that the spatial and temporal distributions of activities, spatial linkages, and communication patterns varied in distinct departments. CONCLUSION This research found that nurses in different departments had different evaluations of satisfaction and environmental characteristics. It also explains the differences in nursing work behaviors and processes found in various departments and sheds light on specialized requirements from the behavior perspective. The findings could help optimize the design of efficient and satisfactory nursing units in different departments.
Collapse
Affiliation(s)
- Xiaodong Xuan
- Department of Architecture, College of Architecture & Art, Hefei University of Technology, China
| | - Xiaoxia Duan
- The Second Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Anhui, China
| | - Zihao Feng
- ARTS Group Co., Ltd, Suzhou, Jiangsu, China
| | - Yihe Zheng
- Department of Architecture, College of Architecture & Art, Hefei University of Technology, China
| |
Collapse
|
6
|
Rowe JT, Parrillo E, Stanford O, Wenzel J, Johnston FM. Individual and Systemic Barriers Blocking Community Health Workers from Helping the Seriously Ill. J Palliat Med 2024; 27:358-366. [PMID: 38010809 PMCID: PMC10903179 DOI: 10.1089/jpm.2022.0516] [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] [Accepted: 09/15/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Objective: Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Design: Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Setting/Subjects: Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. Results: CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. Conclusions: There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.
Collapse
Affiliation(s)
- Julian T. Rowe
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaina Parrillo
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Stanford
- Community Outreach and Engagement Department, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Çakmak C, Uğurluoğlu Ö. The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control 2024; 31:10732748241236327. [PMID: 38411086 PMCID: PMC10901059 DOI: 10.1177/10732748241236327] [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] [Received: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Patient-centered communication is a type of communication that takes place between the provider and the patient. OBJECTIVES It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction. METHOD The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye. RESULTS More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction. CONCLUSION Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.
Collapse
Affiliation(s)
- Cuma Çakmak
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Dicle University, Diyarbakır, Türkiye
| | - Özgür Uğurluoğlu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Türkiye
| |
Collapse
|
8
|
Anandarajah G, Mennillo MR, Wang S, DeFries K, Gottlieb JL. Trust as a Central Factor in Hospice Enrollment Disparities Among Ethnic and Racial Minority Patients: A Qualitative Study of Interrelated and Compounding Factors Impacting Trust. J Palliat Med 2023; 26:1488-1500. [PMID: 37379486 DOI: 10.1089/jpm.2023.0090] [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: 06/30/2023] Open
Abstract
Background: Disparities in end-of-life (EOL) care remain among ethnic/racial minority populations. Choosing hospice care in the United States depends on goals-of-care discussions founded on trust. While studies examine hospice enrollment disparities and others explore trust in hospice settings in general, very few explicitly examine the role of trust in hospice enrollment disparities. Objectives: To explore factors impacting trust and how these might contribute to disparities in hospice enrollment. Design: A qualitative, individual interview study, based on grounded theory. Setting/Subjects: Setting: Rhode Island, USA. Participants: Multiple stakeholders in EOL care, with diverse professional and personal backgrounds. Measurements: In-depth semistructured individual interviews were audio-recorded and transcribed as part of a broader study of hospice enrollment barriers in diverse patients. Analysis: Five researchers did a secondary data analysis, focusing on trust as the central phenomenon of interest. Researchers independently analyzed transcripts, then held iterative group analysis meetings until they reached consensus regarding themes, subthemes, and relationships. Results: Twenty-two participants included five physicians, five nurses, three social workers, two chaplains, one nursing assistant, three administrators, and three patient caregivers/family. Interviews reveal that trust is multidimensional, involving personal- and systems-level trust, and both locus and degree of trust. Factors impacting trust include: fear; communication/relationships; knowledge of hospice; religious/spiritual beliefs; language; and cultural beliefs/experiences. While some are common across groups, several are more prevalent in minority populations. These factors appear to interact in complex ways, unique to individual patients/families, compounding their impact on trust. Conclusions: While gaining patient/family trust regarding EOL decision making is challenging across all groups, minority patients often experience additional compounding factors impacting trust building. More research is needed to mitigate the negative ways these interacting factors impact trust.
Collapse
Affiliation(s)
- Gowri Anandarajah
- Department of Family Medicine and Medical Science, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Meera R Mennillo
- Department of English, University of Rhode Island, Kingston, Rhode Island, USA
| | - Sophie Wang
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Kai'olu DeFries
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Jaya L Gottlieb
- Department of Biology, University of Massachusetts-Amherst, Amherst, Massachusetts, USA
| |
Collapse
|
9
|
Dadich A, Gliniecka M, Cull M, Womsley K. POMSNAME: an aide-mémoire to improve the assessment and documentation of palliative care - a longitudinal project. BMC Palliat Care 2023; 22:157. [PMID: 37865745 PMCID: PMC10590006 DOI: 10.1186/s12904-023-01279-1] [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] [Received: 05/03/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Evidence-based palliative care requires comprehensive assessment and documentation. However, palliative care is not always systemically documented - this can have implications for team communication and patient wellbeing. The aim of this project was to determine the effectiveness of an aide-mémoire - POMSNAME - to prompt the comprehensive assessment of the following domains by clinicians: pain, orientation and oral health, mobility, social situation, nausea and vomiting, appetite, medication, and elimination. METHODS A placard depicting the aide-mémoire was distributed to community-based nurses who received training and support. The case notes of palliative care patients were evaluated one month before the intervention, and was repeated at one month, eight months, and fifty months following the intervention. The 235 case notes pertained to patients who received palliative care from a team of 13 registered nurses at one community health service. RESULTS The documented assessment of palliative care patients improved across all nine domains. The most significant improvements pertained to patients' social situation, orientation, and nausea, eight months after the aide-mémoire was introduced (170.1%, 116.9%, and 105.6%, respectively, all at p < .001). Although oral health and medication assessment declined one-month after the aide-mémoire was introduced (-41.7% and-2.1%, respectively), both subsequently improved, thereafter, at both 8 months and 50 months after the aide-mémoire was introduced. CONCLUSIONS The improvement of palliative care documentation across all nine domains demonstrates the potential of the POMSNAME aide-mémoire to prompt the comprehensive assessment of patients by clinicians with generalist expertise. Research is required to determine whether other domains warrant inclusion and how.
