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Du J, An Z, Wang C, Yu L. Nurses' self-regulation after engaging in end-of-life conversations with advanced cancer patients: a qualitative study. BMC Nurs 2024; 23:344. [PMID: 38778334 PMCID: PMC11110234 DOI: 10.1186/s12912-024-02016-6] [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: 02/06/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Self-regulation is crucial for nurses who engage in in-depth end-of-life conversations with advanced cancer patients, especially in cultural contexts featuring death taboos. An improved understanding of the self-regulation process of nurses can help them address negative emotions and promote self-growth more effectively. Therefore, this study aimed to explore nurses' self-regulation process after end-of-life conversations with advanced cancer patients. METHODS This study employed a descriptive, qualitative approach. Seventeen nurses from four hospitals and a hospice unit in mainland China were interviewed between September 2022 and June 2023. Data were collected through face-to-face semistructured interviews. A thematic analysis method was used to analyse the data following the guidance of regulatory focus theory. RESULTS Three main themes were developed: self-regulation antecedents include personality, experience, and support; promotion or prevention is a possible self-regulation process for nurses; both self-exhaustion and self-growth may be the outcomes of self-regulation, as did seven subthemes. Personality tendencies, life experience, and perceived support may affect nurses' self-regulation, thereby affecting their self-regulation outcomes. CONCLUSIONS Nurses exhibit different self-regulatory tendencies and self-regulation outcomes. The provision of peer support and counselling support to nurses is highly important with regard to achieving good self-regulation outcomes.
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Affiliation(s)
- Jiayi Du
- Radiation Oncology Center, Chongqing University Cancer Hospital, No. 181, Han Yu Road, Shapingba District, Chongqing, 400030, China
| | - Zifen An
- Wuhan University School of Nursing, No.115, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Chunyu Wang
- Radiation Oncology Center, Chongqing University Cancer Hospital, No. 181, Han Yu Road, Shapingba District, Chongqing, 400030, China.
| | - Liping Yu
- Wuhan University School of Nursing, No.115, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.
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2
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Lee EM, Jiménez-Fonseca P, Carmona-Bayonas A, Hernández R, Cruz-Castellanos P, Obispo B, Antoñanzas-Basa M, Palacín-Lois M, Castillo-Trujillo OA, Calderon C. Clinicians' and Advanced Cancer Patients' Estimates of Treatment Efficacy and Toxicity in Oncologic Treatment. Healthcare (Basel) 2023; 11:2222. [PMID: 37570462 PMCID: PMC10419268 DOI: 10.3390/healthcare11152222] [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: 06/23/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
The purpose of the study was to compare curability expectations between clinicians and patients and examine the influence of sociodemographic and clinical variables on these expectations and satisfaction within the clinician-patient relationship. This prospective study, conducted from February 2020 to May 2023, involved 986 advanced cancer patients. The patients completed questionnaires assessing treatment efficacy and toxicity predictions and the Scale to Assess the Therapeutic Relationship (STAR). Seventy-four percent of advanced cancer patients had an inaccurate perception of treatment curability. Clinicians perceived male patients with lung or digestive cancer without adenocarcinoma at locally advanced stages, with fewer comorbidities and better functional status (ECOG), as having higher curability expectations. Clinicians tended to have more realistic expectations than patients, since they had to consider the presence of treatment's side effects, while patients underestimated the possibility of experiencing these adverse effects. Patients who had more favorable expectations regarding survival and quality of life were found to be more satisfied with the care provided by their oncologists. It is crucial for patients to understand the treatment goals and establish realistic expectations in order to actively participate in decision-making and achieve a better quality of life at the end of life.
