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Miyagami T, Watari T, Nishizaki Y, Sekine M, Shigetomi K, Miwa M, Chopra V, Naito T. Survey on nurse-physician communication gaps focusing on diagnostic concerns and reasons for silence. Sci Rep 2024; 14:17362. [PMID: 39075186 PMCID: PMC11286969 DOI: 10.1038/s41598-024-68520-6] [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: 02/26/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024] Open
Abstract
Diagnosis improvement requires physician-nurse collaboration. This study explored nurses' concerns regarding physicians' diagnoses and how they were communicated to physicians. This cross-sectional study, employing a web-based questionnaire, included nurses registered on Japan's largest online media site from June 26, 2023, to July 31, 2023. The survey inquired whether participants felt concerned about a physician's diagnosis within a month, if they communicated their concerns once they arose, and, if not, their reasons. The reasons for not being investigated were also examined. The nurses' frequency of feeling concerned about a physician's diagnosis and the barriers to communicating these concerns to the physician were evaluated. Overall, 430 nurses answered the survey (female, 349 [81.2%]; median age, 45 [35-51] years; median years of experience, 19 [12-25]). Of the nurses, 61.2% experienced concerns about a physician's diagnosis within the past month; 52.5% felt concerned but did not communicate this to the physician. The most common reasons for not communicating included concern about the physician's pride, being ignored when communicating, and the nurse not believing that a diagnosis should be made. Our results highlight the need to foster psychologically safe workplaces for nurses and create educational programs encouraging nurse involvement in diagnosis.
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Affiliation(s)
- Taiju Miyagami
- Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Japan
| | - Yuji Nishizaki
- Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Miwa Sekine
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
- Medical Technology Innovation Center, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kyoko Shigetomi
- Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Mamoru Miwa
- Nikkei Business Publications, Inc, Tokyo, Japan
| | - Vineet Chopra
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Toshio Naito
- Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Hansen DM, Motter T, Keeley MP, Shanholtzer J, Aultman J, Woodward C. Interdisciplinary simulation for nursing and medical students about final conversations: Catalyzing relationships at the end of life (CAREol). Palliat Support Care 2023; 21:798-804. [PMID: 35912673 DOI: 10.1017/s1478951522000992] [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: 11/06/2022]
Abstract
OBJECTIVES Final conversations (FCs) go beyond how patients want to be cared for at the end of life (EOL) and focus on messages of love, identity specific, and unique to an individual and relationship that requires self-examination, everyday talk that normalizes a difficult situation, religious/spiritual messages, and if needed, difficult relationship talk to heal broken relationships. The purpose of the Catalyzing Relationships at the End of Life (CAREol) program was to provide interdisciplinary education to nursing and medical students and clinical faculty about facilitating FCs among patients and families. METHOD This two-part, quasi-experimental program consisted of a cognitive (online) and experiential (live simulation) curriculum experience. Program curriculum, including video vignettes, readings, and live simulation (utilizing actors), was developed by the study team. Reflective journaling and researcher designed pre- and post-tests were used to assess comfort, confidence, importance, and distress regarding FCs and collaboration with other disciplines. RESULTS The pre-/post-test questions demonstrate statistical significance based on a paired t-test with effect sizes supporting the practical importance of the findings for effect size. Preliminary content and thematic analysis of qualitative responses describe categories of the mock team meeting experience and interaction with the actors to change patient and family outcomes. SIGNIFICANCE OF RESULTS Early intervention with the CAREol program provides a framework to help students and clinical faculty facilitate FCs that may result in peace and comfort for patients and families during a difficult time.
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Affiliation(s)
| | | | - Maureen P Keeley
- Department of Communication Studies, Texas State University, San Marcos, TX
| | | | - Julie Aultman
- Northeast Ohio Medical University College of Medicine, Rootstown, OH
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Francis L, Robertson N. Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis. PATIENT EDUCATION AND COUNSELING 2023; 107:107574. [PMID: 36459829 DOI: 10.1016/j.pec.2022.107574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To provide an overview of healthcare practitioners' experiences of breaking bad news. METHOD Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis. RESULTS Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised. CONCLUSIONS Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged. PRACTICE IMPLICATIONS Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.
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Affiliation(s)
- Laura Francis
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
| | - Noelle Robertson
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
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Anestis E, Eccles FJR, Fletcher I, Triliva S, Simpson J. Healthcare professionals' involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study. Disabil Rehabil 2022; 44:7877-7890. [PMID: 34783624 DOI: 10.1080/09638288.2021.2002436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. MATERIALS AND METHODS 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis. RESULTS Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. CONCLUSIONS BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future.Implications for rehabilitationBreaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions.Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them.Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided.Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task.Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sofia Triliva
- Department of Psychology, School of Social Sciences, University of Crete, Rethymnon, Greece
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Bryant J, Hobden B, Waller A, Sanson-Fisher R, Shepherd J. Oncology nurse perceptions about life expectancy discussions: a cross-sectional study exploring what patients want to know, and why doctors don't disclose. Contemp Nurse 2022; 58:424-434. [PMID: 36373372 DOI: 10.1080/10376178.2022.2147848] [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: 11/16/2022]
Abstract