Collapse
Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia.
| | - Martyna Gliniecka
- School of Business, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia
| | - Michelle Cull
- School of Business, Western Sydney University, Locked Bag 1797, Penrith South, NSW, 2751, Australia
| | - Kerrie Womsley
- Illawarra Shoalhaven Local Health District, PO Box 239, Port Kembla, NSW, 2505, Australia
| |
Collapse
|
10
|
Marino LV, Collaḉo N, Coyne S, Leppan M, Ridgeway S, Bharucha T, Cochrane C, Fandinga C, Palframan K, Rees L, Osman A, Johnson MJ, Hurley-Wallace A, Darlington ASE. The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project. Healthcare (Basel) 2023; 11:2706. [PMID: 37893780 PMCID: PMC10606263 DOI: 10.3390/healthcare11202706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.
Collapse
Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicole Collaḉo
- School of Health Sciences, Southampton University, Southampton SO17 1BJ, UK
| | | | | | | | - Tara Bharucha
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Colette Cochrane
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Catarina Fandinga
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Karla Palframan
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Leanne Rees
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahmed Osman
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mark J Johnson
- Neonatal Medicine, Princess Anne Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | | | | |
Collapse
|
11
|
Goni-Fuste B, Pergolizzi D, Monforte-Royo C, Alonso-Babarro A, Belar A, Crespo I, Güell E, Julià-Torras J, Moreno-Alonso D, Nabal Vicuña M, Pascual A, Porta-Sales J, Rocafort J, Rodríguez-Prat A, Rodríguez D, Sala C, Serrano-Bermúdez G, Serna J, Balaguer A. Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP). J Pain Symptom Manage 2023; 66:361-369.e6. [PMID: 37468050 DOI: 10.1016/j.jpainsymman.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
CONTEXT Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. OBJECTIVES To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). METHODS A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. RESULTS The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). CONCLUSION MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.
Collapse
Affiliation(s)
- Blanca Goni-Fuste
- Department of Nursing, School of Medicine and Health Sciences (B.G-F., C.M-R.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences (B.G-F., C.M-R.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain.
| | | | - Alazne Belar
- Instituto Cultura y Sociedad (A.B.), Universidad de Navarra, IdiSNA, Pamplona, Spain
| | - Iris Crespo
- Department of Basic Sciences (I.C.), School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ernest Güell
- Hospital Universitari Sant Pau (E.G., A.P.), Barcelona, Spain
| | - Joaquim Julià-Torras
- School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain; Department of Palliative Care (J.J-T.), Institut Català d'Oncologia Badalona, Badalona, Spain
| | - Deborah Moreno-Alonso
- School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain; Institut Català d'Oncologia L'Hospitalet (D.M-A., G.S-B.), L'Hospitalet, Barcelona, Spain
| | - Maria Nabal Vicuña
- Hospital Universitari Arnau de Vilanova (M.N.V.), Lleida, Spain; Faculty of Medicine (M.N.V.), Universidad de Lleida, Lleida, Spain
| | - Antonio Pascual
- Hospital Universitari Sant Pau (E.G., A.P.), Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain
| | - Javier Rocafort
- Fundación Vianorte-Laguna (J.R.), Madrid, Spain; School of Medicine (J.R.), Francisco de Vitoria University, Madrid, Spain
| | - Andrea Rodríguez-Prat
- Department of Humanities (A.R-P.), School of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Carme Sala
- Consorci Sanitari de Terrassa (C.S.), Terrassa, Spain
| | - Gala Serrano-Bermúdez
- Institut Català d'Oncologia L'Hospitalet (D.M-A., G.S-B.), L'Hospitalet, Barcelona, Spain
| | - Judith Serna
- Hospital Universitari Vall d'Hebron (J.S.), Barcelona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain
| |
Collapse
|
12
|
Engel M, Kars MC, Teunissen SCCM, van der Heide A. Effective communication in palliative care from the perspectives of patients and relatives: A systematic review. Palliat Support Care 2023; 21:890-913. [PMID: 37646464 DOI: 10.1017/s1478951523001165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVES In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals. METHODS A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021. RESULTS In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting. SIGNIFICANCE OF RESULTS Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.
Collapse
Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijke C Kars
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Plevová I, Kadlubová L. Standard operating procedure - palliative care. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2023. [DOI: 10.15452/cejnm.2022.13.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
|
14
|
Aghaei MH, Vanaki Z, Mohammadi E. Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study. Nurs Open 2023; 10:889-900. [PMID: 36065567 DOI: 10.1002/nop2.1357] [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: 06/30/2021] [Revised: 04/07/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023] Open
Abstract
AIM Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon. DESIGN This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis. METHODS Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach. RESULTS Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.
Collapse
Affiliation(s)
- Mir Hossein Aghaei
- School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Zohreh Vanaki
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
15
|
English W, Robinson J, Gott M. Rapport: A conceptual definition from the perspective of patients and families receiving palliative care. PATIENT EDUCATION AND COUNSELING 2023; 106:120-127. [PMID: 36328826 DOI: 10.1016/j.pec.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore patient and family perceptions of rapport in interactions with health professionals and use the findings to develop a conceptual definition of rapport. METHODOLOGY We undertook a qualitative Interpretive Description study; semi-structured interviews were conducted between November 2020 and May 2021. Participants included 18 patients and 11 family members recruited using a random approach from four hospice locations in Aotearoa, New Zealand. Interviews were audio recorded, transcribed, and analysed to develop a conceptual definition of rapport using guidelines (Podsakoff et al., (2016). A COREQ checklist was completed. RESULTS Four dimensions of rapport were identified which formed the basis of a conceptual definition: 1) the type of relating, 2) the essence of rapport experienced, 3) key communication characteristics, and 4) the effect on interactions. CONCLUSION Based on patient and family experiences of rapport, this study formulated a conceptual definition of rapport. This definition will support clinical education and practice and inform future research related to rapport. PRACTICE IMPLICATIONS A conceptual definition of rapport can provide clarity for both research and clinical practice. It may be used as a tool for health professionals to reflect upon their experiences with rapport and develop expertise in this area.
Collapse
Affiliation(s)
- Wendy English
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
16
|
Maze C, Wilkinson C, Stajduhar K, Daudt H, Tysick S. Perceptions of bereaved family members of nursing care on an inpatient hospice palliative care unit. Int J Palliat Nurs 2022; 28:406-418. [PMID: 36151983 DOI: 10.12968/ijpn.2022.28.9.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Understanding family members' (FMs) perceptions of the care provided by nurses is crucial to facilitating positive outcomes for FMs. AIMS To better understand how bereaved FMs perceive the care nurses provide in an inpatient hospice palliative care unit. METHODS An exploratory study was conducted, with an interpretive description methodology. It was guided by the question: 'How do bereaved FMs perceive nursing care in our unit, and how does this influence their bereavement experiences?' A total of 10 FMs-or close friends-who had a significant other die on a palliative care unit were interviewed. FINDINGS Findings support the belief that positive relationships and interactions with nurses impact families' perceptions of end of life. Nurses create a therapeutic environment, building a sense of ease and meaning for patients and families. CONCLUSION Participation of nurses in rituals and patient-honouring practices after death may help families to cope and create positive memories during their grieving process.
