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Foley G, McCauley R, McQuillan R, Ryan K. How do Patients With Advanced Cancer and Family Caregivers Accommodate One Another in Decision-Making? Findings From a Qualitative Study in Specialist Palliative Care. Am J Hosp Palliat Care 2024:10499091241255117. [PMID: 38756049 DOI: 10.1177/10499091241255117] [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: 05/18/2024] Open
Abstract
BACKGROUND Patients with advanced cancer commonly involve family caregivers in decision-making for palliative care. However, how patients with advanced cancer and family caregivers accommodate each other in decision-making is unclear. METHODS A qualitative study in advanced cancer was conducted with 14 patients and 19 family caregivers recruited from two hospices comprising a large regional specialist palliative care service in Ireland. Data comprised semi-structured interviews with participants. The data were analyzed using grounded theory coding procedures. RESULTS Most patients preferred to make care decisions with their family caregiver or at least involve their family caregiver in care discussions. Patients engaged in shared decision-making because they felt they benefited from caregiver support. Patients accommodated family caregiver preferences out of concern for that person and because they trusted them. Family caregivers accommodated patient preferences because they wanted to honor the patient's wishes and felt a responsibility to protect patient autonomy when they had a close relationship with the patient. Prior conflict between the patient and family caregiver was a barrier to mutual accommodation. Although concealment was used as a mechanism to support accommodation between the patient and family caregiver, both sought to communicate openly with other family members to negate potential conflict between each other and the wider family. CONCLUSION Patients with advanced cancer and family caregivers in specialist palliative care support one another by accommodating each other's preferences for patient care. Patients with advanced cancer and family caregivers accommodate one another in decision-making out of a sense of responsibility to one another.
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Affiliation(s)
- Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Regina McQuillan
- Department of Palliative Medicine, St. Francis Hospice, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karen Ryan
- Department of Palliative Medicine, St. Francis Hospice, Dublin, Ireland
- Department of Palliative Care, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
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2
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Barata A, Dhawale T, Newcomb RA, Amonoo HL, Nelson AM, Yang D, Karpinski K, Holmbeck K, Farnam E, Frigault M, Johnson PC, El-Jawahri A. Quality of Life and Prognostic Awareness in Caregivers of Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:452.e1-452.e11. [PMID: 38242441 DOI: 10.1016/j.jtct.2024.01.063] [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: 10/18/2023] [Revised: 12/19/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
Caregivers of patients undergoing chimeric antigen receptor T cell therapy (CAR-T) play a critical role during treatment, yet their experience remains largely unaddressed. We aimed to longitudinally describe quality of life (QoL) and psychological distress, as well as prognostic awareness, in caregivers and explore the association of prognosis awareness with baseline psychological distress. We conducted a longitudinal study of caregivers of patients undergoing CAR-T and examined QoL (CAReGiverOncology QoL questionnaire) and psychological distress (Hospital Anxiety and Depression Scale) prior to CAR-T (baseline) and at days 7, 30, 90, and 180 post-CAR-T. At baseline, caregivers and patients completed the Prognostic Awareness Impact Scale, which examines cognitive understanding of prognosis, emotional coping with prognosis, and adaptive response (ie, capacity to use prognostic awareness to inform life decisions). We enrolled 58% (69 of 120) of eligible caregivers. Caregivers reported QoL impairments that did not change over time (B = 0.09; P = .452). The rates of clinically significant depression and anxiety symptoms were 47.7% and 20.0%, respectively, at baseline, and 39.1% and 17.4% at 180 days. One-third (32%) of the caregivers and patients reported that their oncologist said the cancer is curable. Caregivers' greater emotional coping with prognosis was associated with fewer symptoms of anxiety (B = -.17; P < .001) and depression (B = -.02; P < .001). Cognitive understanding of prognosis and adaptive response were not associated with psychological distress. Caregivers reported QoL impairments throughout the study period. A substantial proportion of caregivers experienced psychological distress and reported misperceptions about the prognosis, highlighting the need for supportive care interventions.