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Affiliation(s)
- Eun Mi Lee
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, 33007 Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, 30008 Murcia, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | | | - Berta Obispo
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | | | | | - Oscar A. Castillo-Trujillo
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, 33007 Oviedo, Spain
| | - Caterina Calderon
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
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Salvadé H, Stiefel F, Bourquin C. "You'll need to settle your affairs": How the subject of death is approached by oncologists and advanced cancer patients in follow-up consultations. Palliat Support Care 2022:1-9. [PMID: 36354030 DOI: 10.1017/s147895152200147x] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This qualitative study aimed to investigate communication about death in consultations with patients undergoing chemotherapy with no curative intent. Specifically, we examined (i) how the topic of death was approached, who raised it, in what way, and which responses were elicited, (ii) how the topic unfolded during consultations, and (iii) whether interaction patterns or distinguishing ways of communicating can be identified. METHODS The data consisted of 134 audio-recorded follow-up consultations. A framework of sensitizing concepts was developed, and interaction patterns were looked for when death was discussed. RESULTS The subject of death and dying was most often initiated by patients, and they raised it in various ways. In most consultations, direct talk about death was initiated only once. We identified 4 interaction patterns. The most frequent consists of indirect references to death by patients, followed by a direct mention of the death of a loved one, and a statement of the oncologists aiming to skip the subject. SIGNIFICANCE OF RESULTS Patients and oncologists have multiple ways of raising, pursuing, addressing and evacuating the subject of death. Being attentive and recognizing these ways and associated interaction patterns can help oncologists to think and elaborate on this topic and to facilitate discussions.
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Affiliation(s)
- Hélène Salvadé
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Bonvin S, Stiefel F, Gholam M, Bourquin C. Calling situated: a survey among medical students supplemented by a qualitative study and a comparison with a surveyed sample of physicians. BMC MEDICAL EDUCATION 2022; 22:619. [PMID: 35971124 PMCID: PMC9376571 DOI: 10.1186/s12909-022-03642-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Calling within the medical context receives growing academic attention and empirical research has started to demonstrate its beneficial effects. The purpose of this study is to investigate what motivates students to enter medical school and what role calling may play (i), to evaluate if calling influences the way in which they experience their studies (ii), and to compare medical students' experience of calling with those of physicians. METHODS A questionnaire survey was distributed among medical students (N = 1048; response rate above 60%) of the University of Lausanne in Switzerland. It was supplemented by a group discussion between bachelor medical students (N = 8) and senior physicians (N = 4), focusing on different facets of calling. An existing data set of a survey among physicians, addressing calling with the same questionnaire, was used to compare students' and physicians' attitudes towards calling. Survey data were analyzed with the habitual statistical procedures for categorical and continuous variables. The group discussion was analyzed with thematic analysis. RESULTS The survey showed that experiencing calling is a motivational factor for study choice and influences positively choice consistency. Students experiencing calling differed from those who did not: they attributed different definitions to calling, indicated more often prosocial motivational factors for entering medical school and perceived the learning context as less burdensome. The analysis of the group discussion revealed that the concept of calling has a fluid definition. It was conceived as having the characteristics of a double-edged sword and as originating from within or outside or from a dialectic interplay between the inner and outer world. Finally, calling is experienced less often by physicians than by medical students, with a decreasing prevalence as the immersion in the clinical years of the study of medicine progresses. CONCLUSIONS Calling plays an important role in study choice and consistency of medical students. Given its relevance for medical students and its ramifications with the learning context, calling should become a topic of the reflexive parts of the medical curriculum. We critically discuss the role played by calling for medical students and provide some perspectives on how calling could be integrated in the reflection and teaching on physicianhood.
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Affiliation(s)
- S Bonvin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Gholam
- Center of Epidemiological Psychiatry and Psychopathology (CEPP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Dunand A, Saraga M. Le choc de la nouvelle : perspective psycho-oncologique sur la communication médecin–malade. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les communications des médecins à leurs patients sont souvent rapportées en consultation psychologique lorsqu’elles ont un impact fort. Trois cas cliniques illustrent le fait que cette communication est complexe, dépend des acteurs en présence et de la situation, et qu’une approche standardisée est difficilement applicable. Le rôle du psychologue envers le patient est de l’aider à intégrer l’effet de cette communication. Envers le médecin, il est de lui permettre de communiquer de façon nuancée avec ses patients.
