Being on the Frontline: Nurses' Experiences Providing End-of-Life Care to Adults With Hematologic Malignancies

Ethical Dilemmas and Coping Experiences of Nurses Caring for Patients With Hematologic Cancer: A Phenomenological Study

The study aimed to evaluate the ethical dilemmas faced by nurses who provide care to patients with hematologic cancer and determine their coping mechanisms using a phenomenological approach. This qualitative study was conducted with 35 nurses employed in clinics specializing in hematologic cancer patient care, living in diverse regions of Turkey, using semistructured, in-depth interviews through the WhatsApp mobile application. The snowball sampling technique was utilized to identify participants, and interviews continued until data saturation was achieved. All interviews were recorded and subsequently transcribed. Data analysis was conducted using Colaizzi's phenomenological analysis method, with the study adhering to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting. In the analysis of the data, 2 categories (ethical dilemma situations and coping experiences) and 6 subthemes (treatment, care, professional values and beliefs, emotions, struggling with emotional burdens, and psychosocial approach) emerged. According to the results, nurses responsible for hematologic cancer patients struggle with ethical dilemmas in healthcare delivery and face challenges in effectively addressing them, which could potentially impact the quality of healthcare provided by nurses.

Haematological nurses' experiences about palliative care trajectories of patients with life-threatening haematological malignancies: A qualitative study

AIMS

To explore haematological nurses' experiences about the palliative care trajectories of patients with life-threatening haematological malignancies.

DESIGN

A qualitative study with a descriptive and explorative design.

METHODS

Data were collected through 12 individual semi-structured interviews of nurses who work with patients with haematological malignancies from four hospitals in Norway. The data were analysed using systematic text condensation. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Three categories emerged from the data analysis: focus on a cure delays integration of palliative care, dialogue with patients facilitates palliative care and the need for enhanced interdisciplinary understanding.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution since nurses' experiences were explored.

The effect of music therapy interventions on fatigue in patients with hematological cancers: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

To systematically synthesize the effect of music therapy interventions applied to patients with hematological cancer on fatigue.

METHODS

The searches were conducted on PubMed, Web of Science, EBSCOhost/CINAHL Complete, Science Direct, Scopus, Cochrane Library, Ovid, ProQuest, and Springer Link databases until August 2021 without any year limitation. The review covered the period between 2003 and 2020. Comprehensive Meta-Analysis 3 software was used in the analysis of meta-analysis data. The meta-analysis was carried out following the PRISMA checklist. Risks of bias were examined by two independent researchers using the Cochrane Collaboration tool.

RESULTS

Six randomized controlled trials consisting of 279 participants were included in the systematic review and meta-analysis. The count of music therapy interventions in the included studies ranged between 1 and 8 sessions per participant, each of which was 20 to 45 min long. The music therapy interventions applied to patients with hematological cancers were found to be effective in reducing the severity of fatigue (95% Cl = 0.10 ~ 0.57; Hedge's g = 0.03; p = 0.006).

CONCLUSIONS

The findings of the meta-analysis indicated that music therapy interventions made important and positive contributions to reducing fatigue in patients with hematological cancer. Music therapy interventions are a convenient method to reduce fatigue because they are comfortable and non-invasive. It will be beneficial to increase the awareness of nurses about the implementation of music therapy interventions. It is recommended that music therapy interventions applied to patients with a diagnosis of hematological cancer should be considered interventions that can be used together with other non-pharmacological or pharmacological methods to reduce fatigue.

Prevalence and predictors of burnout and work-life balance within the haematology cancer nursing workforce

PURPOSE

The effects of burnout can have serious consequence for individual nurse's, patients and healthcare organisations. The aim of this study was to assess prevalence and predictors of burnout and work-life balance amongst haemato-oncology nurses.