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Affiliation(s)
- Anna Barata
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Tejaswini Dhawale
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ashley M Nelson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel Yang
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Karpinski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine Holmbeck
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Emelia Farnam
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Matt Frigault
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
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3
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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4
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O’Donnell EK, Shapiro YN, Yee AJ, Nadeem O, Laubach JP, Branagan AR, Anderson KC, Mo CC, Munshi NC, Ghobrial IM, Sperling AS, Agyemang EA, Burke JN, Harrington CC, Hu BY, Richardson PG, Raje NS, El-Jawahri A. Quality of life, psychological distress, and prognostic perceptions in caregivers of patients with multiple myeloma. Blood Adv 2022; 6:4967-4974. [PMID: 35848842 PMCID: PMC9631626 DOI: 10.1182/bloodadvances.2022007127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022] Open
Abstract
Although caregivers of patients with multiple myeloma (MM) play a critical role in supporting their loved ones throughout the illness course, studies examining caregiver quality of life (QOL), psychological distress, and prognostic awareness are lacking. We conducted a cross-sectional, multisite study of patients undergoing treatment with MM and their caregivers. Eligible caregivers were enrolled to 1 of 3 cohorts based on lines of therapy. Caregivers completed validated questionnaires to assess their QOL, psychological distress, and perceptions of prognosis. We enrolled 127 caregivers of patients with MM (newly diagnosed [n = 43], 2-3 lines of therapy [n = 40], and ≥4 lines of therapy [n = 44]). Caregiver QOL and psychological distress did not differ by line of therapy. The rate of clinically significant anxiety, depression, and posttraumatic stress disorder symptoms were 44.1% (56/127), 15.8% (20/127), and 24.4% (31/127), respectively. When examined in dyads, caregivers reported higher rates of clinically significant anxiety (44.4% [55/124] vs 22.5% [28/124]) compared with patients with MM. Most caregivers (84.2%, 101/120) reported that the oncologist had informed them that the patient's cancer was incurable; however, only 50.9% (58/114) and 53.6% (59/110) of caregivers acknowledged the patient's cancer was terminal and incurable, respectively. Caregivers of patients undergoing treatment for MM experience substantial psychological distress across the disease continuum, particularly anxiety. The majority of caregivers of patients with MM report that knowing the patient's prognosis is extremely important and report that the oncologist told them that the patient was incurable. Nevertheless, a significant portion of caregivers believe that the patient's MM is curable.
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Affiliation(s)
- Elizabeth K. O’Donnell
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Andrew J. Yee
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General/North Shore Cancer Center, Danvers, MA
| | - Omar Nadeem
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Jacob P. Laubach
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Andrew R. Branagan
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kenneth C. Anderson
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Clifton C. Mo
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Nikhil C. Munshi
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Irene M. Ghobrial
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Adam S. Sperling
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
- Brigham and Women’s Hospital, Boston, MA
| | | | - Jill N. Burke
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Bonnie Y. Hu
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Paul G. Richardson
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA; and
| | - Noopur S. Raje
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
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5
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van Oosterhout SPC, Ermers DJM, Ploos van Amstel FK, van Herpen CML, Schoon Y, Perry M, van Geel M, Kuip EJM, Engels Y. Experiences of bereaved family caregivers with shared decision making in palliative cancer treatment: a qualitative interview study. BMC Palliat Care 2021; 20:137. [PMID: 34493262 PMCID: PMC8423331 DOI: 10.1186/s12904-021-00833-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with incurable cancer face complex medical decisions. Their family caregivers play a prominent role in shared decision making processes, but we lack insights into their experiences. In this study, we explored how bereaved family caregivers experienced the shared decision making process. Methods We performed a qualitative interview study with in-depth interviews analysed with inductive content analysis. We used a purposive sample of bereaved family caregivers (n = 16) of patients with cancer treated in a tertiary university hospital in the Netherlands. Results Four themes were identified: 1. scenarios of decision making, 2. future death of the patient 3. factors influencing choices when making a treatment decision, and 4. preconditions for the decision making process. Most family caregivers deferred decisions to the patient or physician. Talking about the patient’s future death was not preferred by all family caregivers. All family caregivers reported life prolongation as a significant motivator for treatment, while the quality of life was rarely mentioned. A respectful relationship, close involvement, and open communication with healthcare professionals in the palliative setting were valued by many interviewees. Family caregivers’ experiences and needs seemed to be overlooked during medical encounters. Conclusions Family caregivers of deceased patients with cancer mentioned life prolongation, and not quality of life, as the most important treatment aim. They highly valued interactions with the medical oncologist and being involved in the conversations. We advise medical oncologists to take more effort to involve the family caregiver, and more explicitly address quality of life in the consultations. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00833-z.