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6
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Maya S, Banerjee SC, Chawak S, Parker PA, Kandikattu S, Chittem M. Oncologists' experience with discussing cancer prognosis with patients and families: perspectives from India. Transl Behav Med 2021; 11:1896-1904. [PMID: 34170321 PMCID: PMC8686106 DOI: 10.1093/tbm/ibab070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nondisclosure of prognosis of advanced cancer is commonly practiced in some Asian cultures including India; but research is limited. To describe experiences of Indian oncologists in discussing cancer prognosis with people with cancer and their caregivers, with a focus on barriers and facilitators of prognostic discussions. Thirty oncologists practicing in South India, Hyderabad participated in semi-structured interviews; and analyzed using Interpretative Phenomenological Analysis. Barriers included system-level, patient-level, and physician-level challenges as obstructions to open and honest interactions around cancer prognosis. Most of the barriers focused on communication-related challenges. Lack of communication skills training for providers coupled with over-reliance on use of euphemisms, hesitation in communicating with "weak" patient, and struggles to establish healthcare proxy described communication-related barriers. The study also described factors including family involvement in cancer care and empathic communication as facilitators of honest and open communication about prognosis. In particular, rapport building and getting to know the patient, use of empathic communication, engaging in gradual and individualized disclosure, and balancing hope with honesty were communication-related facilitators that aid open communication with patients with cancer and their caregivers about prognosis and plan of care. Results provide implications for development of communication skills trainings for oncology physicians in India. Adapting, delivering, and evaluating existing communication skills training programs, particularly around discussions of prognosis and goals of care is a requisite step for providing patient-centered and supportive care to patients with cancer and their caregiving families.
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Affiliation(s)
- Sravannthi Maya
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | - Shweta Chawak
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | | | | | - Mahati Chittem
- Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
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Ernstmann N, Nakata H, Meurer L, Weiß J, Geiser F, Vitinius F, Petermann-Meyer A, Burgmer M, Sonntag B, Teufel M, Karger A. Participative development and evaluation of a communication skills-training program for oncologists-patient perspectives on training content and teaching methods. Support Care Cancer 2021; 30:1957-1966. [PMID: 34626250 PMCID: PMC8794992 DOI: 10.1007/s00520-021-06610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022]
Abstract
Background Using the 6-step approach to curriculum development for medical education, we developed a communication skills training (CST) curriculum for oncology and evaluated this curriculum from the perspective of cancer patients. Methods We conducted a qualitative interview study with cancer patients, collecting data using semi-structured face-to-face or telephone interviews with a short standardized survey. We fully transcribed the audiotaped interviews and conducted the content analysis using MAXQDA 2020. We analyzed the quantitative sociodemographic data descriptively. Results A total of 22 cancer patients participated, having a mean age of 60.6 (SD, 13.2) years and being predominantly female (55%). The patients believed that the CST curriculum addressed important aspects of patient-centered communication in cancer care. They emphasized the importance of physicians acquiring communication skills to establish a trusting relationship between doctor and patient, show empathy, inform patients, and involve them in treatment decisions. The patients had some doubts concerning the usefulness of strict protocols or checklists (e.g., they feared that protocol adherence might disturb the conversation flow). Discussion Although it was a challenge for some participants to take the perspective of a trainer and comment on the CST content and teaching methods, the patients provided a valuable perspective that can help overcome blind spots in CST concepts.