Background: Sensitive and patient-centred discussion about life expectancy has clear benefits for patients with advanced cancer and their families. The perceptions of oncology nurses about disclosure of life expectancy, and the barriers to disclosure, have rarely been explored. Objectives/Aims/Hypotheses: To examine oncology nurses' perceptions of the: (1) proportion of patients with advanced cancer who want, receive and understand estimates of life expectancy; (2) reasons why doctors may not provide estimates of life expectancy. Design: Cross-sectional survey. Methods: Australian oncology nurses who were members of a professional society or worked at a participating metropolitan cancer centre were emailed a link to an anonymous online survey. Participants provided socio-demographic characteristics and their perceptions about the proportion of patients with advanced cancer who (a) want, (b) are provided with, (c) receive and (d) understand estimates of life expectancy, as well as the reasons estimates of life expectancy may not be provided. Results: A total of 104 nurses participated. While 51% of nurses perceived that most patients (>75%) want to be provided with an estimate of their life expectancy, 63% of nurses reported that <50% of patients were provided with an estimate. Further, 85% of nurses indicated that <50% of patients understand the estimate. The most frequent reason nurses perceived doctors did not provide an estimate of life expectancy was because the doctor didn't have an accurate idea of life expectancy (80.8%). Almost one-fifth of nurses (18.3%) thought that doctors did not provide estimates because they felt it was not their responsibility to do so. Conclusions: Strategies to ensure a patient-centred approach to life expectancy discussions with patients with advanced cancer are urgently needed. Impact statement: Oncology nurses perceive that many patients with advanced cancer are not provided with an accurate estimate of their life expectancy and few understand the information provided to them.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Kiker WA, Rutz Voumard R, Plinke W, Longstreth WT, Curtis JR, Creutzfeldt CJ. Prognosis Predictions by Families, Physicians, and Nurses of Patients with Severe Acute Brain Injury: Agreement and Accuracy. Neurocrit Care 2022; 37:38-46. [PMID: 35474037 PMCID: PMC10760982 DOI: 10.1007/s12028-022-01501-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Effective shared decision-making relies on some degree of alignment between families and the medical team regarding a patient's likelihood of recovery. Patients with severe acute brain injury (SABI) are often unable to participate in decisions, and therefore family members make decisions on their behalf. The goal of this study was to evaluate agreement between prognostic predictions by families, physicians, and nurses of patients with SABI regarding their likelihood of regaining independence and to measure each group's prediction accuracy. METHODS This observational cohort study, conducted from 01/2018 to 07/2020, was based in the neuroscience and medical/cardiac intensive care units of a single center. Patient eligibility included a diagnosis of SABI-specifically stroke, traumatic brain injury, or hypoxic ischemic encephalopathy-and a Glasgow Coma Scale ≤ 12 after hospital day 2. At enrollment, families, physicians, and nurses were asked separately to predict a patient's likelihood of recovering to independence within 6 months on a 0-100 scale, regardless of whether a formal family meeting had occurred. True outcome was based on modified Rankin Scale assessment through a family report or medical chart review. Prognostic agreement was measured by (1) intraclass correlation coefficient; (2) mean group prediction comparisons using paired Student's t-tests; and (3) prevalence of concordance, defined as an absolute difference of less than 20 percentage points between predictions. Accuracy for each group was measured by calculating the area under a receiver operating characteristic curve (C statistic) and compared by using DeLong's test. RESULTS Data were collected from 222 patients and families, 45 physicians, and 103 nurses. Complete data on agreement and accuracy were available for 187 and 177 patients, respectively. The intraclass correlation coefficient, in which 1 indicates perfect correlation and 0 indicates no correlation, was 0.49 for physician-family pairs, 0.40 for family-nurse pairs, and 0.66 for physician-nurse pairs. The difference in mean predictions between families and physicians was 23.5 percentage points (p < 0.001), 25.4 between families and nurses (p < 0.001), and 1.9 between physicians and nurses (p = 0.38). Prevalence of concordance was 39.6% for family-physician pairs, 30.0% for family-nurse pairs, and 56.2% for physician-nurse pairs. The C statistic for prediction accuracy was 0.65 for families, 0.82 for physicians, and 0.76 for nurses. The p values for differences in C statistics were < 0.05 for family-physician and family-nurse groups and 0.18 for physician-nurse groups. CONCLUSIONS For patients with SABI, agreement in predictions between families, physicians, and nurses regarding likelihood of recovery is poor. Accuracy appears higher for physicians and nurses compared with families, with no significant difference between physicians and nurses.
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Affiliation(s)
- Whitney A Kiker
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.
| | - Rachel Rutz Voumard
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Wesley Plinke
- Oregon Health and Sciences University School of Medicine, Portland, OR, USA
| | - W T Longstreth
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - Claire J Creutzfeldt
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA
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Sigler LE, Althouse AD, Thomas TH, Arnold RM, White D, Smith TJ, Chu E, Rosenzweig M, Smith KJ, Schenker Y. Effects of an Oncology Nurse-Led, Primary Palliative Care Intervention (CONNECT) on Illness Expectations Among Patients With Advanced Cancer. JCO Oncol Pract 2022; 18:e504-e515. [PMID: 34767474 PMCID: PMC9014423 DOI: 10.1200/op.21.00573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with advanced cancer often have unrealistic expectations about prognosis and treatment. This study assessed the effect of an oncology nurse-led primary palliative care intervention on illness expectations among patients with advanced cancer. METHODS This study is a secondary analysis of a cluster-randomized trial of primary palliative care conducted at 17 oncology clinics. Adult patients with advanced solid tumors for whom the oncologist would not be surprised if died within 1 year were enrolled. Monthly visits were designed to foster realistic illness expectations by eliciting patient concerns and goals for their medical care and empowering patients and families to engage in discussions with oncologists about treatment options and preferences. Baseline and 3-month questionnaires included questions about life expectancy, treatment intent, and terminal illness acknowledgment. Odds of realistic illness expectations at 3 months were adjusted for baseline responses, patient demographic and clinical characteristics, and intervention dose. RESULTS Among 457 primarily White patients, there was little difference in realistic illness expectations at 3 months between intervention and standard care groups: 12.8% v 11.4% for life expectancy (adjusted odds ratio [aOR] = 1.15; 95% CI, 0.59 to 2.22; P = .684); 24.6% v 33.3% for treatment intent (aOR = 0.76; 95% CI, 0.44 to 1.27; P = .290); 53.6% v 44.7% for terminal illness acknowledgment (aOR = 1.28; 95% CI, 0.81 to 2.00; P = .288). Results did not differ when accounting for variation in clinic sites or intervention dose. CONCLUSION Illness expectations are difficult to change among patients with advanced cancer. Additional work is needed to identify approaches within oncology practices that foster realistic illness expectations to improve patient decision making.