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Affiliation(s)
- Sanne P C van Oosterhout
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54 (160), 6525 EP, Nijmegen, The Netherlands.
| | - Daisy J M Ermers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje van Geel
- Department of Process Improvement and Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evelien J M Kuip
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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6
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McCauley R, McQuillan R, Ryan K, Foley G. Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis. Palliat Med 2021; 35:875-885. [PMID: 33794713 PMCID: PMC8114453 DOI: 10.1177/0269216321999962] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients in palliative care are usually conceptualised as recipients of support from family caregivers. Family caregivers in palliative care are typically defined as providers of support to patients. Little is known about reciprocal dimensions of support provision between patients and family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care and factors that contribute to or obstruct mutual support between patients and family caregivers in palliative care. DESIGN Systematic review and narrative synthesis of original peer-reviewed research published between January 2000 and March 2020. DATA SOURCES Medline, CINAHL, Embase, AMED, PsycINFO and PsycARTICLES. RESULTS After full-text screening, 10 studies were included. We identified that patients and family caregivers in palliative care can support one another by mutually acknowledging the challenges they face, by remaining positive for one another and by jointly adapting to their changing roles. However, patients and family caregivers may not routinely communicate their distress to each other or reciprocate in distress disclosure. A lack of mutual disclosure pertaining to distress can result in conflict between patients and family caregivers. CONCLUSIONS Few studies have focused in whole or in part, on reciprocal dimensions of support provision between patients with advancing non-curable conditions, and their family caregivers in palliative care. Further research is required to identify key domains of mutual support between patients and family caregivers in palliative care.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland.,Royal College of Surgeons of Ireland, Dublin, Ireland.,Beaumont Hospital Dublin, Dublin, Ireland
| | - Karen Ryan
- University College Dublin, Dublin, Ireland.,Mater Hospital Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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7
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Rodi H, Detering K, Sellars M, Macleod A, Todd J, Fullerton S, Waller A, Nolte L. Exploring advance care planning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study. Support Care Cancer 2020; 29:3677-3688. [DOI: 10.1007/s00520-020-05878-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023]
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8
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Gray TF, Forst D, Nipp RD, Greer JA, Temel JS, El-Jawahri A. Prognostic Awareness in Caregivers of Patients with Incurable Cancer. J Palliat Med 2020; 24:561-569. [PMID: 32996821 DOI: 10.1089/jpm.2020.0236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Little is known about how patients with incurable cancer and caregivers differ in their prognostic awareness, and the relationship between caregiver prognostic awareness and their psychological distress. Objective: To investigate prognostic awareness in caregivers of patients with incurable cancer and prognostic discordance in patient-caregiver dyads and its association with psychological distress. Design: This is a cross-sectional study. Setting/Subjects: In total, subjects were 390 caregivers of adults with incurable lung, gastrointestinal, and brain cancers at a cancer center in the northeastern United States. Measurements: The Prognosis and Treatment Perceptions Questionnaire was used to assess prognostic awareness and Hospital Anxiety and Depression Scale to assess psychological distress. Results: In total, 39.7% (n = 147/370) and 