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Affiliation(s)
- Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany. .,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.
| | - Hannah Nakata
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Lena Meurer
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Johanna Weiß
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Franziska Geiser
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Frank Vitinius
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrea Petermann-Meyer
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Münster and University Hospital of Münster, Münster, Germany
| | - Bernd Sonntag
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Department of Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - André Karger
- Center for Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany.,Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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8
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Taylor A, Bleiker J, Hodgson D. Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce. Radiography (Lond) 2021; 27 Suppl 1:S43-S49. [PMID: 34393068 DOI: 10.1016/j.radi.2021.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Compassion is a poorly understood concept in diagnostic and therapeutic radiography, but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. Two separately conducted doctoral research projects, one therapeutic and one diagnostic, aimed to conceptualise compassion in order to understand its meaning and behavioural expression. METHODS A constructivist approach was taken with appropriate ethical approval. Patients and carers, student radiographers and radiographers took part in interviews and focus groups and tweets were harvested from a Twitter journal club discussion between radiographers of the second author's published literature review. Data were transcribed and analysed thematically. FINDINGS Key aspects of communication are fundamental to giving compassionate patient-centred care. These include verbal and non-verbal cues, actively listening and engaging and establishing rapport with the patient. Specific skills associated with these are also identified in these studies. CONCLUSION Keeping the patient as a person at the centre of radiographic practice in the rapidly evolving technical and cultural environment in which it exists requires timely and appropriate behavioural expressions of compassion from radiographers deploying a range of highly specific communication and interpersonal skills. IMPLICATIONS FOR PRACTICE When undertaking reflective practice, radiographers could consider key aspects of how they communicate with patients, including: verbal (in particular the language they use with patients and their tone of voice); non-verbal (especially eye contact and smiling and their body language). They could also usefully explore and develop skills in reading their patients' body language as well as their own in order to pick up subtle or hidden cues that might suggest a patient is suffering emotionally or psychologically. Finally, they could think about the sort of targeted questions they could ask of patients when welcoming them into the x-ray or treatment room that would both facilitate the procedure and leave the patient feeling that their radiographer had taken a genuine interest in them and their situation. These reflections could then be used to possibly modify their existing communications with their patients.
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Affiliation(s)
- A Taylor
- Weston Park Cancer Centre, Sheffield, United Kingdom. https://twitter.com/@AmyTaylM
| | - J Bleiker
- University of Exeter, Exeter, United Kingdom
| | - D Hodgson
- Sheffield Hallam University, Sheffield, United Kingdom
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9
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Gilad D, Goldblatt H, Zeilig G. End-of-life conversation from both sides of the bed: voices of family and staff. Disabil Rehabil 2020; 44:2774-2783. [PMID: 33222556 DOI: 10.1080/09638288.2020.1849426] [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: 10/22/2022]
Abstract
PURPOSE Prolonged living with chronic illness and disability expands the discussion of end-of-life conversation because of the complex role of intercommunication among patient, family, and healthcare staff. Little is known about such interaction from participants' different perspectives. This qualitative case study examined end-of-life conversation among patient, family, and staff during long-term hospitalization in a neurological rehabilitation department. METHODS After the patient's death, 18 participants responded to in-depth semi-structured interviews: 16 healthcare staff and two family members (the patient's wife and brother). In addition, we used the wife's autoethnographic documentation of her experiences during end-of-life conversation. RESULTS Thematic analysis produced three themes: (1) The Rehabilitation Department's Mission - Toward Life or Death? (2) The Staff's Perception of the Patient; (3) Containing Death: End-of-life Conversation from Both Sides of the Bed. These themes represented participants' different perspectives in the intercommunication in overt and covert dialogues, which changed over time. Death's presence-absence was expressed by movement between clinging to life and anticipating death. CONCLUSION The study findings emphasize the importance of practitioners' training to accept and openly discuss death as an inseparable part of life-long disability, and the implementation of this stance during end-of-life care via sensitive conversations with patients and their families.IMPLICATIONS FOR REHABILITATIONIt is vital for rehabilitation professionals to be trained to process and accept end-of-life issues as a natural and inseparable part of the life discourse among people with disabilities and their families.Rehabilitation professionals need to acquire tools to grasp the spoken and unspoken issues related to life and death, and to communicate their impressions and understandings with people with disabilities and their families.Rehabilitation professionals need to encourage an open dialogue when communicating with people with disabilities and their families on processes related to parting and death.
