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Raunkiær M, Shabnam J, Marsaa K, Kurita GP, Sjøgren P, Guldin MB. When and how to stop palliative antineoplastic treatment and to organise palliative care for patients with incurable cancer. Int J Palliat Nurs 2023; 29:499-506. [PMID: 37862155 DOI: 10.12968/ijpn.2023.29.10.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Improving the organisational aspects of the delivery of palliative care in order to support patients throughout their disease trajectory has received limited attention. AIM To investigate the opportunities and barriers related to organising palliation for people with terminal cancer and their families. METHODS An explorative interview study was conducted among 31 nurses and three physicians concerning an intervention facilitating a fast transition from treatment at a cancer centre at a university hospital to palliation at home. A thematic analysis was conducted. FINDINGS This article presents three out of seven themes: 1) improvement in the cessation of antineoplastic treatment in palliation; 2) improvement in organisations delivering palliation; and 3) improvement in multidisciplinary and cross-sectoral collaboration. CONCLUSIONS The results demonstrate the demand for flexible, family-centred and integrated palliation at all levels, from communication and the collaborative relationship between healthcare professionals and families to service sectors.
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Affiliation(s)
- Mette Raunkiær
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Jahan Shabnam
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Geana Paula Kurita
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Denmark; Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus, and Institute for Public Health, Aarhus University
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Lipworth W. Moral Lacunae in the Management of Dual Agency Dilemmas Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?". Int J Health Policy Manag 2022; 11:2349-2351. [PMID: 35297236 PMCID: PMC9808263 DOI: 10.34172/ijhpm.2022.6779] [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: 09/14/2021] [Accepted: 03/05/2022] [Indexed: 01/12/2023] Open
Abstract
Waitzberg and colleagues' participants articulate a wide range of strategies to manage tensions between clinical and economic obligations. There are, however, three notable absences in the data. First, all strategies described by participants are underpinned by the assumption that clinical (and associated administrative) practices need to either align with economic considerations or be made more compatible with them. Second, the dual agency dilemma was framed exclusively as existing at the level of the health care institution, with little attention paid to obligations to broader health systems. Third, there was no evidence of critical questioning of the priorities of the hospitals in which participants work. These absences do not render the strategies used by Weitzberg and colleagues' participants morally "wrong," but they do suggest that people who are deeply embedded in a system might fail to recognise the full range of moral concerns and moral possibilities.
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Affiliation(s)
- Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, NSW, Australia
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Merollini KMD, Gordon LG, Ho YM, Aitken JF, Kimlin MG. Cancer Survivors’ Long-Term Health Service Costs in Queensland, Australia: Results of a Population-Level Data Linkage Study (Cos-Q). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159473. [PMID: 35954835 PMCID: PMC9368477 DOI: 10.3390/ijerph19159473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022]
Abstract
Worldwide, the number of cancer survivors is rapidly increasing. The aim of this study was to quantify long-term health service costs of cancer survivorship on a population level. The study cohort comprised residents of Queensland, Australia, diagnosed with a first primary malignancy between 1997 and 2015. Administrative databases were linked with cancer registry records to capture all health service utilization. Health service costs between 2013–2016 were analyzed using a bottom-up costing approach. The cumulative mean annual healthcare expenditure (2013–2016) for the cohort of N = 230,380 individuals was AU$3.66 billion. The highest costs were incurred by patients with a history of prostate (AU$538 m), breast (AU$496 m) or colorectal (AU$476 m) cancers. Costs by time since diagnosis were typically highest in the first year after diagnosis and decreased over time. Overall mean annual healthcare costs per person (2013–2016) were AU$15,889 (SD: AU$25,065) and highest costs per individual were for myeloma (AU$45,951), brain (AU$30,264) or liver cancer (AU$29,619) patients. Our results inform policy makers in Australia of the long-term health service costs of cancer survivors, provide data for economic evaluations and reinforce the benefits of investing in cancer prevention.
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Affiliation(s)
- Katharina M. D. Merollini
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
- Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia
- Correspondence: ; Tel.: +61-7-5202-3159
| | - Louisa G. Gordon
- Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia;
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- School of Biomedical Sciences, Queensland University of Technology, St. Lucia, QLD 4072, Australia;
| | - Yiu M. Ho
- Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia;
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700, Australia
| | - Joanne F. Aitken
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- Cancer Council Queensland, Fortitude Valley, QLD 4006, Australia
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4006, Australia
| | - Michael G. Kimlin
- School of Biomedical Sciences, Queensland University of Technology, St. Lucia, QLD 4072, Australia;
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Latham JS, Butchard S, Mason SR. Physician emotional experience of communication and decision making with end-of-life patients: qualitative studies systematic review. BMJ Support Palliat Care 2022:bmjspcare-2021-003446. [PMID: 35414630 DOI: 10.1136/bmjspcare-2021-003446] [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: 11/01/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the emotional experience of physicians in acute settings when encountering end-of-life conversations and decision making. METHOD Thematic synthesis of qualitative studies. Medline, PsychInfo, PubMed, BNI and CIAHL were searched from 1985 to 2021 for studies published in English. Data extraction was informed by a framework created for assessing methodological quality by Polanin, Pigott, Espelage and Grotpeter (2019) and adapted by Draper et al. (2019). RESULTS Of 8429 papers identified, 17 were selected for review. Two themes containing 10 subthemes described the emotional and psychological factors impacting the experience of end-of-life care, namely: a tension between desire and ability to communicate end-of-life news, and a conflict of hiding versus revealing self across several practical and emotional contexts. CONCLUSION Medical training is only a small factor in how well a person copes with end-of-life care and may sometimes feed negative appraisals . Lack of support from senior colleagues, fear of criticism and a sense of perceived failure were linked to lower self-efficacy in end-of-life care. Beyond learning practical skills, physicians benefit from understanding the psychological factors impacting their experience and in building self-efficacy, and observing senior colleagues effectively process strong and difficult emotions. PRACTICAL IMPLICATIONS Promoting personal reflection and sharing of the experiences encountered in end-of-life care, especially modelled from senior colleagues, may contribute to improvements in competence and reduce the impact of heroism, feelings of failure and avoidance in practice.