17.3% (n = 64/370) caregivers reported clinically significant anxiety and depression symptoms. And 53.7% of caregivers reported the patients' cancer as "curable" and 44.1% reported the cancer was "not terminal." Caregivers' report of curability was not associated with their anxiety (odds ratio [OR] = 0.99, p = 0.93) or depression (OR = 1.05, p = 0.32) symptoms. Among 42.5% (124/292) and 26.0% (76/292) of dyads (n = 292), both patients and their caregivers agreed in their perception of the cancer as curable and incurable, respectively. In 19.9% of dyads (n = 58), patients reported their cancer as curable, while their caregivers reported it as incurable. In 11.6% of dyads (n = 34), patients reported the cancer as incurable while caregivers reported it as curable. Conclusions: More than half of caregivers have misperceptions about the patients' likelihood of cure, and one-third of patient-caregiver dyads have discordant perceptions. Supportive care interventions may facilitate conversations and enhance prognostic understanding in patients with incurable cancer and their caregivers.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah Forst
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Joseph A Greer
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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9
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Experiences of spouses of patients with cancer from the notification of palliative chemotherapy discontinuation to bereavement: A qualitative study. Eur J Oncol Nurs 2020; 45:101721. [PMID: 32065935 DOI: 10.1016/j.ejon.2020.101721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/04/2019] [Accepted: 01/13/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Many patients with advanced cancer choose palliative chemotherapy. Considering its purpose of palliation and not treatment, it is important to consider the life of family caregivers. Family caregivers who experience bereavement undergo extreme stress, which is particularly high among patients' spouses. The present study aims to clarify the experiences of the spouses of patients at the hospitals in Japan after the notification of palliative chemotherapy discontinuation until bereavement. METHOD We interviewed the spouses of 13 patients who received palliative chemotherapy using a semistructured interview guide. Each spouse was interviewed twice. The interviews were transcribed verbatim, and key concepts were identified using a grounded theory analytic approach. RESULTS After the hospital's recommendation for palliative chemotherapy discontinuation, the spouses had "bewilderment over having to discontinue palliative chemotherapy" and experienced "difficulty in facing bereavement." The spouses having "difficulty to give up hope for the patient's survival," felt "bafflement over caregiving at the terminal stage," which would be their responsibility in the future. Further, they had "hesitation in being honest to the patient" and were engaged in "knowing how to live with the patient until bereavement." CONCLUSION Nurses need to encourage the patients and spouses to honestly express how they feel from the early stages of palliative chemotherapy. Furthermore, nurses should help spouses with how they face bereavement. This result may help prevent anticipatory grief, which may lead to excessive stress and emotional distress on the family caregivers.
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10
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11
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Aminaie N, Mirlashari J, Lehto RH, Lashkari M, Negarandeh R. Iranian Cancer Patients Perceptions of Barriers to Participation in Decision-Making: Potential Impact on Patient-Centered Care. Asia Pac J Oncol Nurs 2019; 6:372-380. [PMID: 31572757 PMCID: PMC6696813 DOI: 10.4103/apjon.apjon_11_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care. Methods: Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients. Results: Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities’ limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs). Conclusions: Barriers may impact the perceived ability of Iranian patients’ with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.