METHODS

This study employed a cross-sectional survey design. Haematology cancer nurses attending a 2-day conference in Ireland, during Oct 2019 were recruited. Anonymised data were collected on: 1) socio-demographics and occupational variables, 2) burnout using Maslach Burnout Inventory and 3) satisfaction with work-life balance.

RESULTS

There was an 80.4% survey completion rate (n = 78 of 97). One-third of haemato-oncology nurses reported high levels of emotional exhaustion, with an additional 46% experiencing moderate levels. Despite this, 64% of nurses highlighted a moderate or high level of personal accomplishment. Demographics such as <40yrs old, unmarried, working ≥25hrs per week and having 6-10 years' experience in haemato-oncology, all showed trends towards increased burnout, although none reached statistical significance. Over half (58%) surveyed were dissatisfied with their work-life balance. Nurses with dependent children had statistically significant poorer work-life balance scores. In addition, one-third reported they did not receive adequate support or reasonable adjustments from their organisation, with inpatient nurses finding this particularly challenging.

RELEVANCE TO CLINICAL PRACTICE

Taking into consideration the high levels of burnout, healthcare organisations should have a responsibility to teach approaches of stress management, self-care and foster resilience within their workforce. Oncology nurses with dependent children, working in in-patient settings, have identified a need for greater flexibility with working conditions, to improve work-life balance.

Factors contributing to burnout and work-life balance in adult oncology nursing: An integrative review

PURPOSE

Occupational stress and burnout are highlighted as the most prevalent workplace issues for adult oncology nurses. With today's global nursing workforce shortage; coupled with oncology being an inherently challenging and complex speciality, this clearly indicates the need to understand factors that contribute to burnout in adult oncology nurses and improve work-life balance. The aim of this integrative review is to synthesis the evidence on burnout and work-life balance for adult oncology nurses.

METHOD

A systematic search of four databases (CINAHL, Ovid Medline, PsycINFO and Scopus), identified 17 quantitative and three mixed-method studies. Studies were critically appraised using the Mixed Methods Appraisal Tool. Following data extraction, a qualitative evidence synthesis utilising an inductive approach was adopted to better understand influential factors, generating analytical themes.

RESULTS

One study had a specific focus on what ameliorates work-life balance for oncology nurses; depicting an area that warrants further study. All studies reported on burnout, of which six analytical themes were further categorised into two broad themes, namely: (1) 'Inability to thrive': struggling with workplace burnout due to organisational challenges and (2) 'Personal perspectives influencing burnout', for adult oncology nurses. Burnout was influenced by multiple oncology-specific factors due to quantitative workload demands and disease acuity. Workplace culture, shift in additional hours being worked remotely and personal characteristics of the nurse, also influenced susceptibility for the development of burnout in oncology nurses.

CONCLUSION

Confronting burnout and promoting wellness are the shared responsibility of both individual adult oncology nurses and their organisations to build resilience and help sustain and build workforce capacity.

A qualitative evidence synthesis of healthcare professionals' experiences and views of palliative care for patients with a haematological malignancy

INTRODUCTION

Patients with haematological malignancies may not be receiving appropriate referrals to palliative care and continuing to have treatments in the end stages of their disease. This systematic review of qualitative research aimed to synthesise healthcare professionals' (HCPs) views and experiences of palliative care for adult patients with a haematologic malignancy.

METHODS

A systematic search strategy was undertaken across eight databases. Thomas and Harden's approach to thematic analysis guided synthesis on the seventeen included studies. GRADE-GRADEQual guided assessment of confidence in the synthesised findings.

RESULTS

Three analytic themes were identified: (a) "Maybe we can pull another 'rabbit out of the hat'," represents doctors' therapeutic optimism, (b) "To tell or not to tell?" explores doctors' decision-making around introducing palliative care, and (c) "Hospice, home or hospital?" describes HCPs concerns about challenges faced by haematology patients at end of life in terms of transfusion support and risk of catastrophic bleeds.

CONCLUSION

Haematologists value the importance of integrated palliative care but prefer the term "supportive care." Early integration of supportive care alongside active curative treatment should be the model of choice in haematology settings in order to achieve the best outcomes and improved quality of life.