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Affiliation(s)
- Lauren E. Sigler
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Emory Palliative Care Center, Emory University School of Medicine, Atlanta, GA,Lauren E. Sigler, MD, Emory Palliative Care Center, Emory University School of Medicine, 1821 Clifton Road NE, Suite 1017 Atlanta, GA 30329; e-mail:
| | - Andrew D. Althouse
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Teresa H. Thomas
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Robert M. Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Douglas White
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Department of Critical Care Medicine, Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas J. Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, New York, NY
| | - Margaret Rosenzweig
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Kenneth J. Smith
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
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Crucefix AL, Fleming APL, Lebus CS, Slowther AM, Fritz Z. Sharing a written medical summary with patients on the post-admission ward round: A qualitative study of clinician and patient experience. J Eval Clin Pract 2021; 27:1235-1242. [PMID: 33960593 DOI: 10.1111/jep.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Sharing aspects of the traditional medical record with patients has been successful in primary and antenatal care, but has not been investigated in the UK inpatient setting. Our aim was to evaluate the impact on patient and clinician experience of providing patients with a written lay summary of their care-plan in the acute care setting. METHOD We carried out a qualitative interview study on two acute medicine wards in an NHS University Teaching Hospital for a 4-week period in 2019. A summary record, designed in response to suggestions from doctors and patients from a previous study, was distributed to patients on the first ward round after admission. Eligible participants included all doctors and nurses working on and all patients and their families attending the acute medical units; patients were excluded if they lacked capacity to consent or were under 18. We interviewed 20 patients, 10 relatives, 10 doctors and 7 nurses. RESULTS Patients felt that the summary improved their ability to remember details about their care so they could more accurately and easily update their relatives. They did not feel that the summary induced anxiety. Patient-doctor communication was improved: patients felt empowered to ask more questions and doctors felt that it solidified their plan and encouraged them to avoid medical jargon. Most patients felt the summary included the 'right' amount of information. Healthcare professionals were more concerned about the risk of breaching confidentiality than patients. Doctors felt that providing summaries was time-consuming; there were differing opinions about whether this was a worthwhile investment of time. Clinicians recognized that the traditional medical record has many roles. CONCLUSIONS A summary record could empower patients and improve patient-doctor communication but would require additional clinician and administrative time.
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Affiliation(s)
| | | | | | | | - Zoë Fritz
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge Clinical School, Cambridge, UK
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Kiker WA, Rutz Voumard R, Andrews LIB, Holloway RG, Brumback LC, Engelberg RA, Curtis JR, Creutzfeldt CJ. Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury. JAMA Netw Open 2021; 4:e2128991. [PMID: 34673964 PMCID: PMC8531991 DOI: 10.1001/jamanetworkopen.2021.28991] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Shared decision-making requires key stakeholders to align in perceptions of prognosis and likely treatment outcomes. OBJECTIVE For patients with severe acute brain injury, the objective of this study was to better understand prognosis discordance between physicians and families by determining prevalence and associated factors. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods cross-sectional study analyzed a cohort collected from January 4, 2018, to July 22, 2020. This study was conducted in the medical and cardiac intensive care units of a single neuroscience center. Participants included families, physicians, and nurses of patients admitted with severe acute brain injury. EXPOSURES Severe acute brain injury was defined as stroke, traumatic brain injury, or hypoxic ischemic encephalopathy with a Glasgow Coma Scale score less than or equal to 12 points after hospital day 2. MAIN OUTCOMES AND MEASURES Prognosis discordance was defined as a 20% or greater difference between family and physician prognosis predictions; misunderstanding was defined as a 20% or greater difference between physician prediction and the family's estimate of physician prediction; and optimistic belief difference was defined as any difference (>0%) between family prediction and their estimate of physician prediction. Logistic regression was used to identify associations with discordance. Optimistic belief differences were analyzed as a subgroup of prognosis discordance. RESULTS Among 222 enrolled patients, prognostic predictions were available for 193 patients (mean [SD] age, 57 [19] years; 106 men [55%]). Prognosis discordance occurred for 118 patients (61%) and was significantly more common among families who identified with minoritized racial groups compared with White families (odds ratio [OR], 3.14; CI, 1.40-7.07, P = .006); among siblings (OR, 4.93; 95% CI, 1.35-17.93, P = .02) and adult children (OR, 2.43; 95% CI, 1.10-5.37; P = .03) compared with spouses; and when nurses perceived family understanding as poor compared with good (OR, 3.73; 95% CI, 1.88-7.40; P < .001). Misunderstanding was present for 80 of 173 patients (46%) evaluated for this type of prognosis discordance, and optimistic belief difference was present for 94 of 173 patients (54%). In qualitative analysis, faith and uncertainty emerged as themes underlying belief differences. Nurse perception of poor family understanding was significantly associated with misunderstanding (OR, 2.06; 95% CI, 1.07-3.94; P = .03), and physician perception with optimistic belief differences (OR, 2.32; 95% CI, 1.10-4.88; P = .03). CONCLUSIONS AND RELEVANCE Results of this cross-sectional study suggest that for patients with severe acute brain injury, prognosis discordance between physicians and families was common. Efforts to improve communication and decision-making should aim to reduce this discordance and find ways to target both misunderstanding and optimistic belief differences.
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Affiliation(s)
- Whitney A. Kiker
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Rachel Rutz Voumard
- Harborview Medical Center, Department of Neurology, University of Washington, Seattle
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Leah I. B. Andrews
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Robert G. Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Lyndia C. Brumback
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Ruth A. Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Claire J. Creutzfeldt
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Harborview Medical Center, Department of Neurology, University of Washington, Seattle
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10
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McCracken C, McAndrew N, Schroeter K, Klink K. Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members. Clin J Oncol Nurs 2021; 25:E35-E43. [PMID: 34269348 DOI: 10.1188/21.cjon.e35-e43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncology healthcare professionals (HCPs), particularly nurses, experience moral distress. However, little is known about the impact of moral distress on oncology teams. OBJECTIVES The purpose of this study was to describe moral distress as it is experienced by oncology teams in practice. METHODS 32 oncology team members participated in eight focus groups. Content analysis was used to identify key themes. Two investigators collaboratively analyzed the data, and findings were independently reviewed by two additional investigators. FINDINGS The following six themes emerged.