Collapse
Affiliation(s)
- Carolyn Maze
- Staff Nurse, Victoria Hospice, Island Health, Canada
| | - Carolyn Wilkinson
- Program Manager, Palliative and End of Life Care, Island Health, Canada
| | - Kelli Stajduhar
- Professor and Canada Research Chair (Tier 1) in Palliative Approaches to Care in Aging & Community Health, School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Canada
| | - Helena Daudt
- Director of Education and Research, Victoria Hospice, Canada
| | - Shelley Tysick
- Palliative Care Coordinator, Palliative and End of Life Care, Island Health, Canada
| |
Collapse
|
17
|
Qama E, Diviani N, Grignoli N, Rubinelli S. Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:1470-1487. [PMID: 34593262 DOI: 10.1016/j.pec.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.
Collapse
Affiliation(s)
- Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Nicola Grignoli
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, 6850 Mendrisio, Switzerland.
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group Guido A, Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| |
Collapse
|
18
|
Durieux BN, Berrier A, Catzen HZ, Gray TF, Lakin JR, Cunningham R, Morris SE, Tulsky JA, Sanders JJ. " I think that she would have wanted. . .": Qualitative interviews with bereaved caregivers reveal complexity in measuring goal-concordant care at the end of life. Palliat Med 2022; 36:742-750. [PMID: 35164612 DOI: 10.1177/02692163221078472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. AIM To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. DESIGN Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. SETTING/PARTICIPANTS Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. RESULTS Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. CONCLUSIONS Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer.
Collapse
Affiliation(s)
| | - Anna Berrier
- Dana-Farber Cancer Institute, Boston, MA, USA.,Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tamryn F Gray
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Joshua R Lakin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rebecca Cunningham
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sue E Morris
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Justin J Sanders
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Xu T, Qin Y, Ou X, Zhao X, Wang P, Wang M, Yue P. End-of-life communication experiences within families of people with advanced Cancer in China: A qualitative study. Int J Nurs Stud 2022; 132:104261. [DOI: 10.1016/j.ijnurstu.2022.104261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 12/24/2022]
|
20
|
English W, Gott M, Robinson J. The meaning of rapport for patients, families, and healthcare professionals: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2-14. [PMID: 34154861 DOI: 10.1016/j.pec.2021.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Rapport is considered fundamental to clinical relationships but is a concept which is rarely defined. This review explores how rapport is defined, characterised, and operationalised in healthcare. METHODS A scoping review methodology was used. Data were synthesised using thematic analysis. The review process adhered to the Preferred Reporting System for Meta-Analysis for Scoping reviews (PRISMA-ScR). RESULTS Medline, CINAHL, and psychINFO were searched with thirty-four studies meeting inclusion criteria. Results were presented in two themes: The meanings of rapport and the implications for building rapport. CONCLUSIONS This scoping review found rapport has no commonly shared definition or conceptualisation in the reviewed research. At the same time rapport is operationalised and characterised. Factors that facilitate, and hinder rapport-building were identified. Having a consistently used definition and conceptualisation will benefit the research that is needed into patient and family experiences and outcomes of rapport. PRACTICE IMPLICATIONS It is crucial for health professionals to incorporate simple kind gestures into practice to facilitate rapport. Equally it is necessary for health professionals to review their practice for dismissive, avoiding behaviours that impede rapport-building and consider how they spend their time with patients.
Collapse
Affiliation(s)
- Wendy English
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
21
|
Muraya T, Akagawa Y, Andoh H, Chiang C, Hirakawa Y. Improving person-centered advance care planning conversation with older people: a qualitative study of core components perceived by healthcare professionals. J Rural Med 2021; 16:222-228. [PMID: 34707731 PMCID: PMC8527630 DOI: 10.2185/jrm.2021-022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: The non-medical needs of patients, such as values and personal
preferences, are likely to be omitted from advance care planning (ACP) discussions because
of a lack of readiness and awareness on the part of healthcare professionals. The aim of
the present study was to identify core components perceived by multidisciplinary
healthcare professionals to improve person-centered ACP conversations with older
people. Methods: The study participants were healthcare professionals (physicians,
nurses, and care managers) working in different cities. This qualitative study was
performed online using eight individual in-depth interviews and one subsequent focus group
composed of eight healthcare professionals. The interviews and focus group discussion were
audio-recorded online and transcribed verbatim. The aim of the analysis of the individual
in-depth interviews was to summarize the transcribed results, create a conceptual
framework for person-centered ACP conversation, and provide meaningful interpretations of
the focus group participant discourse. The qualitative data were then analyzed by
inductive manual coding using a qualitative content analysis approach. Results: Five themes capturing the core components for successful
person-centered ACP were extracted from the ideas voiced by participants: Placing highest
value on patient autonomy and human life; uncovering patient’s true feelings and desires;
sharing collected information on patients’ end-of-life wishes with other team members;
relaying patients’ wishes to the physician; and handling conflicts among patients,
relatives, and healthcare professionals. Conclusion: The results provide guidelines for the future development of
novel, value-based, person-centered ACP practice for multidisciplinary healthcare
professionals.
Collapse
Affiliation(s)
| | - Yuko Akagawa
- Department of Clinical Nursing, Akita University Graduate School of Health Science, Japan
| | - Hideaki Andoh
- Department of Clinical Nursing, Akita University Graduate School of Health Science, Japan
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
22
|
Mazhari F, Khoshnood Z. Exploring the care needs of Iranian patients with cancer: a qualitative content analysis. BMC Nurs 2021; 20:138. [PMID: 34372854 PMCID: PMC8351099 DOI: 10.1186/s12912-021-00659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND: Cancer is currently one of the most critical health problems worldwide. Different studies have shown that disease can reduce people's ability to take care of themselves and this makes them face many needs. Therefore, this study aimed to investigate unmet needs faced by patients with cancer. METHODS: This study employed a conventional, qualitative content analysis method. Data saturation was achieved after interviewing 13 participants in 15 interview sessions. With the in-depth semi-structured approach, the participants were asked to narrate their experiences of self-care needs in the process of disease. The collected data were analyzed using Graneheim and Lundman's method through the following steps: Construction of the units of analysis, construction of codes of meaning, condensation, extracting codes, and categorization (subcategories, categories, and the core category) . RESULTS: Data analysis revealed two main categories. The first category was "Deficiency in disease management" with three subcategories: "the need to get rid of annoying physical symptoms"," the need for a caregiver to help with the daily routine", and "feeling frustrated and giving up treatment". The second main category covered "the need for sympathetic and knowledgeable caregivers" with the following five subcategories:" the need for sympathy and interaction with the nurse", "the need to hear the truth about the illness ", "the need for appropriate therapeutic interaction from physicians", "Inadequate qualification of medical secretaries about the patient", and" need for advice from psychologists for psychological adaptation". CONCLUSION: The most critical need reported by the patients was the need for compassionate and informed caregivers. So nursing management and care with kindness, competence, and conscience is the fundamental right of patients with cancer. Identifying patients' needs and problems can be used as a background for increasing the knowledge and experience of nurses and providing care for patients with cancer.