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Affiliation(s)
- Dvorit Gilad
- The Center for Research and Study of the Family, School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Gabi Zeilig
- Division of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Department of Physical Medicine and Rehabilitation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation. J Med Imaging Radiat Sci 2020; 51:S59-S71. [PMID: 33199246 DOI: 10.1016/j.jmir.2020.08.003] [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: 05/01/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level. AIMS To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists. METHODS/MATERIALS Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups. RESULTS An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient. DISCUSSION/CONCLUSION Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.
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11
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Kremeike K, Frerich G, Romotzky V, Boström K, Dojan T, Galushko M, Shah-Hosseini K, Jünger S, Rodin G, Pfaff H, Perrar KM, Voltz R. The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach. BMC Palliat Care 2020; 19:49. [PMID: 32299415 PMCID: PMC7164236 DOI: 10.1186/s12904-020-00548-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. METHODS Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. RESULTS 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die". CONCLUSIONS We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maren Galushko
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Medical Faculty, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS), University of Cologne, Cologne, Germany
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Stiefel F, Bourquin C. Moving toward the next generation of communication training in oncology: The relevance of findings from qualitative research. Eur J Cancer Care (Engl) 2019; 28:e13149. [PMID: 31429157 DOI: 10.1111/ecc.13149] [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: 01/28/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The critics and recommendations for communication training in oncology call for new ideas, which may contribute to designing the next generation of training. The aim of this work was to search the literature on communication in oncology for empirically grounded observations that might be useful for the development of training approaches. METHODS The approach consists of identifying findings that might serve as cues for the design of the next generation of training. The literature search strategy allowed the inclusion of 68 articles. RESULTS Findings of the articles showed that multiple factors shape clinical communication: the functions and effects of information provision, the relational and interactional aspects of communication, its patient- and context-related dimensions, and the intrapsychic and context-related barriers hampering the patient encounter that clinicians are facing. CONCLUSION A way to reach all oncologists and to provide training centred on the singular needs of participants is a shift in the focus of training from communication tasks or communication-related situations to the clinician. PRACTICE IMPLICATIONS Training should focus on the competencies and qualities to be developed by clinicians, such as being flexible, able to adapt to the singular patient, sensitive to interactional aspects of communication, which influence the clinical encounter.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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Salmon P, Young B. How could we know if communication skills training needed no more evaluation? The case for rigour in research design. PATIENT EDUCATION AND COUNSELING 2019; 102:1401-1403. [PMID: 31189493 DOI: 10.1016/j.pec.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Bridget Young
- Department of Health Services Research, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
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Li S, Hubner A. The Impact of Web-Based Ratings on Patient Choice of a Primary Care Physician Versus a Specialist: Randomized Controlled Experiment. J Med Internet Res 2019; 21:e11188. [PMID: 31254337 PMCID: PMC6625218 DOI: 10.2196/11188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/04/2019] [Accepted: 05/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Physician review websites have empowered prospective patients to acquire information about physicians. However, little is known about how Web-based ratings on different aspects of a physician may affect patients’ selection of physicians differently. Objective The objectives of this study were to examine (1) how patients weigh ratings on a physician’s technical skills and interpersonal skills in their selection of physicians and (2) whether and how people’s choice of a primary care physician versus a specialist is affected differently by Web-based ratings. Methods A 2×2×2×2 between-subjects experiment was conducted. Over 600 participants were recruited through a crowdsourcing website and randomly assigned to view a mockup physician review Web page that contained information on a physician’s basic information and patients’ ratings. After reviewing the Web page, participants were asked to complete a survey on their perceptions of the physician and willingness to seek health care from the physician. Results The results showed that participants were more willing to choose a physician with higher ratings on technical skills than on interpersonal skills compared with a physician with higher ratings on interpersonal skills than on technical skills, t369.96=22.36, P<.001, Cohen d=1.22. In the selection of different types of physicians, patients were more likely to choose a specialist with higher ratings on technical skills than on interpersonal skills, compared with a primary care physician with the same ratings, F1,521=5.34, P=.021. Conclusions The findings suggest that people place more weight on technical skills than interpersonal skills in their selection of a physician based on their ratings on the Web. Specifically, people are more likely to make a compromise on interpersonal skills in their choice of a specialist compared with a primary care physician. This study emphasizes the importance of examining Web-based physician ratings in a more nuanced way in relation to the selection of different types of physicians. Trial Registration ISRCTN Registry ISRCTN91316463; http://www.isrctn.com/ISRCTN91316463