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Affiliation(s)
| | - Natalie McAndrew
- Froedtert and the Medical College of Wisconsin Froedtert Hospital
| | | | - Katie Klink
- Froedtert and the Medical College of Wisconsin Froedtert Hospital
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Gleason K, Harkless G, Stanley J, Olson APJ, Graber ML. The critical need for nursing education to address the diagnostic process. Nurs Outlook 2021; 69:362-369. [PMID: 33455815 PMCID: PMC8178169 DOI: 10.1016/j.outlook.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Diagnostic errors are among the most common medical errors and the deadliest. The National Academy of Medicine recently concluded that diagnostic errors represent an urgent national concern. Their first recommendation to address this issue called for promoting the key role of the nurse in the diagnostic process. Registered nurses across clinical settings significantly contribute to the medical diagnostic process, though their role in diagnosis has historically gone unacknowledged. In this paper, we review the history and current state of diagnostic education in pre-licensure registered nurse preparation, introduce interprofessional individual- and team-based competencies to improve diagnostic safety, and discuss the next steps for nursing education. Nurses educated and empowered to fully participate in the diagnostic process are essential for achieving better, safer patient outcomes.
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Affiliation(s)
| | | | - Joan Stanley
- American Association of Colleges of Nursing, Washington, DC
| | | | - Mark L Graber
- Society to Improve Diagnosis in Medicine, Chicago, IL
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12
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Cheng Q, Duan Y, Wang Y, Zhang Q, Chen Y. The physician-nurse collaboration in truth disclosure: from nurses' perspective. BMC Nurs 2021; 20:38. [PMID: 33676508 PMCID: PMC7937200 DOI: 10.1186/s12912-021-00557-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Collaboration between physicians and nurses is critical. However, a limited number of studies have provided insights into the status of physician-nurse collaboration in truth disclosure. METHODS A cross-sectional survey was conducted using an electronic questionnaire among Chinese nurses who attended a provincial conference. The Nurse-Physician Collaboration Scale was administered to nurses to assess the collaboration in truth disclosure from their perspective. A multiple-choice question was asked to assess the perceived difficulties in truth disclosure. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to evaluate physician-nurse collaboration in truth disclosure. RESULTS A total of 287 nurses completed the survey, and 279 of them reported that they had carried out truth disclosures among patients. The average score for physician-nurse collaboration in truth disclosure was 3.98 ± 0.72. The majority of nurses (73.1-81%) responded positively to different dimensions of collaboration in truth disclosure. The results of multiple stepwise regression analysis showed that seniority (B = - 0.111, 95% confidence interval [CI] = - 0.167-- 0.055, p < 0.001) and frequency of truth disclosure (B = 0.162, 95%CI = 0.076-0.249, p < 0.001) were the only two factors associated with collaboration in truth disclosure between physicians and nurses. The most common barrier perceived by nurses was fear of patients' negative emotions or their suicide attempts after truth telling. CONCLUSIONS Most nurses responded positively to physician-nurse collaboration in truth disclosure. Various difficulties existed in the practice of truth-telling collaboration. Further studies are required to test the potential interventions to promote cooperation between nurses and physicians in truth disclosure.
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Affiliation(s)
- Qinqin Cheng
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yinglong Duan
- The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ying Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qinghui Zhang
- Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yongyi Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China.
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13
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Vena JA, Copel LC. A concept analysis of remission within the domain of cancer survivorship. Nurs Forum 2021; 56:421-428. [PMID: 33634534 DOI: 10.1111/nuf.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
AIM This concept analysis aims to formulate a unique theoretical definition of the term remission as used in cancer survivorship. BACKGROUND Inadequate communication between healthcare providers and cancer survivors is a shared burden affecting survivor well-being. Healthcare providers regularly use the term remission in cancer prognosis, treatment, and long-term cancer management; yet, how healthcare providers and cancer survivors define and interpret the concept of remission is less understood. DESIGN The Walker and Avant method of concept analysis was applied to define the term remission within the domain of cancer survivorship. DATA SOURCE: Three health sciences databases were chosen for the literature search, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline. REVIEW METHODS: Included research articles were evaluated to define the antecedents, attributes, consequences, and empirical referents of the term remission. RESULTS A cancer diagnosis is the most commonly cited antecedent to cancer remission. During remission, most cancer patients are free of measurable or symptomatic disease; however, the remission milestone is complemented by multiple physical and psychological symptoms. More specific cancer remission attributes include anxiety, recurrence fears, self-perseverance, and loss of social support. Both positive and negative outcomes accompany cancer remission, including acceptance of the treatment journey, appreciation for life, hope, persistent anxiety, personal relief, and triggered memories. CONCLUSIONS This concept analysis reviewed numerous publications to understand remission in the context of cancer survivorship. Advanced practice and registered nurses have a continued opportunity to improve the communication methods of patient-centered teaching and care planning for cancer patients in remission.
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Affiliation(s)
- Joseph A Vena
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Linda C Copel
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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14
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Melis P, Galletta M, Aviles Gonzalez CI, Contu P, Jimenez Herrera MF. Experiencing communication related to knowing the cancer diagnosis and prognosis: A multi-perspective interpretative phenomenological study. Eur J Oncol Nurs 2021; 51:101904. [PMID: 33578333 DOI: 10.1016/j.ejon.2021.101904] [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: 05/03/2020] [Revised: 12/12/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the phenomenon of communication related to knowing the diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses. METHODS Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) -who were linked by a carer-cared relationship-were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants' narratives. RESULTS Two overarching themes were identified: The first theme "the «what is it?» and the «what will happen to me?»" illustrates the two different paths of communication of diagnosis and prognosis. The second theme "Matching and mismatching in identifying the others as speakers" shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions. CONCLUSIONS Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses' perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
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Affiliation(s)
- Paola Melis
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | | | - Paolo Contu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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15
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Grignoli N, Wullschleger R, Di Bernardo V, Amati M, Zanini C, Malacrida R, Rubinelli S. Hope and therapeutic privilege: time for shared prognosis communication. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106157. [PMID: 33055136 DOI: 10.1136/medethics-2020-106157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs' perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from different positions and experience, including doctors and nurses in four different departments (intensive care, oncology, palliative care, rehabilitation), were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient's timing and sharing the patient's wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs' emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation.