Collapse
Affiliation(s)
- Fariba Mazhari
- Department of Fundamental Nursing, Geriatric Care Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zohreh Khoshnood
- Nursing Research Center, Razi School Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
23
|
Amanatullah DF, Eppler SL, Shah RF, Mertz K, Roe AK, Murasko M, Kamal RN. A Qualitative Study of Patient Themes for the Quality of the Total Joint Arthroplasty Experience. Orthopedics 2021; 44:117-122. [PMID: 34038694 DOI: 10.3928/01477447-20210217-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients have limited involvement in the development of quality measures that address the experience of undergoing total joint arthroplasty (TJA). Current quality measures may not fully assess the aspects of care that are important to patients. The goal of this study was to understand quality of care in TJA from the patient perspective by exploring patients' knowledge gaps, experiences, and goals. The authors completed a prospective qualitative analysis of patients who had undergone hip or knee TJA. Patients completed an open-ended, structured questionnaire about the surgical and recovery process as it relates to quality of care. The authors used a phenomenologic approach and purposeful sampling to enroll 74 patients 6 to 8 weeks after TJA. Responses underwent thematic analysis. Codes were used to identify themes that were important to patients in quality of care in TJA. The authors identified 3 themes: (1) returning to activity without pain or complication, which included psychological, functional, and complication-related goals; (2) negotiating the physical and psychological challenges of recovery, which encompassed the need for assistance from the caregiver as well as psychological and physical barriers to recovery; and (3) being prepared and informed for the process of surgery, including physical, logistical, and psychological preparation. Both patients and health systems may benefit from efforts to address these patient-centered themes of quality care through quality measures for TJA (eg, improving the psychological challenges of recovery). Future quality measures, such as assessment of patient experience, may be made more patient centered if they measure and improve aspects of care that matter to patients. [Orthopedics. 2021;44(2):117-122.].
Collapse
|
24
|
Woods JA, Katzenellenbogen JM, Murray K, Johnson CE, Thompson SC. Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study. BMJ Open 2021; 11:e042268. [PMID: 33727263 PMCID: PMC7970279 DOI: 10.1136/bmjopen-2020-042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. DESIGN Cohort study. SETTING Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). PARTICIPANTS 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. OUTCOME MEASURES Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. RESULTS Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398). CONCLUSIONS Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
Collapse
Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- The Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
25
|
Aghaei MH, Vanaki Z, Mohammadi E. Inducing a sense of worthiness in patients: the basis of patient-centered palliative care for cancer patients in Iran. BMC Palliat Care 2021; 20:38. [PMID: 33653323 PMCID: PMC7927376 DOI: 10.1186/s12904-021-00732-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. METHOD For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman's method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. RESULTS From content analysis, 3 main categories; considering patient's spirituality, maintaining patient's dignity during care, and reducing patient's suffering, were found. The essence of these categories reflect on the care-providers' consideration and effort in "inducing a sense of worthiness" in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. CONCLUSION For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.
Collapse
Affiliation(s)
| | - Zohreh Vanaki
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
26
|
Rosted E, Aabom B, Hølge-Hazelton B, Raunkiær M. Comparing two models of outpatient specialised palliative care. BMC Palliat Care 2021; 20:33. [PMID: 33602200 PMCID: PMC7893925 DOI: 10.1186/s12904-021-00727-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Ideally, patients with life-threatening illness who are suffering from multiple symptoms and reduced quality of life should receive palliative care that addresses their specific needs. The many well-defined clinical pathways may not always leave room for a person-centred and individual approach with respect to symptom control, psychosocial and spiritual support, and practical issues. In deciding how to organize outpatient specialist palliative care (SPC), it is relevant to include the perspectives of both patients and families. Thus, the aim of this study was to compare two models for outpatient SPC: first contact between patient, next-of-kin and doctor/nurse in the form of a home visit; and first visit in the hospital setting. Method The study was a comparative mixed methods study with follow-up at one and 3 months. It started with a quantitative strand in the form of a 38-item questionnaire. Data were analysed using linear mixed effects models, with maximum likelihood estimation for each outcome variable. The repeated measurements on patient level were modelled by including random intercepts of patients in the mixed model. Results In total, 190 participants were enrolled, of whom 102 answered the first questionnaire. No differences were found between the two SPC interventions when development in satisfaction with care, communication or overall quality of life were compared. At baseline, a significantly higher score for satisfaction was found, in favour of first visit taking place in the hospital setting (65.91 vs. 55.83; p = 0.03) measured by FAMCARE-P16, and more patients were satisfied with availability of nurses and their abilities to listen and communicate than of doctors. Conclusion Specialist palliative care is in request for many patients in the late phase of their disease. We found no significant differences in satisfaction with care, communication with health professionals or in overall quality of life between the two models. This may imply that access to SPC is more important than the model that is applied, and that a person-centred approach together with time available may matter more than the context. These two factors should be considered when implementing SPC.