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Affiliation(s)
- Siyue Li
- College of Media and International Culture, Zhejiang University, Hangzhou, China
| | - Austin Hubner
- School of Communication, The Ohio State University, Columbus, OH, United States
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Brown SL, Salmon P. Reconciling the theory and reality of shared decision-making: A "matching" approach to practitioner leadership. Health Expect 2018; 22:275-283. [PMID: 30478979 PMCID: PMC6543140 DOI: 10.1111/hex.12853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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16
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Stiefel F, Kiss A, Salmon P, Peters S, Razavi D, Cervantes A, Margulies A, Bourquin C. Training in communication of oncology clinicians: a position paper based on the third consensus meeting among European experts in 2018. Ann Oncol 2018; 29:2033-2036. [PMID: 30412225 DOI: 10.1093/annonc/mdy343] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician's self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.
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Affiliation(s)
- F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland.
| | - A Kiss
- Division of Psychosomatic Medicine, Basel University Hospital, Switzerland
| | - P Salmon
- Faculty of Humanities and Social Sciences, Liverpool University, UK
| | - S Peters
- Medical Oncology Service, Lausanne University Hospital, Switzerland
| | - D Razavi
- Jules Bordet Institute and Brussels University, Belgium
| | | | - A Margulies
- EONS Education Working Group, Zurich, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland
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17
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Stiefel F, Saraga M, Bourquin C. Enjeux futurs de la communication et de l’enseignement de la communication en oncologie. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Berney A, Bourquin C. Enseignement prégradué à la communication clinique : la situation emblématique de l’annonce de diagnostic en oncologie. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stiefel F, de Vries M, Bourquin C. Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations. Eur J Cancer Care (Engl) 2018; 27:e12859. [PMID: 29873149 DOI: 10.1111/ecc.12859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 11/27/2022]
Abstract
This systematic review synthesises the literature on Communication Skills Training (CST) programmes for oncology professionals to identify their core components and compare them with the recommendations formulated in a position paper based on a European expert consensus meeting. A systematic literature search was conducted using MEDLINE (OVID and PUBMED), CINAHL, EMBASE, PSYCHINFO, Web of Science and the Cochrane Library. The analytic approach relied on an a priori framework based on the position paper's recommendations, generating several themes. Forty-nine articles were included. The CST programmes reported between 2010 and 2016 were heterogeneous. Some recommendations, especially those regarding content and pedagogic tools, were followed by most providers, while others, such as setting, objectives and participants, were not. This synthesis raises questions on how CST programmes are conceived and how they could or should be conceived in future. While medicine, especially clinical communication, is socially and culturally embedded, some recommendations regarding CST programmes seem to be universally valuable, contributing to ensure quality and enhanced credibility, and thus endorsement and sustained implementation, of CST programmes in the oncology setting.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Mirjam de Vries
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
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20
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De Vries AMM, Gholamrezaee MM, Verdonck-de Leeuw IM, de Roten Y, Despland JN, Stiefel F, Passchier J. Physicians' emotion regulation during communication with advanced cancer patients. Psychooncology 2018; 27:929-936. [PMID: 29266589 DOI: 10.1002/pon.4614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In cancer care, optimal communication between patients and their physicians is, among other things, dependent on physicians' emotion regulation, which might be related to physicians' as well as patients' characteristics. In this study, we investigated physicians' emotion regulation during communication with advanced cancer patients, in relation to physicians' (stress, training, and alexithymia) and patients' (sadness, anxiety, and alexithymia) characteristics. METHODS In this study, 134 real-life consultations between 24 physicians and their patients were audio-recorded and transcribed. The consultations were coded with the "Defence Mechanisms Rating Scale-Clinician." Physicians completed questionnaires about stress, experience, training, and alexithymia, while patients completed questionnaires about sadness, anxiety, and alexithymia. Data were analysed using linear mixed effect models. RESULTS Physicians used several defence mechanisms when communicating with their patients. Overall defensive functioning was negatively related to physicians' alexithymia. The number of defence mechanisms used was positively related to physicians' stress and alexithymia as well as to patients' sadness and anxiety. Neither physicians' experience and training nor patients' alexithymia were related to the way physicians regulated their emotions. CONCLUSIONS This study showed that physicians' emotion regulation is related to both physician (stress and alexithymia) and patient characteristics (sadness and anxiety). The study also generated several hypotheses on how physicians' emotion regulation relates to contextual variables during health care communication in cancer care.