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Affiliation(s)
- Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Consultation-Liaison Psychiatry Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Valentina Di Bernardo
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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16
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Testoni I, Wieser MA, Kapelis D, Pompele S, Bonaventura M, Crupi R. Lack of Truth-Telling in Palliative Care and Its Effects among Nurses and Nursing Students. Behav Sci (Basel) 2020; 10:E88. [PMID: 32403378 PMCID: PMC7287675 DOI: 10.3390/bs10050088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
Unclear communication of inauspicious prognoses may disorientate both patients and their relatives, drastically jeopardizing the planning of palliative care. This paper considers the issue of truth-telling in the communicative problems of nurses and students of nursing with terminally ill patients. The fundamental objective is the analysis of the difficulties related to the lack of truth-telling and how it might impact their professional and personal lives. A qualitative study was realized, involving 47 participants, both nurses (25) and nursing students (22), working in palliative care units or in associations of volunteers for the assistance of oncological patients. The exploration was focused on the way they relate to patients who are not aware of their real health conditions and their consequences. Particular attention was paid to their opinions concerning what could be done in order to manage such problematic situations in the near future.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied psychology (FISPPA), University of Padova, 35131 Padova, Italy; (I.T.); (S.P.)
- Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | | | - Dafni Kapelis
- Palliative Care Department, ULSS n. 8 Asolo, 31011 Treviso, Italy;
| | - Sara Pompele
- Department of Philosophy, Sociology, Pedagogy and Applied psychology (FISPPA), University of Padova, 35131 Padova, Italy; (I.T.); (S.P.)
| | | | - Robert Crupi
- NewYork-Presbyterian Queens, New York, NY 11355, USA;
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17
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The COMFORT Communication Model: A Nursing Resource to Advance Health Literacy in Organizations. J Hosp Palliat Nurs 2020; 22:229-237. [PMID: 32282558 DOI: 10.1097/njh.0000000000000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COMFORT Model has recently been revised based on feedback from bedside nurses working in palliative care and oncology and includes the following components: Connect, Options, Making Meaning, Family Caregiver, Openings, Relating, and Team. Based on clinical and nonclinical research in hospital, hospice, palliative care, and interdisciplinary education settings, the authors present the updated COMFORT Model. Originally introduced in 2012 to support the work of the nurse, the model is not a linear guide, an algorithm, a protocol, or a rubric for sequential implementation by nurses, but rather a set of communication principles that are practiced concurrently and reflectively during patient/family care. In its restructuring, we focus on the role of health literacy throughout the COMFORT components in relationship to the health literacy attributes of a health care organization. A brief summary of COMFORT components is provided and includes strategies and competencies contributing to a health-literate care organization. Both health literacy and COMFORT are explored using specific communication challenges that underscore the role of the nurse in accomplishing person-centered and culturally responsive care, especially in chronic and terminal illness. The integration of the COMFORT Model into nursing education is proposed.
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18
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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19
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Hov R, Bjørsland B, Kjøs BØ, Wilde-Larsson B. A sense of security in palliative homecare in a Norwegian municipality; dyadic comparisons of the perceptions of patients and relatives - a quantitative study. BMC Palliat Care 2020; 19:7. [PMID: 31926557 PMCID: PMC6954541 DOI: 10.1186/s12904-020-0513-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/07/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND As palliative care increasingly takes place in patients' homes, perceptions of security among patients in the late palliative phase and their relatives are important. AIM To describe and compare patient-relative dyads regarding their perceptions of security in palliative homecare, including the perceived security of the actual care given to the patients, as well as the subjective importance of that care. METHODS A cross sectional questionnaire study including 32 patient-relative dyads was conducted in an urban municipality in Norway. Patients were in a late palliative phase and received palliative homecare. Each patient proposed one relative. Data were collected using a modified version of the Quality from the Patients' Perspective instrument (QPP), which focuses on security and comprises three dimensions: medical-technical competence, identity-orientation approach and physical-technical conditions. Context-specific scales containing four aspects (competence, continuity, coordination/cooperation, availability) were added. The instrument contains two response scales; perceived reality (PR) and subjective importance (SI). Data were analysed by descriptive statistics, Chi-squared test, T-test and Wilcoxon's signed rank test. RESULTS Patients had high mean scores on the PR-scale for the sense of security in palliative homecare in the dimensions of medical-technical competence and physical-technical conditions. There were three low mean scores on the PR-scale: the aspect of continuity from patients and the aspects of continuity and coordination/cooperation from relatives. The patients scored the SI scale statistically significantly higher than the PR scale in the identity-orientation approach dimension and in the aspect of continuity, while relatives did so in all dimensions and aspects. The intra-dyadic patient-relative comparisons show statistically significant lower scores from relatives on the PR-scale in the dimensions of medical-technical competence, physical-technical conditions, identity-orientation approach and the aspect coordination/cooperation. CONCLUSIONS There are several statistically significant differences between patients and relatives' perceptions of security in the palliative homecare received (PR) compared with the subjective importance of the care (SI) and statistically significant differences in the patient-relative dyads in PR. A relatively mutual sense of security in palliative homecare is important for patient-relative dyads, as relatives often provide care and act as patients' spokespersons. What they assess as important can guide the development of palliative homecare.
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Affiliation(s)
- Reidun Hov
- Department of Nursing, Inland Norway University of Applied Sciences, Elverum, Norway. .,Centre for Development of Institutional and Home Care Services, Hamar Municipality, Hedmark, Norway.
| | - Bente Bjørsland
- Department of Nursing, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Bente Ødegård Kjøs
- Centre for Development of Institutional and Home Care Services, Hamar Municipality, Hedmark, Norway
| | - Bodil Wilde-Larsson
- Department of Nursing, Inland Norway University of Applied Sciences, Elverum, Norway.,Department of Health Science, Discipline of Nursing Science, Karlstad University, Karlstad, Sweden
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20
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Newman AR, Linder L, Haglund K. The Nurse's Role in Prognosis-Related Communication in Pediatric Oncology Nursing Practice. J Pediatr Oncol Nurs 2019; 37:313-320. [PMID: 31833447 DOI: 10.1177/1043454219891989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses' operational definition of PRC, (2) nurses' roles in PRC, and (3) nurses' preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.