Collapse
Affiliation(s)
- Elizabeth Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark. .,Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense C, Denmark.
| | - Birgit Aabom
- Department of Oncology and Palliative Care, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense C, Denmark.,Department of Research Support, Zealand University Hospital, Munkesøvej 14, 4000, Roskilde, Denmark
| | - Mette Raunkiær
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| |
Collapse
|
27
|
Empathic and listening styles of first year undergraduate nursing students: A cross-sectional study. J Prof Nurs 2020; 36:611-615. [PMID: 33308562 DOI: 10.1016/j.profnurs.2020.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Effective communication and empathy are fundamental to nurse-patient relationships and good nursing practice. Although the importance of listening is widely accepted in the nursing practice, little research exists regarding the empathic and listening styles of undergraduate nursing students. PURPOSE This study investigated empathic and listening styles of first year nursing students. METHOD A cross-sectional study of 135 first year Bachelor of Nursing (BN) students from one Australian university completed paper-based versions of the revised Listening Styles Profile (LSP) and Active-Empathic Listening Scale (AELS). RESULTS Participants reported strong preference for 'people' listening style and 'responding' empathic listening process. No statistically significant differences were found between male and female students. People-oriented LSP was strongly correlated with the three stages of AELS, Content-oriented LSP was strongly correlated with Processing and with Responding AELS and Action-oriented LSP was strongly correlated with Processing AELS. CONCLUSION It is not only important that communication skills training exists in the nursing curriculum but ensuring that knowledge learnt in the classroom is transferred to the clinical setting. Nurses must consistently implement active listening techniques and effective communication skills with all patients.
Collapse
|
28
|
Scholz B, Goncharov L, Emmerich N, Lu VN, Chapman M, Clark SJ, Wilson T, Slade D, Mitchell I. Clinicians' accounts of communication with patients in end-of-life care contexts: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1913-1921. [PMID: 32650998 DOI: 10.1016/j.pec.2020.06.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Communication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians' understandings of communication in end-of-life care. METHODS A systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms "palliative care," "terminal care" or "end-of-life care," and "communication". Articles were assessed for quality using a modified JQI-QARI tool. RESULTS The findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication. CONCLUSION Training needs for effective communication in end-of-life contexts are not currently being met. PRACTICE IMPLICATIONS Clinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.
Collapse
Affiliation(s)
- Brett Scholz
- Medical School, The Australian National University, Canberra, Australia.
| | - Liza Goncharov
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Nathan Emmerich
- Medical School, The Australian National University, Canberra, Australia
| | - Vinh N Lu
- College of Business and Economics, The Australian National University, Canberra, Australia
| | - Michael Chapman
- Medical School, The Australian National University, Canberra, Australia; Canberra Health Service, ACT Health, Canberra, Australia
| | - Shannon J Clark
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Tracey Wilson
- Medical Intensive Care Unit, University of Maryland, Baltimore, USA
| | - Diana Slade
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Medical School, The Australian National University, Canberra, Australia; Canberra Health Service, ACT Health, Canberra, Australia
| |
Collapse
|
29
|
Starr LT, Ulrich CM, Junker P, Appel SM, O'Connor NR, Meghani SH. Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients. J Pain Symptom Manage 2020; 60:801-810. [PMID: 32454185 PMCID: PMC7508853 DOI: 10.1016/j.jpainsymman.2020.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT African Americans are less likely to receive hospice care and more likely to receive aggressive end-of-life care than whites. Little is known about how palliative care consultation (PCC) to discuss goals of care is associated with hospice enrollment by race. OBJECTIVES To compare enrollment in hospice at discharge between propensity-matched cohorts of African Americans with and without PCC and whites with and without PCC. METHODS Secondary analysis of a retrospective cohort study at a high-acuity hospital; using stratified propensity-score matching for 35,154 African Americans and whites aged 18+ admitted for conditions other than childbirth or rehabilitation, who were not hospitalized at end of study, and did not die during index hospitalization (hospitalization during which first PCC occurred). RESULTS Compared with African Americans without PCC, African Americans with PCC were 15 times more likely to be discharged to hospice from index hospitalization (2.4% vs. 36.5%; P < 0.0001). Compared with white patients without PCC, white patients with PCC were 14 times more likely to be discharged to hospice from index hospitalization (3.0% vs. 42.7%; P < 0.0001). CONCLUSION In propensity-matched cohorts of seriously ill patients, PCC to discuss goals of care was associated with significant increases in hospice enrollment at discharge among both African Americans and whites. Research is needed to understand how PCC influences decision making by race, how PCC is associated with postdischarge hospice outcomes such as disenrollment and hospice lengths of stay, and if PCC is associated with improving racial disparities in end-of-life care.
Collapse
Affiliation(s)
- Lauren T Starr
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Center for Bioethics, Philadelphia, Pennsylvania, USA.
| | - Connie M Ulrich
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Junker
- Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Scott M Appel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nina R O'Connor
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA
| |
Collapse
|
30
|
Watson’s Human Caring Theory-Based Palliative Care: A Discussion Paper. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.103027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
: Palliative care is one of the most basic care approaches for providing care to patients with life-threatening illnesses. Applying theories in palliative care provision results in such cares’ development and organization and guides health care providers in this direction. One of the caring theories that can be focused on palliative care is Watson’s human caring theory, which despite its applicability in palliative care, has not been studied much. Thus, this study aimed at assessing how to use this theory in palliative care that can be applied to health care providers in all clinical specialties and societies with different cultures.
Collapse
|
31
|
Aghaei MH, Vanaki Z, Mohammadi E. Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients. Indian J Palliat Care 2020; 26:86-94. [PMID: 32132791 PMCID: PMC7017707 DOI: 10.4103/ijpc.ijpc_181_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/02/2019] [Indexed: 01/04/2023] Open
Abstract
Aim Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. Methods In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. Results Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. Conclusion Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.
Collapse
Affiliation(s)
- Mir Hossein Aghaei
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zohreh Vanaki
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
32
|
Smith D, Thorpe JM, Ersek M, Kutney-Lee A. Identifying Optimal Factor Scores on the Bereaved Family Survey: Implications for Practice and Policy. J Pain Symptom Manage 2019; 58:108-114. [PMID: 30980885 DOI: 10.1016/j.jpainsymman.2019.04.002] [Citation(s) in RCA: 5] [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: 12/10/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
Abstract
CONTEXT The Bereaved Family Survey (BFS) is used to evaluate the quality of end-of-life (EOL) care in Veterans Affairs inpatient settings. The BFS consists of a global Performance Measure (BFS-PM) and three factors that relate to specific aspects of EOL care. OBJECTIVE The purpose of this study was to identify empirically based target scores on each BFS factor that are most strongly related to a rating of "excellent" on the BFS-PM. METHODS We conducted a cross-sectional analysis of BFS and Veteran clinical data from January 2012 to January 2016. Logistic regression models were constructed for each potential cut point on the three BFS factors and accounted for facility case-mix and nonresponse bias. Model fit was assessed primarily using the Liu Index, Bayesian Information Criterion (BIC), and classification accuracy values. RESULTS Our analytic sample included 40,180 Veterans whose next-of-kin completed a BFS. The mean BFS response rate across study years was 58%. A score of 14 or higher on the Respectful Care and Communication factor (range 0-15) had the lowest BIC (121355) and highest percent correctly classified (81.2%). The Emotional and Spiritual Support factor (range 0-9) had an optimal score of 8 or higher (BIC = 133685; % correctly classified = 77.1%). An optimal cut point on the Benefits factor was not identified. CONCLUSION The identification of data-driven targets makes BFS factor scores more useful to clinicians and administrators focused on improving quality of EOL care in their facilities. Our results lend support for prioritizing quality improvement efforts related to respectful care and communication.