The Experiences of Family Caregivers at the End of Life: Suffering, Compassion Satisfaction and Support of Health Care Professionals: Experiences of Caregivers at the End of Life

A death with dignity is influenced by the quality of care offered to patients. The objective of this study was to identify, through the firsthand experiences and insights of family caregivers, the key elements related to the care offered to patients with a terminal illness at the end of life. This multicenter qualitative study was based on the paradigm of hermeneutic phenomenology. Participants were relatives of patients with terminal illness who had been identified as primary caregivers. Five discussion groups and 41 in-depth interviews were organized with a total of 81 participants. The content of the interviews was analyzed based on the methods developed by Giorgi (J Phenom Psychol 1997;28(2):235-260). The results indicate the existence of 3 dimensions: the caregiver's suffering, compassion satisfaction with the care provided, and the support of health care professionals. Understanding the experiences of family members providing end-of-life care allows improved care and provides dignity in death. Health and social systems must provide comprehensive assistance covering the different aspects of needed care. Health professionals occupy a privileged position in the care of these patients and their families.

Reciprocal Dynamics of Dignity in End-of-Life Care: A Multiperspective Systematic Review of Qualitative and Mixed Methods Research

Background:

Preserving terminally ill patients’ dignity and well-being through dignified and holistic care has become the overarching goal in palliative care services. However, dignity is a multifaceted concept with a wide range of interpretations under different cultural contexts.

Aim:

The aim of this review is to understand the variations in subjective interpretations and constitutions of dignity in palliative or end-of-life care via an integrative worldview.

Design:

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used SPIDER tool to screen for appropriate and relevant articles for analysis.

Data Sources:

Four major databases were searched including CINAHL, ERIC, Medline, and PsycARTICLES between 2009 and 2018. Forty-eight qualitative studies that examined dignity from the perspectives of patients, family caregivers, and health-care professionals were selected for full text data analysis using thematic synthesis.

Results:

Analysis of the various concepts of dignity revealed 18 themes that were further categorized into 7 conceptual categories: (1) self-determination, (2) existential liberty, (3) relational connectedness, (4) caregiving revitalization, (5) mindful humanity, (6) patient–family care, and (7) sustainable culture. These 7 categories span across individual, familial, and institutional dimensions, forming a new Dynamic Reciprocity of Dignity model.

Conclusions:

The Dynamic Reciprocity of Dignity model highlights the importance of adopting a systemic lens to address dignity-related needs and concerns at the end of life, while providing insights on how compassionate care and self-compassion can serve as the foundation of dignified care, which in turn serve as a buffer against patients’ existential suffering as well as caregivers’ burnout and fatigue. Recommendations for clinical practice and future research directions are discussed.

Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care?

PURPOSE OF REVIEW

Integrated palliative care for those with advanced solid tumors yields significant benefits in patient and caregiver outcomes. However, most palliative care clinical trials have excluded patients with hematologic malignancies. There is growing interest in whether integrated palliative care may yield similar benefits in hematologic malignancy patients and caregivers, but there has been little direct evidence of benefit in this population. This review summarizes new data on palliative care issues in hematologic malignancies, published in the preceding 12 months.

RECENT FINDINGS

Most newly published evidence on this topic from the last year is descriptive of unmet needs, poor end-of-life care outcomes or unique differences and issues posed by hematologic malignancies as compared to solid tumors. A few articles describe models of collaborative care in hematologic malignancies, and just one describes the impact of an integrated palliative care intervention on patient and caregiver outcomes. Several studies point to transfusions as a unique and problematic barrier to high-quality end-of-life care in hematologic malignancies.

SUMMARY

Recent evidence confirms that hematologic malignancy patients have unique and often unmet palliative care needs, and also have worse end-of-life outcomes. More work is needed to develop and test integrated palliative care interventions in this population.