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Affiliation(s)
- Naism Aminaie
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Mirlashari
- Department of Pediatric and Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Obstetric and Gynecology Department, University of British Colombia, Canada
| | - Rebecca H Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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12
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Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care. J Adv Nurs 2019; 75:2059-2071. [PMID: 30734354 DOI: 10.1111/jan.13970] [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: 08/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers. BACKGROUND Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. DESIGN Qualitative metasynthesis. DATA SOURCES Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. REVIEW METHODS Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. RESULTS The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. CONCLUSION Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
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Bollig G, Brandt F, Ciurlionis M, Knopf B. Last Aid Course. An Education For All Citizens and an Ingredient of Compassionate Communities. Healthcare (Basel) 2019; 7:healthcare7010019. [PMID: 30696095 PMCID: PMC6473377 DOI: 10.3390/healthcare7010019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022] Open
Abstract
Due to demographic changes, the need for palliative care in the community and at home is expected to rise in the coming years. The care that is given by family members and general practitioners plays a vital role in basic palliative care. Knowledge in palliative care is very limited or totally absent in most communities, and information about the effects of educational procedures in teaching non-professionals in basic palliative care is sparse. In the Last Aid course, the public knowledge approach and the initial experiences from the implementation process are described. In addition, a review of the literature on educational efforts regarding palliative care for non-professionals and the existing literature on Last Aid courses is provided. An international working group has established a curriculum for Last Aid courses based on four teaching hours (45 minutes each). The feasibility of Last Aid courses for the public has been tested in pilot courses. The experiences with Last Aid courses in different countries are overall very positive. Last Aid courses are well-attended. The evaluation of questionnaires in a German pilot study has shown a favorable response. Last Aid courses may form the educational basis of compassionate communities, and are well-suited to inform the public about palliative care and end-of-life care.
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Affiliation(s)
- Georg Bollig
- Palliative Care Team, Medical Department Sønderborg/Tønder, South Jutland Hospital, 6400 Sønderborg, Denmark.
- Medical Research Unit, Institute of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark.
- Last Aid International, 24837 Schleswig, Germany.
| | - Frans Brandt
- Palliative Care Team, Medical Department Sønderborg/Tønder, South Jutland Hospital, 6400 Sønderborg, Denmark.
- Medical Research Unit, Institute of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark.
| | | | - Boris Knopf
- Last Aid International, 24837 Schleswig, Germany.
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Kim K, Heinze K, Xu J, Kurtz M, Park H, Foradori M, Nolan MT. Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography. West J Nurs Res 2018; 40:1861-1884. [PMID: 28816094 PMCID: PMC6474239 DOI: 10.1177/0193945917723010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.
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Affiliation(s)
| | | | - Jiayun Xu
- University of Utah, Salt Lake City, USA
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Douglas SL, Lipson AR, Daly BJ. Analyzing Goals of Care in Advanced Cancer Patients and Their Family Caregivers: Evidence-based Research. ACTA ACUST UNITED AC 2018; 2. [PMID: 30467555 PMCID: PMC6245603 DOI: 10.32648/2577-9516/2/1/003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The study objective was to determine concordance between patients and family caregivers' preferences for quality or length of life over time. Background Patients with advanced cancer are confronted with difficult decisions throughout their course of treatment and at end of life (EOL). These decisions can be influenced by their family caregivers' preferences for the patient's cancer treatment. Methods Using a longitudinal, descriptive study design from an on-going study, data were collected on an adult sample of patients with advanced stage GI or lung cancers and their family caregivers (n=237). Using a one item visual analog scale (0-100 with higher number indicating a preference for length of life over quality of life), patients and family caregivers were asked "regarding your/your loved one's care, what is most important to you right now?" Data were collected every 3 months until 15 months or patient's death. Results At enrollment, the preference scores between patients (48.5) and family caregivers (42.6) were closely aligned. At the last assessment prior to death, these scores diverged with the caregivers favoring goals associated with quality of life over length of life (p=.02). Discussion Patients and family caregivers have differing preferences and these goals of care can change over time. Attention to these differences could be used to guide conversations between patients and family caregivers regarding preferences at EOL.