Collapse
Affiliation(s)
- Dawn Smith
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
| | - Joshua M Thorpe
- VA Pittsburgh Healthcare System, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
33
|
Family Caregivers’ Satisfaction With Specialized End-of-Life Care Provided at Home. J Hosp Palliat Nurs 2019; 21:412-421. [DOI: 10.1097/njh.0000000000000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Högberg C, Alvariza A, Beck I. Patients’ experiences of using the Integrated Palliative care Outcome Scale for a person‐centered care: A qualitative study in the specialized palliative home‐care context. Nurs Inq 2019; 26:e12297. [DOI: 10.1111/nin.12297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Cecilia Högberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Palliative Home Care Capio ASIH Dalen Stockholm Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Palliative Home Care Capio ASIH Dalen Stockholm Sweden
| | - Ingela Beck
- Institute for Palliative Care Lund University and Region Skåne Lund Sweden
- Oncology, Department of Clinical Sciences Lund, Faculty of Medicine Lund University Lund Sweden
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| |
Collapse
|
35
|
Eppler SL, Kakar S, Sheikholeslami N, Sun B, Pennell H, Kamal RN. Defining Quality in Hand Surgery From the Patient's Perspective: A Qualitative Analysis. J Hand Surg Am 2019; 44:311-320.e4. [PMID: 30031599 DOI: 10.1016/j.jhsa.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Quality measures are used to evaluate health care delivery. They are traditionally developed from the physician and health system viewpoint. This approach can lead to quality measures that promote care that may be misaligned with patient values and preferences. We completed an exploratory, qualitative study to identify how patients with hand problems define high-quality care. Our purpose was to develop a better understanding of the surgery and recovery experience of hand surgery patients, specifically focusing on knowledge gaps, experience, and the surgical process. METHODS A steering committee (n = 10) of patients who had previously undergone hand surgery reviewed and revised an open-ended survey. Ninety-nine patients who had undergone hand surgery at 2 tertiary care institutions completed the open-ended, structured questionnaire during their 6- to 8-week postoperative clinic visit. Two reviewers completed a thematic analysis to generate subcodes and codes to identify themes in high-quality care from the patient's perspective. RESULTS We identified 4 themes of high-quality care: (1) Being prepared and informed for the process of surgery, (2) Regaining hand function without pain or complication, (3) Patients and caregivers negotiating the physical and psychological challenges of recovery, and (4) Financial and logistical burdens of undergoing hand surgery. CONCLUSIONS Multiple areas that patients identify as representing high-quality care are not reflected in current quality measures for hand surgery. The patient-derived themes of high-quality care can inform future patient-centered quality measure development. CLINICAL RELEVANCE Efforts to improve health care delivery may have the greatest impact by addressing areas of care that are most valued by patients. Such areas include patient education, system navigation, the recovery process, and cost.
Collapse
Affiliation(s)
- Sara L Eppler
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Beatrice Sun
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Hillary Pennell
- Department of Communication, University of Missouri, Columbia, MO
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
36
|
Cu Rejnö Å, Berg LK. Communication, the Key in Creating Dignified Encounters in Unexpected Sudden Death - With Stroke as Example. Indian J Palliat Care 2019; 25:9-17. [PMID: 30820095 PMCID: PMC6388597 DOI: 10.4103/ijpc.ijpc_117_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: The aim of this study was to illuminate the communication and its meaning in unexpected sudden death with stroke as example, as experienced by stroke team members and next of kin. Subject and Methods: The study has a qualitative design. Secondary analysis of data from four previous interview studies with stroke team members; physicians, registered nurses, and enrolled nurses from the stroke units (SU) and next of kin of patients who had died due to acute stroke during hospital stay were utilized. Results: Communication is revealed as the foundation for care and caring with the overarching theme foundation for dignified encounters in care built-up by six themes illuminating the meaning of communication in unexpected sudden death by stroke. Conclusion: Communication shown as the foundation for dignified encounters in care as experienced by stroke team members and next of kin enables the patient to come forth as a unique person and uphold absolute dignity in care. Acknowledging the next of kin's familiarity with the severely ill patient will contribute to personalizing the patient and in this way be the ground for a person centeredness in care despite the patients’ inability to defend their own interests. Through knowledge about the patient as a person, the foundation for dignified care is given, expressed through respect for the patient's will and desires and derived through conversations between carers and next of kin.
Collapse
Affiliation(s)
- Åsa Cu Rejnö
- Department of Medicine, Stroke Unit, Skaraborg Hospital Skövde, Skövde, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Linda K Berg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
37
|
Almada AL, Casquinha P, Cotovio V, Santos MJHD, Caixeiro A. The Potential Role of Psychosocial Rehabilitation in Palliative Care. J R Coll Physicians Edinb 2018; 48:311-317. [DOI: 10.4997/jrcpe.2018.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering and improve the quality of life of patients and their families. The existence of psychopathology is common in patients undergoing palliative care, and psychiatric comorbidities, such as depression and anxiety, are frequent and often underdiagnosed. This work constitutes a review of the literature and a reflection on the potential role of psychosocial rehabilitation in mental health in palliative care. Psychosocial rehabilitation may play a role in the mental health of patients undergoing palliative care, contributing to the minimisation of symptoms, support in daily life activities, the improvement of quality of life and the preparation for death.