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Affiliation(s)
- Amy R Newman
- Marquette University, Milwaukee, WI, USA.,Children's Hospital of Wisconsin, Wauwatosa, WI, USA
| | - Lauri Linder
- University of Utah, Salt Lake City, UT, USA.,Primary Children's Medical Center, Salt Lake City, UT, USA
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21
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Liu Y, Yang J, Song L, Yang X, Yin Y, Yan L. Nurses' experiences and attitudes toward diagnosis disclosure for cancer patients in China: A qualitative study. Psychooncology 2019; 28:2415-2421. [PMID: 31702852 DOI: 10.1002/pon.5273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To qualitatively investigate and explore oncology nurses' perceptions of cancer diagnosis disclosure (CDD) for cancer patients. METHODS Purposive sampling led to the inclusion of 25 nurses with diverse characteristics from four inpatient oncology nursing wards in two tertiary hospitals. Semistructured, one-on-one, in-depth interviews were conducted. Colaizzi's analysis method was performed with NVivo software to develop categories and themes. RESULTS Four themes were identified: (a) impact of CDD, including advantages and disadvantages for patients and nurse distress; (b) barriers to CDD, including requests from family members, patients themselves, and communication skills; (c) strategies for CDD, including communication with family members, physician-nurse collaboration, and patient education; and (d) nurses' roles in CDD, including active participants and promoters and advocates. CONCLUSIONS More channels of information and education on cancer, cancer diagnosis, life, and death will be needed in the future. Nurses should actively participate in cancer diagnosis delivery, and more collaboration between nurses and physicians must occur.
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Affiliation(s)
- Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Jinhong Yang
- Oncology Department, Weifang People's Hospital, Weifang, China
| | - Lei Song
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yanling Yin
- School of Nursing, Weifang Medical University, Weifang, China
| | - Liping Yan
- Hospital Administration Office, Weifang People's Hospital, Weifang, China
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22
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Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication. PLoS One 2019; 14:e0224394. [PMID: 31661529 PMCID: PMC6818780 DOI: 10.1371/journal.pone.0224394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.
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Affiliation(s)
- Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Rehabilitation Clinic, Ente Ospedaliero Cantonale, Novaggio, Switzerland
- Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Julia Amann
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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23
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Shepherd-Banigan M, Kaufman BG, Decosimo K, Dadolf J, Boucher NA, Mahanna EP, Bruening R, Sullivan C, Wang V, Hastings SN, Allen KD, Sperber N, Coffman CJ, Van Houtven CH. Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention. J Nurs Scholarsh 2019; 52:23-33. [PMID: 31497935 DOI: 10.1111/jnu.12511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FIVES). DESIGN Prior to implementation in eight sites, a multidisciplinary study team made systematic adaptations to the curriculum content and delivery process using input from the original randomized controlled trial (RCT); a stakeholder advisory board comprised of national experts in caregiver education, nursing, and implementation; and a veteran/caregiver engagement panel. To address site-specific implementation barriers in diverse settings, we applied the Replicating Effective Programs implementation framework. FINDINGS Adaptations to HI-FIVES content and delivery included identifying core/noncore curriculum components, reducing instruction time, and simplifying caregiver recruitment for clinical settings. To enhance curriculum flexibility and potential uptake, site personnel were able to choose which staff would deliver the intervention and whether to offer class sessions in person or remotely. Curriculum materials were standardized and packaged to reduce the time required for implementation and to promote fidelity to the intervention. CONCLUSIONS The emphasis on flexible intervention delivery and standardized materials has been identified as strengths of the adaptation process. Two key challenges have been identifying feasible impact measures and reaching eligible caregivers for intervention recruitment. CLINICAL RELEVANCE This systematic implementation process can be used to rapidly adapt an intervention to diverse clinical sites and contexts. Nursing professionals play a significant role in educating and supporting caregivers and care recipients and can take a leading role to implement interventions that address skills and unmet needs for caregivers.