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Affiliation(s)
- Sara L Douglas
- Arline H. & Curtis F. Garvin Professor, FPB School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Amy R Lipson
- Senior Research Associate, FPB School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Barbara J Daly
- The Gertrude Perkins Oliva Professor in Oncology Nursing, FPB School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
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da Silva Barreto M, Garcia-Vivar C, Silva Marcon S. Methodological quality of Grounded Theory research with families living with chronic illness. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Duggleby W, Tycholiz J, Holtslander L, Hudson P, Nekolaichuk C, Mirhosseini M, Parmar J, Chambers T, Alook A, Swindle J. A metasynthesis study of family caregivers' transition experiences caring for community-dwelling persons with advanced cancer at the end of life. Palliat Med 2017; 31:602-616. [PMID: 28618898 DOI: 10.1177/0269216316673548] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Family caregivers (broadly defined as family and friends) experience multiple concurrent transitions when caring for a person with advanced cancer. AIMS To (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience. DESIGN Sandelowski and Barroso's methodology for synthesizing qualitative research included (a) a comprehensive search of empirical literature, (b) quality appraisal of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. DATA SOURCES Literature was sourced from six electronic data bases. Inclusion criteria were as follows: (a) published qualitative studies (and mixed-method designs) of the caregiving experience of family caregivers of community-living persons with advanced cancer at the end of life, (b) participants (caregivers and care recipients) of 18 years of age and above, (c) studies published in English in any country, and (d) studies published between 2004 and 2014. RESULTS A total of 72 studies were included in the metasynthesis. Family caregivers experience a "life transition" whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient. CONCLUSION The findings provide a framework to guide the development of supportive programs and future research.
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Affiliation(s)
- Wendy Duggleby
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jamie Tycholiz
- 2 Strategic Planning and Policy Development, Alberta Health, Edmonton, AB, Canada
| | - Lorraine Holtslander
- 3 College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,4 University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Hudson
- 5 Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,6 The University of Melbourne, Melbourne, VIC, Australia.,7 Palliative Care, Queen's University Belfast, Belfast, UK
| | - Cheryl Nekolaichuk
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Jasneet Parmar
- 9 Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.,10 Network of Excellence in Seniors' Health and Wellness, Covenant Health, Knoxville, TN, USA
| | - Thane Chambers
- 11 University of Alberta Libraries, Edmonton, AB, Canada
| | - Angele Alook
- 12 Alberta Union of Provincial Employees, Edmonton, AB, Canada
| | - Jennifer Swindle
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Yamamoto S, Arao H, Masutani E, Aoki M, Kishino M, Morita T, Shima Y, Kizawa Y, Tsuneto S, Aoyama M, Miyashita M. Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors. J Pain Symptom Manage 2017; 53:862-870. [PMID: 28189769 DOI: 10.1016/j.jpainsymman.2016.12.348] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/21/2016] [Accepted: 12/20/2016] [Indexed: 11/21/2022]
Abstract
CONTEXT Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. OBJECTIVES To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. METHODS This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. RESULTS Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P < 0.001). Multiple regression analyses revealed that higher burden was associated with selecting a place of EOL care that differed from that desired by participants (P < 0.001) and patients (P = 0.034), decision making without knowing the patient's wishes and values (P < 0.001) and without participants sharing their wishes and values with the patient's doctors and/or nurses (P = 0.022), and making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). CONCLUSION Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important.