Collapse
Affiliation(s)
- AL Almada
- Psychiatric resident (5th year), Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - P Casquinha
- Psychiatrist, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - V Cotovio
- Psychiatrist and Psychotherapist, Clinical Director of the Psychiatric Hospital, Casa de Saúde do Telhal, Sintra, Portugal
| | - MJ Heitor dos Santos
- Psychiatrist, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Portugal
- Psychiatrist, Instituto de Saúde Ambiental Faculdade de Medicina, Universidade de Lisboa, Portugal
- Head of the Psychiatry and Mental Health Department of Hospital Beatriz Ângelo, Loures, Portugal
| | - A Caixeiro
- Psychiatrist, Head of the Rehabilitation Unit in Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| |
Collapse
|
38
|
Engel M, Brinkman-Stoppelenburg A, Nieboer D, van der Heide A. Satisfaction with care of hospitalised patients with advanced cancer in the Netherlands. Eur J Cancer Care (Engl) 2018; 27:e12874. [DOI: 10.1111/ecc.12874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/13/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Marijanne Engel
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
| | | | - Daan Nieboer
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
| | - Agnes van der Heide
- Department of Public Health; Erasmus Medical Center; Rotterdam the Netherlands
| |
Collapse
|
39
|
Toh HJ, Low JA, Lim ZY, Lim Y, Siddiqui S, Tan L. Jonsen's Four Topics Approach as a Framework for Clinical Ethics Consultation. Asian Bioeth Rev 2018; 10:37-51. [PMID: 33717274 DOI: 10.1007/s41649-018-0047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 01/24/2023] Open
Abstract
This was an in-depth qualitative study that looked at the reasons patients were referred to the Clinical Ethics Committee (CEC) of an acute hospital in Singapore and explore how the CEC approached cases referred. Jonsen's four topics approach was applied in the deliberative process for all cases. A comprehensive review of the case records of 28 patients referred consecutively to the CEC from 1 January 2012 to 31 December 2014 was conducted. Data and information was collated from the referral forms, patient medical records, and emails communicated among CEC members. A deductive approach to thematic analysis based on Jonsen's four topics approach was used to analyze the documents. Majority of the patients were male (94%), Chinese (76%), and above 65 years of age (41%). Ethical dilemmas surfaced due to differences in opinion regarding withholding of aggressive management (53%), withdrawing treatment (35%), and ascertaining patient's autonomy (12%). In most cases, the patients' preference on end-of-life care was unknown (82%). The main reasons for referral to the CEC were conflicts in clinical management and uncertainty about the decision-making capacity of patients. The CEC members tended to emphasize on "patient preference" more than the other quadrants in the four topics approach as they worked through each case. The Jonsen's four topics approach lays the groundwork to frame ethical dilemmas that can be easily applied in the clinical setting and is a useful tool for the CEC's teaching and discussion. Nonetheless, the approach only organizes ethical dilemmas and requires clinicians to apply own judgment in weighing ethical principles. Further studies can look into adapting the four topics approach to suit the local practices and context.
Collapse
Affiliation(s)
- Hui Jin Toh
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore
| | - James Alvin Low
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore.,Education Research, Geriatric Education and Research Institute, Singapore, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Zhen Yu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yvonne Lim
- Clinical Services, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Lawrence Tan
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| |
Collapse
|
40
|
Estacio CF, Butow PN, Lovell MR, Dong ST, Clayton JM. What is symptom meaning? A framework analysis of communication in palliative care consultations. PATIENT EDUCATION AND COUNSELING 2017; 100:2088-2094. [PMID: 28619270 DOI: 10.1016/j.pec.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations. METHODS Framework analysis was conducted with 40 palliative care consultation transcripts. RESULTS 55% of consultations discussed symptom meaning. Six themes regarding patients' symptom meanings emerged while four themes conveyed physicians' responses to these utterances. Key symptom meanings included symptoms representing diminished function and uncertainty about symptom cause or future. Physicians usually gave scientific medical responses concerning symptom cause and treatment, versus reassurance or empathy. CONCLUSION This study has provided greater insight into the different symptom meanings that exist for palliative care patients. Physicians' responses highlight their reliance on medical information when patients are distressed. Future studies should explore the impact of different responses on patient outcomes, and health practitioners' views about optimal responses. PRACTICE IMPLICATIONS Physicians could explore symptom meanings with their patients, looking out for those identified here. Apart from information-giving and treatment, active listening to these concerns as they present in consultations may help improve the therapeutic relationship and better guide optimal care.
Collapse
Affiliation(s)
- Celina F Estacio
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia.
| | - Melanie R Lovell
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Skye T Dong
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| | - Josephine M Clayton
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia
| |
Collapse
|
41
|
Pino M, Parry R, Feathers L, Faull C. Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff. Palliat Med 2017; 31:707-715. [PMID: 28590153 PMCID: PMC5557161 DOI: 10.1177/0269216317696419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. AIM To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes. DESIGN We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark's thematic analysis. SETTING/PARTICIPANTS Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). RESULTS Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. CONCLUSION Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent.
Collapse
Affiliation(s)
- Marco Pino
- 1 Department of Social Sciences, Loughborough University, Loughborough, UK
| | - Ruth Parry
- 2 School of Health Sciences, The University of Nottingham, Nottingham, UK
| | | | | |
Collapse
|
42
|
Carpenter JG, McDarby M, Smith D, Johnson M, Thorpe J, Ersek M. Associations between Timing of Palliative Care Consults and Family Evaluation of Care for Veterans Who Die in a Hospice/Palliative Care Unit. J Palliat Med 2017; 20:745-751. [PMID: 28471732 DOI: 10.1089/jpm.2016.0477] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Palliative care consultations (PCC) improve end-of-life (EOL) care, although they may occur too late in an illness to effect the best outcomes. Evidence about the optimal timing of PCC is limited. OBJECTIVE To examine the associations between PCC timing and bereaved families' evaluation of care. METHODS A retrospective, cross-sectional analysis of data collected between October 2011 and September 2014 was conducted with 5,592 patients who died in a Veterans Affairs inpatient hospice/palliative care unit. The independent measure was the date of first documented PCC within 180 days of death. Outcomes came from the validated Bereaved Family Survey (BFS) and included one global and three subscale scores characterizing EOL care in the last month of life. RESULTS After adjustment for patient and facility characteristics, family members of veterans whose first PCC occurred 91-180 days before death were more likely to rate overall care as "excellent" compared with those whose PCC occurred 0-7 days before death, 67.9% versus 62.1%, respectively (adjusted odds ratio = 1.37; confidence interval [95% CI] 1.08-1.73). Mean scores on two of the three subscales also were significantly higher for veterans receiving PCC 31-90 days before the veteran's death compared with those who had their first PCC 0-7 days before death: Respectful Care and Communication, 13.6 versus 13.4, respectively (β = 0.26; 95% CI 0.11-0.41), and Emotional and Spiritual Support, 7.6 versus 7.4, respectively (β = 0.22; 95% CI 0.03-0.41). CONCLUSIONS Earlier PCC is associated with greater family satisfaction with care. Strategies that are aimed at conducting PCC earlier in life-limiting illness are needed.