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Affiliation(s)
- Megan Shepherd-Banigan
- Research Health Scientist, Durham VA Health Care System, and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Brystana G Kaufman
- Postdoctoral Research Fellow, Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kasey Decosimo
- Research Health Scientist Specialist, Durham VA Health Care System, Durham, NC, USA
| | - Joshua Dadolf
- Clinical Social Worker/Intervention Specialist, Durham VA Health Care System, Durham, NC, USA
| | - Nathan A Boucher
- Research Health Scientist, Durham VA Health Care System, and Assistant Research Professor, Sanford School of Public Policy, Duke University, Durham, NC, USA.,Core Faculty, Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Elizabeth P Mahanna
- Research Health Scientist Specialist, Durham VA Health Care System, Durham, NC, USA
| | - Rebecca Bruening
- Research Health Scientist Specialist, Durham VA Health Care System, Durham, NC, USA
| | - Caitlin Sullivan
- Research Health Scientist Specialist, Durham VA Health Care System, Durham, NC, USA
| | - Virginia Wang
- Research Health Scientist, Durham VA Health Care System, and Associate Professor, Department of Population Health Sciences, Duke University, and Associate Professor, Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - S Nicole Hastings
- Research Health Scientist, Durham VA Health Care System, and Associate Professor, Division of Geriatrics, Department of Medicine, Duke University, and Associate Professor, Department of Population Health Sciences, Duke University, and Senior Fellow, Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
| | - Kelli D Allen
- Research Health Scientist, Durham VA Health Care System, Durham, NC, and Professor, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nina Sperber
- Research Health Scientist, Durham VA Health Care System, and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Cynthia J Coffman
- Research Health Scientist, Durham VA Health Care System, and Associate Professor, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Courtney H Van Houtven
- Core Faculty, Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Research Health Scientist, Durham VA Health Care System, and Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA
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Maranna S. Educating sonographers in attributes of “breaking bad news” to foster positive emotional well‐being. SONOGRAPHY 2019. [DOI: 10.1002/sono.12188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sandhya Maranna
- School of Health SciencesUniversity of South Australia Adelaide Australia
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25
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Donnelly F, Feo R, Jangland E, Muntlin Athlin Å. The management of patients with acute abdominal pain in the emergency department: A qualitative study of nurse perceptions. Australas Emerg Care 2019; 22:97-102. [PMID: 31056349 DOI: 10.1016/j.auec.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute abdominal pain is a common reason for presentation to the emergency department. Understanding the role of nurses involved in management of acute abdominal pain is important for improving patient care and outcomes. The aim of this study was to understand the perceptions of emergency nurses in the management of acute abdominal pain. METHODS Using a qualitative design, a purposeful sample (n=9) of experienced registered nurses was recruited from the emergency department of a large tertiary public hospital in South Australia. Semi-structured interviews, informed by literature describing the management of acute abdominal pain, were used to identify the perceptions of emergency nurses when caring for patients with acute abdominal pain. RESULTS Thematic analysis of interviews identified four themes: Centrality of Diagnosis; Busyness and Patient Management; Systems Issues; and Communication Challenges. Of the four themes, the Centrality of Diagnosis was especially important to the nurses' sense of contribution to patient care. Care was also affected by the busyness of the environment, the systems and processes in place to manage patients and communication in the emergency department. CONCLUSIONS The management of patients with acute abdominal pain is influenced by how nurses participate in the diagnostic process. Nurses identified their role in this process and described how this role impacted their delivery of fundamental care. Further studies of the nursing contribution to diagnosis, communication, and the systems that affect care delivery in the emergency department are required.
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Affiliation(s)
- Frank Donnelly
- Adelaide Nursing School, Faculty of Health and Medical Sciences, Level 4, Adelaide Health & Medical Sciences Building, Cnr North Terrace & George Street, Adelaide, SA 5005, Australia.
| | - Rebecca Feo
- College of Nursing & Health Sciences, Flinders University,Sturt Road, Bedford Park, South Australia 5042, GPO Box 2100, Adelaide, SA 5001, Australia.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
| | - Åsa Muntlin Athlin
- Adelaide Nursing School, Faculty of Health and Medical Sciences, Level 4, Adelaide Health & Medical Sciences Building, Cnr North Terrace & George Street, Adelaide, SA 5005, Australia; Department of Emergency Care and Internal Medicine, Entrance 40, Level 3 (contact address: 5th floor), Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Sweden.
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26
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Adamson M, Cotoc C, Choi K, Notaro S. Cancer Communication Outside of the Physician-Patient Relationship: The Experience of Communicating and Understanding the Meaning of Prognosis. Am J Hosp Palliat Care 2019; 36:711-717. [PMID: 30818959 DOI: 10.1177/1049909119832811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RESEARCH QUESTION How does the process of engagement and integration of sources of information outside patient-physician interaction affect how individuals with cancer interpret their treatment experience and prognosis? BACKGROUND Studies of patient-physician communication of prognosis in oncology highlight areas where misunderstanding occurs: understanding consequences of treatment, likelihood of treatment success, probability of cure, status/progression of illness, and prognosis. Theories proposing mechanisms that underlie this discrepancy cannot account for all instances of misunderstanding, including when complete and direct physician disclosure occurs. Prior research focused on patient-physician communication event(s) and immediate antecedents and consequences. However, less is known about what happens to information once it has been communicated and how a patient's process to interpret the meaning of their experience affects their understanding of it. Our study explores this question by examining patient communication with sources of information other than treating physicians. METHODOLOGY We conducted 10 semi-structured qualitative interviews with individuals diagnosed with 4 types of cancer at different stages. The interviews were analyzed using inductive qualitative analysis. RESULTS Participants in our sample consulted a variety of additional sources to give context and understanding to their communicated prognosis. These were important contributors to how they understood their prognosis and incorporated that understanding. They included family, friends/acquaintances, cancer survivors, support/survivor groups, secondary health-care staff, and relevant informational materials. Different motivations for seeking out these sources were also expressed. Participants expressed a link between their understanding of their prognosis and the variety of outside sources they enlisted for input and support.
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Affiliation(s)
- Matthew Adamson
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Crina Cotoc
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kelsey Choi
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stephen Notaro
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Dobrozsi S, Tomlinson K, Chan S, Belongia M, Herda C, Maloney K, Long C, Vertz L, Bingen K. Education Milestones for Newly Diagnosed Pediatric, Adolescent, and Young Adult Cancer Patients: A Quality Improvement Initiative. J Pediatr Oncol Nurs 2019; 36:103-118. [PMID: 30600752 DOI: 10.1177/1043454218820906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The diagnosis of cancer in a child, adolescent, or young adult is an emotionally overwhelming time. To improve the quality of education and support provided to patients and caregivers with a new cancer diagnosis, we executed a quality improvement initiative to (a) define key education milestones for the delivery of essential education during the first 2 months following diagnosis and (b) to define role accountability within the multidisciplinary team for delivery of content and execution of tasks. To develop education milestones, we (a) identified educational content from review of the literature, (b) determined the sequence of content delivery through qualitative interviews with patients and caregivers, and (c) developed education milestones by evaluation of existing workflows. To develop task lists, we (a) determined which multidisciplinary team member was best suited to deliver specific content and (b) defined discrete tasks required to execute education milestones. Key content topics and preferred sequence are as follows: Emotional Adjustment to Diagnosis, When and How to Call the Doctor, Medication Management, Practical Needs, Line Care, and Access to Nontherapeutic Clinical Trials. Eight education milestones were defined across the initial 2 months following cancer diagnosis. The education milestones are paired with task lists. The education milestones and task lists guide the execution of complex education across a multidisciplinary service line in an emotionally challenging time. Early information focuses on essential content, role responsibility is clearly defined, and psychosocial support services are purposefully and iteratively integrated into care during the initial weeks following a cancer diagnosis.