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Affiliation(s)
- Sena Yamamoto
- Department of Nursing, Social Medical Corporation Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Eiko Masutani
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Miwa Aoki
- Faculty of Nursing, University of Kochi, Kochi, Japan
| | - Megumi Kishino
- Department of Nursing, Kobe University Hospital, Kobe, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Maho Aoyama
- Community Health Nursing, Course of Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Witkamp E, Droger M, Janssens R, van Zuylen L, van der Heide A. How to Deal With Relatives of Patients Dying in the Hospital? Qualitative Content Analysis of Relatives' Experiences. J Pain Symptom Manage 2016; 52:235-42. [PMID: 27090852 DOI: 10.1016/j.jpainsymman.2016.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 01/31/2016] [Accepted: 02/18/2016] [Indexed: 11/21/2022]
Abstract
CONTEXT Hospital care and communication tend to be focused on the individual patient, and decision making is typically based on the principle of individual autonomy. It can be questioned whether this approach is adequate when a patient is terminally ill. OBJECTIVES Our aim was to explore the involvement and experiences of relatives in the hospital during the patient's last phase of life. METHODS This study was embedded in a retrospective questionnaire study on the quality of dying of a consecutive sample of patients who died in a general university hospital in The Netherlands. We performed a secondary qualitative analysis of relatives' comments and answers to open questions. Relatives of 951 deceased adult patients were asked to complete a questionnaire; 451 questionnaires were returned and analyzed for this study. RESULTS Relatives expressed a need for 1) comprehensible, timely, and sensitive information and communication, 2) involvement in decision making, 3) acknowledgment of their position, 4) being able to trust health care staff, and 5) rest and privacy. When relatives felt that their role had sufficiently been acknowledged by health care professionals (HCPs), their experiences were more positive. CONCLUSION Relatives emphasized their relation with the patient and their involvement in care of the patient dying in the hospital. An approach of HCPs to care based on the concept of individual autonomy seems inadequate. The role of relatives might be better addressed by the concept of relational autonomy, which provides HCPs with opportunities to create a relationship with relatives in care that optimally addresses the needs of patients.
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Affiliation(s)
- Erica Witkamp
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Faculty of Nursing and Center of Expertise in Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
| | - Mirjam Droger
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Metamedica, EMGO+, VU Medical Center, Amsterdam, The Netherlands
| | - Rien Janssens
- Department of Metamedica, EMGO+, VU Medical Center, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Van Beek K, Siouta N, Preston N, Hasselaar J, Hughes S, Payne S, Radbruch L, Centeno C, Csikos A, Garralda E, van der Eerden M, Hodiamont F, Radvanyi I, Menten J. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliat Care 2016; 15:26. [PMID: 26940753 PMCID: PMC4778279 DOI: 10.1186/s12904-016-0100-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 12/25/2022] Open
Abstract
Background Palliative Care (PC) aims to improve the quality of life for patients with cancer and their families and its benefits have been demonstrated by several studies. The objective of this systematic review is to assess the integration of PC in the content of guidelines/pathways of adult cancer patients in Europe. Methods We included studies of adult patients with cancer published from 01/01/1995 and 31/12/2013 in Europe in six languages. We searched nine electronic databases, hand-searched six journals and also performed citation tracking. Studies were ranked using Emanuel’s Integrated Palliative Care (IPC) criteria, a tool containing 11 domains to assess PC content in guidelines. Two reviewers screened the results and narrative synthesis has been employed. Results We identified a total of 28,277 potentially relevant articles from which 637 were eligible for full-text screening. The final review included 60 guidelines and 14 pathways. Eighty percent (80 %) of the guidelines/pathways emphasize a holistic approach and 66 % focus on PC interventions aimed at reducing suffering. Fifty seven percent (57 %) did not discuss referral criteria for PC. Of all studies, five fulfilled at least 10/11 IPC criteria. Differences existed with regard to the referral criteria for bereavement care and the continuous adjustment of goals of care. Conclusion Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel’s IPC criteria could serve as benchmarks of IPC.
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Affiliation(s)
- Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Eduardo Garralda
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Marlieke van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Ildiko Radvanyi
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
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Sherman DW, McGuire DB, Free D, Cheon JY. A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 2014; 48:385-99.e1-2. [PMID: 24291294 DOI: 10.1016/j.jpainsymman.2013.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 01/06/2023]
Abstract
CONTEXT Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role. OBJECTIVES To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population. METHODS This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed. RESULTS The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs. CONCLUSION Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the significance of the future study and the need to develop interventions to support family caregivers in their roles.