Collapse
Affiliation(s)
- Joan G Carpenter
- 1 Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Meghan McDarby
- 1 Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Dawn Smith
- 1 Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Megan Johnson
- 1 Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Joshua Thorpe
- 2 Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center , Pittsburgh, Pennsylvania.,3 Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy , Pittsburgh, Pennsylvania
| | - Mary Ersek
- 1 Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania.,4 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| |
Collapse
|
43
|
Kim HM, Hwang SW, Hwang IC, Choi YS, Lee YJ. Actual and recalled perceptions of the end-of-life care situations among bereaved families of cancer patients: A longitudinal pilot study. Psychooncology 2017; 26:2304-2306. [DOI: 10.1002/pon.4399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Hyo Min Kim
- Department of Family Medicine; Kyungpook National University Medical Center; Daegu South Korea
| | - Sun Wook Hwang
- Catholic University St. Paul's Hospital; Seoul South Korea
| | - In Cheol Hwang
- Gachon University Gil Medical Center; Incheon South Korea
| | | | | |
Collapse
|
44
|
Litzelman K, Kent EE, Mollica M, Rowland JH. How Does Caregiver Well-Being Relate to Perceived Quality of Care in Patients With Cancer? Exploring Associations and Pathways. J Clin Oncol 2016; 34:3554-3561. [PMID: 27573657 PMCID: PMC5074348 DOI: 10.1200/jco.2016.67.3434] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Perceived quality of care (QOC) is an increasingly important metric of care quality and can be affected by such factors among patients with cancer as quality of life and physician trust. This study sought to evaluate whether informal caregiver well-being was also associated with perceived QOC among patients with cancer and assessed potential pathways that link these factors. Methods This study used data from the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium. Patients with lung and colorectal cancer enrolled in CanCORS (N = 689) nominated an informal caregiver to participate in a caregiving survey. Both groups self-reported sociodemographic, psychosocial, and caregiving characteristics; cancer characteristics were obtained from the CanCORS core data set. Multivariable logistic regression was used to assess the association between caregiver psychosocial factors and subsequent patient-perceived QOC, controlling for earlier patient-perceived QOC and covariates. Secondary analysis examined potential pathways that link these factors. Results Patients whose informal caregiver had higher levels of depressive symptoms were significantly more likely to report fair or poor QOC (odds ratio, 1.06; 95% CI, 1.01 to 1.13). When caregivers reported fair or poor self-rated health, patients were more than three times more likely to report fair or poor perceived QOC (odds ratio, 3.76; 95% CI, 1.76 to 9.55). Controlling for patient psychosocial factors and physician communication and coordination of medical care reduced the effect size and/or statistical significance of these relationships. Conclusion Informal caregivers are an important part of the care team and their well-being is associated with patient-perceived QOC. Engaging informal cancer caregivers as part of the care team and conducting ongoing risk stratification screening and intervention to optimize their health may improve patient-reported outcomes and QOC.
Collapse
Affiliation(s)
- Kristin Litzelman
- Kristin Litzelman, University of Wisconsin-Madison and University of Wisconsin-Extension, Madison, WI; Erin E. Kent, Michelle Mollica, and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Erin E. Kent
- Kristin Litzelman, University of Wisconsin-Madison and University of Wisconsin-Extension, Madison, WI; Erin E. Kent, Michelle Mollica, and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Michelle Mollica
- Kristin Litzelman, University of Wisconsin-Madison and University of Wisconsin-Extension, Madison, WI; Erin E. Kent, Michelle Mollica, and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Julia H. Rowland
- Kristin Litzelman, University of Wisconsin-Madison and University of Wisconsin-Extension, Madison, WI; Erin E. Kent, Michelle Mollica, and Julia H. Rowland, National Cancer Institute, Bethesda, MD
| |
Collapse
|
45
|
What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit. PLoS One 2016; 11:e0158830. [PMID: 27389693 PMCID: PMC4936709 DOI: 10.1371/journal.pone.0158830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The aims of the study were to examine a) patients’ knowledge of palliative care, b) patients’ expectations and needs when being admitted to a palliative care unit, and c) patient’s concept of a good palliative care physician. Methods The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques. Results The results revealed four themes: (1) information about palliative care, (2) supportive care needs, (3) being treated in a palliative care unit, and (4) qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient’s language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment. Conclusions The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient’s needs will enable medical teams to improve professional and individualized care.
Collapse
|
46
|
|
47
|
Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying. PLoS One 2016; 11:e0156174. [PMID: 27243630 PMCID: PMC4887020 DOI: 10.1371/journal.pone.0156174] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design Conversation analysis of video- and audio-recorded consultations. Participants Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce–then later further articulate–EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions Through communicating–via open elaboration solicitations–in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
Collapse
|
48
|
Wentlandt K, Seccareccia D, Kevork N, Workentin K, Blacker S, Grossman D, Zimmermann C. Quality of Care and Satisfaction With Care on Palliative Care Units. J Pain Symptom Manage 2016; 51:184-92. [PMID: 26598036 DOI: 10.1016/j.jpainsymman.2015.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 01/22/2023]
Abstract
CONTEXT There is little research on quality of care specific to palliative care units (PCUs). OBJECTIVES To delineate important aspects of satisfaction with care and quality of care on a PCU, as described by inpatients, family caregivers, and health care professionals. METHODS Qualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. Interviews and focus groups were semistructured to elicit comments about satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method, with an inductive, constant comparison approach to identify themes, and were coded to saturation. RESULTS Key elements of quality care and patient satisfaction on a PCU were grouped into six domains: 1) interprofessional team: a team of experts comprising multiple disciplines functioning as a unit; 2) communication: developing rapport, addressing expectations, providing information, listening actively, and facilitating end-of-life discussions; 3) attentive, personalized care: anticipatory and responsive compassionate care with tailored management of physical and nonphysical symptoms; 4) family-centered: support of patients and caregivers within a family; 5) accessible and consistent: appropriate resources and adequate staff to provide consistent care; and 6) supportive setting: a bright noninstitutionalized setting allowing both privacy and socialization. CONCLUSION The elements identified support the delivery of quality care. They may act as a guide for those planning to develop PCUs and form the basis for measures of satisfaction with care.
Collapse
Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dori Seccareccia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nanor Kevork
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Kevin Workentin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto East General Hospital, Toronto, Ontario, Canada
| | - Susan Blacker
- Department of Cancer Services Planning and Performance, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daphna Grossman
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Baycrest, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology & Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Campbell Family Cancer Research Institute, Ontario Cancer Institute, Toronto, Ontario, Canada.
| |
Collapse
|