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Affiliation(s)
| | | | | | | | - Carolyn Herda
- 2 Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | | | - Catherine Long
- 3 Prevea Health/St. Vincent's Hospital, Green Bay, WI, USA
| | - Lori Vertz
- 3 Prevea Health/St. Vincent's Hospital, Green Bay, WI, USA
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Newman AR, Haglund K, Rodgers CC. Pediatric oncology nurses' perceptions of prognosis-related communication. Nurs Outlook 2019; 67:101-114. [PMID: 30527513 PMCID: PMC6538266 DOI: 10.1016/j.outlook.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. PURPOSE Provide an exploration of pediatric oncology nurses' experiences with prognosis-related communication (PRC). METHOD Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. FINDINGS Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. DISCUSSION Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations.
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Affiliation(s)
- Amy R Newman
- Marquette University Milwaukee, WI; College of Nursing, University of Utah, Salt Lake City, UT; Department of Pediatrics-Hematology/Oncology/Transplant, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Cheryl C Rodgers
- Duke University School of Nursing, Durham, NC (published posthumously: DOD July 7, 2018)
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Wittenberg E, Reb A, Kanter E. Communicating with Patients and Families Around Difficult Topics in Cancer Care Using the COMFORT Communication Curriculum. Semin Oncol Nurs 2018; 34:264-273. [PMID: 30100368 DOI: 10.1016/j.soncn.2018.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To examine nurse communication in cancer care and offer communication strategies for quality palliative care nursing. DATA SOURCES Communication strategies offered are based on the COMFORT Communication curriculum, an evidence-based communication training program. CONCLUSION Whole-patient assessment, a major component of palliative care, involves communication that includes eliciting the patient's story, addressing health literacy needs, being mindful of burnout, and relating to the patient and family. IMPLICATIONS FOR NURSING PRACTICE Quality communication skills are essential to oncology nursing, especially given their vital role in cancer care.
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Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential. J Pediatr Nurs 2018; 40:63-73. [PMID: 29776481 DOI: 10.1016/j.pedn.2018.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 12/16/2022]
Abstract
THEORETICAL PRINCIPLES Pediatric oncology nurses are particularly vulnerable to emotional distress. Responsible for the oversight of a child's care, these nurses sustain close interactions with multiple patients and families over time, many of whom are coping with life-limiting diagnoses. The world of pediatric oncology nurses is one where tragedy is routinely witnessed thus demanding self-care and healing across a continuum. PHENOMENON ADDRESSED The aim of this article is to outline and review the emotional sequelae of pediatric oncology nurses' work and to suggest interventions to support well-being in light of prolonged caregiving. Three major categories that are addressed include the aspects of clinical practice that influence caregiving, the risks of burnout, compassion fatigue, moral distress and grief, and interventions to counteract these phenomena. RESEARCH LINKAGES Future-nursing research should focus upon the development of validated, psychometrically sound measurement tools to assess nurse-specific variants of burnout, compassion fatigue, moral distress, and nurse grief. Qualitative research should investigate the relationship between personal variables, workplace and team characteristics, age and experience, and their influence on the predominance of burnout, compassion fatigue, moral distress, and nurse grief. Lastly, the phenomena of resiliency demands further study.
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Coad J, Smith J, Pontin D, Gibson F. Consult, Negotiate, and Involve: Evaluation of an Advanced Communication Skills Program for Health Care Professionals. J Pediatr Oncol Nurs 2018; 35:296-307. [DOI: 10.1177/1043454218765136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Effective communication is central to children, young people, and their families’ experiences of health care. Most patient complaints in developed health care systems result from ineffective communication, including inadequate information provision, not feeling listened to, failure to value patients concerns, and patients not feeling involved in care decisions. Advanced communication skills training is now embedded within cancer care policy in the United Kingdom and now features prominently within cancer education in many countries. Here, we share findings from a research evaluation of an advanced communication skills training program dedicated to health professionals caring for children and young people with cancer. We evaluated participants’ (n = 59) perceptions of the program, impact on their skills, knowledge, competence, and confidence. An appreciative inquiry design was adopted; data included interviews, precourse-postcourse evaluations, e-mail blog survey, and 360-degree reflective work records. The framework approach underpinned data analysis and triangulation of data sets. Key findings highlighted good and poor practice in health professionals’ engagement with children, young people, and their families; the purpose of communicating effectively was not always consistent with collaborative working. Attending a program helped participants expand their knowledge of communication theories and strategies. Participants valued using simulated scenarios to develop their skills and were keen to use their new skills to enhance care delivery. Our emphasis within this evaluation, however, remained on what was communicated, when and how, rather than to what effect. The impact of programs such as these must now be evaluated in terms of patient benefit.
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Gleason KT, Davidson PM, Tanner EK, Baptiste D, Rushton C, Day J, Sawyer M, Baker D, Paine L, Himmelfarb CRD, Newman-Toker DE. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractNurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.
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Palliative Care Communication in the ICU: Implications for an Oncology-Critical Care Nursing Partnership. Semin Oncol Nurs 2017; 33:544-554. [PMID: 29107532 DOI: 10.1016/j.soncn.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the development, launch, implementation, and outcomes of a unique multisite collaborative (ie, IMPACT-ICU [Integrating Multidisciplinary Palliative Care into the ICU]) to teach ICU nurses communication skills specific to palliative care. To identify options for collaboration between oncology and critical care nurses when integrating palliation into nursing care planning. DATA SOURCES Published literature and collective experiences of the authors in the provision of onco-critical-palliative care. CONCLUSION While critical care nurses were the initial focus of education, oncology, telemetry, step-down, and medical-surgical nurses within five university medical centers subsequently participated in this learning collaborative. Participants reported enhanced confidence in communicating with patients, families, and physicians, offering emotional support and involvement in family meetings. IMPLICATIONS FOR NURSING PRACTICE Communication education is a vital yet missing element of undergraduate nursing education. Programs should be offered in the work setting to address this gap in needed nurse competency, particularly within the context of onco-critical-palliative care.
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