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Affiliation(s)
- A M M De Vries
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland.,Vrije Universiteit Amsterdam, Department of Clinical Psychology, Emgo+ Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| | - M M Gholamrezaee
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - I M Verdonck-de Leeuw
- Vrije Universiteit Amsterdam, Department of Clinical Psychology, Emgo+ Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| | - Y de Roten
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - J N Despland
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - F Stiefel
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - J Passchier
- Vrije Universiteit Amsterdam, Department of Clinical Psychology, Emgo+ Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
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Stiefel F, Nakamura K, Terui T, Ishitani K. The Collusion Classification Grid: A Supervision and Research Tool. J Pain Symptom Manage 2018; 55:e1-e3. [PMID: 29122617 DOI: 10.1016/j.jpainsymman.2017.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Department of Psychiatry, University Hospital Lausanne, Lausanne, Switzerland.
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Berney A, Carrard V, Schmid Mast M, Bonvin R, Stiefel F, Bourquin C. Individual training at the undergraduate level to promote competence in breaking bad news in oncology. Psychooncology 2017; 26:2232-2237. [DOI: 10.1002/pon.4452] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Alexandre Berney
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
| | - Valérie Carrard
- Faculty of Business and Economics; Lausanne University; Lausanne Switzerland
| | | | - Raphael Bonvin
- Medical Education Unit, Faculty of Biology and Medicine; Lausanne University; Lausanne Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
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23
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Stiefel F, Nakamura K, Terui T, Ishitani K. Collusions Between Patients and Clinicians in End-of-Life Care: Why Clarity Matters. J Pain Symptom Manage 2017; 53:776-782. [PMID: 28062352 DOI: 10.1016/j.jpainsymman.2016.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, unreflected behaviors, and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for both, patient and clinician. After an introductory definition of collusion, two archetypal situations of collusion-based on material from a regular supervision of a palliative care specialist by a liaison psychiatrist-and means of working through collusion are presented. The theoretical framework of collusion is then described and the conceptual shortcomings of the palliative care literature in this respect discussed, justifying the call for more clarity. Finally, cultural aspects and societal injunctions on the dying, contributing to the development of collusion in end-of-life care, are discussed.
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Affiliation(s)
- Friedrich Stiefel
- Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan; University Hospital Lausanne, Lausanne, Switzerland.
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Dittrich C, Stiefel F, Kiss A, Dizon DS. Reply to the letter to the editor 'Integrating communication as a core skill in the global curriculum for medical oncology' by Horlait et al. Ann Oncol 2017; 28:905-906. [PMID: 28049138 DOI: 10.1093/annonc/mdw679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Dittrich
- Centre for Oncology and Haematology, Kaiser Franz Josef-Spital, and Applied Cancer Research - Institution for Translational Research, Vienna, Austria
| | - F Stiefel
- Psychiatric Liaison Service, Department of Psychiatry, University Hospital of Lausanne-CHUV, Lausanne, Switzerland
| | - A Kiss
- Psychosomatic Division, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - D S Dizon
- Gynecologic Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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