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Affiliation(s)
| | | | - David Free
- Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York, USA
| | - Joo Young Cheon
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Balance artistry: the healthy parent's role in the family when the other parent is in the palliative phase of cancer--challenges and coping in parenting young children. Palliat Support Care 2013; 12:317-29. [PMID: 24103392 DOI: 10.1017/s1478951513000953] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this review was to provide a systematic overview of knowledge on how advanced cancer in a parent impacts the healthy parent's role in a family with children aged 6-12 years, and the types of help that they require in order to cope. Despite the large number of families living with a parent affected by cancer, the literature is limited concerning the needs and outcomes for the healthy parents and their need for support in managing their children's needs, when the partner is seriously ill or is in the palliative phase of cancer. METHOD Comprehensive literature searches were undertaken by systematically searching for qualitative articles published during the period 1989-2009. The quality assessment was evaluated using a predefined "checklist to assess qualitative research." RESULTS Seven articles met our eligibility criteria. Four distinct themes emerged that describe the healthy parent's role in the family, whose life is now characterized by uncertainty and who is attempting to maintain a balance between the needs of their children, the patient, and themselves: (1) new roles without a script, (2) attempting to maintain a safe and normal life, (3) feeling alone even within the family, and (4) support to help young family members. SIGNIFICANCE OF RESULTS The present review provides new knowledge and insight into how healthy parents manage the challenges in parenting young children, coping with their everyday lives, and taking on new roles when their partner has advanced cancer or is dying. The healthy parent cannot balance the needs of all family members. To reach the goals of palliative care, nurses and other health professionals are encouraged to offer the patient, the healthy parent, and the children practical and emotional support.
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Hogden A, Greenfield D, Nugus P, Kiernan MC. What are the roles of carers in decision-making for amyotrophic lateral sclerosis multidisciplinary care? Patient Prefer Adherence 2013; 7:171-81. [PMID: 23467637 PMCID: PMC3589077 DOI: 10.2147/ppa.s40783] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Family carers of patients with amyotrophic lateral sclerosis (ALS) are presumed to have frequent involvement in decision-making for symptom management and quality of life. To better understand and improve decision-making, we investigated the range and extent of carer participation in decision-making. By focusing on the perspectives of ALS support carers, the study aimed to explore carer participation in decision-making, to identify carer roles, and determine the facilitators and barriers to carer participation in decision-making for ALS multidisciplinary care. PARTICIPANTS AND METHODS An exploratory, in-depth study was conducted with eight carers of ALS patients from two specialized ALS multidisciplinary clinics. Carers participated in semi-structured interviews that were audio recorded and transcribed then coded and analyzed for emergent themes. RESULTS Carers made a significant contribution to ALS decision-making. Their roles were: promoting the patient voice, promoting patient health literacy, and providing emotional support and logistical assistance. Facilitators of carer participation in decision-making were perceived to be: health professional endorsement of patients' decision-making style; access to credible information sources; evidence-based information from the ALS clinic, ALS support association, and health practitioners; supportive relationships with family and friends; spiritual faith; ease of contact with ALS services; and availability of physical and practical support for carers. Barriers to carer participation included: changes to patient communication and cognition; conflict between respect for patients' independence and patients' best interest; communication breakdown between patient, carer, and service providers; the confronting nature of disease information; credibility of Internet sites; carer coping strategies; lack of support for the carer; and the burden of care. CONCLUSION Carers enhance ALS patient-centered care through their participation in decision-making. They collaborate with patients and health professionals to form a decision-making triad within specialized multidisciplinary ALS clinical care. Nevertheless, health professional engagement with carers as collaborative partners is acknowledged to be a significant challenge.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales
- Correspondence: Anne Hogden Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia Tel +61 4 0110 3688 Fax +61 2 9663 4926 Email
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales
| | - Matthew C Kiernan
- Prince of Wales Clinical School, University of New South Wales and Neuroscience Research Australia, Sydney, NSW, Australia
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