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Affiliation(s)
- John S Latham
- Department of Clinical Psychology, University of Liverpool, Liverpool, UK
| | - Sarah Butchard
- Department of Clinical Psychology, University of Liverpool, Liverpool, UK
| | - Stephen R Mason
- Palliative Care Unit, School of Medicine, University of Liverpool, Liverpool, UK
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Lindén L. Running out of time: The case of patient advocacy for ovarian cancer patients' access to PARP inhibitors. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:2141-2155. [PMID: 34636047 DOI: 10.1111/1467-9566.13385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
This article analyses patient advocacy for ovarian cancer patients' access to a group of new targeted cancer treatments, so-called poly (adenosine diphosphate ribose) polymerase (PARP) inhibitors. Ovarian cancer is often detected in its advanced stages and has relatively poor survival rates. Based on ethnographic fieldwork with the Gynae Cancer Group, a Swedish patients' group, this article examines ovarian cancer patient advocates' engagement with biomedicine as a rarely considered topic in the social sciences. Adopting a modified version of the science and technology studies perspective on evidence-based activism, I analyse how ovarian cancer patient advocates engage in the 'epistemic activities' of framing, producing and mobilising 'credentialed' and 'experiential' knowledge. I show how patient advocates, alone and together with professionals and the media, engage in epistemic activities to 'act upon' ovarian cancer patients' anticipated limited time and poor prognosis: patient advocates mobilise around PARP inhibitors as offering hope, access to these drugs as an urgent matter and ovarian cancer care as unequal. The article contributes to the sociological literature on novel cancer treatments and patient advocacy through its ethnographic tracing of cancer advocacy tropes and knowledge practices, centred on the temporal figure of 'the patient running out of time'.
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Affiliation(s)
- Lisa Lindén
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
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Kerr A, Chekar CK, Swallow J, Ross E, Cunningham-Burley S. Accessing targeted therapies for cancer: self and collective advocacy alongside and beyond mainstream cancer charities. NEW GENETICS AND SOCIETY 2021; 40:112-131. [PMID: 34720747 PMCID: PMC8547735 DOI: 10.1080/14636778.2020.1868986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
As precision oncology has evolved, patients and their families have become more involved in efforts to access these treatments via fundraising and campaigning that take place outside of the larger cancer charities. In this paper, we explore the solidarities, networks, and emotional work of the UK-based access advocates, drawing on the stories of nine advocates, which included interviews and content analyses of their social media posts and coverage of their case in news, commentary, and fundraising websites. We consider the emotional and knowledge work of building networks that spanned consumerist and activist agendas, forged individual and collective goals, and orientations toward the public, private, and third sectors as part of securing support and access. Through these various practices, the actors we have studied cultivated personal advantage and solidarities with other patients and advocates, and in so doing engaged in self and collective advocacy alongside and beyond mainstream cancer charities.
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Affiliation(s)
| | - Choon Key Chekar
- Faculty of Health and Medicine, Lancaster University, LancasterUK
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Hauge AM. One last round of chemo? Insights from conversations between oncologists and lung cancer patients about prognosis and treatment decisions. Soc Sci Med 2020; 266:113413. [PMID: 33096509 DOI: 10.1016/j.socscimed.2020.113413] [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] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
One more chemo or one too many? The increasing use of expensive cancer treatments close to the patient's death is often explained by oncologists' failure to communicate to patients how close to dying they are, implying that patients are often both ill-prepared and over-treated when they die. This article aims at interrogating the politically charged task of prognosticating. Drawing on an ethnographic study of conversations between oncologists and patients with metastatic lung cancer in a Danish oncology clinic, I show that oncologists utilize, rather than avoid, prognostication in their negotiations with patients about treatment withdrawal. The study informs the emerging sociology of prognosis in three ways: First, prognostication is not only about foreseeing and foretelling, but also about shaping the patient's process of dying. Second, oncologists prognosticate differently depending on the level of certainty about the patient's trajectory. To unfold these differences, the article provides a terminology that distinguishes between four 'modes of prognostication', namely hinting, informing, calibrating and organizing. Third, prognosticating can unfold over time through multiple consultations, emphasizing the relevance of adopting methodologies enabling the study of prognosticating over time.
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Affiliation(s)
- Amalie M Hauge
- VIVE - the Danish Center for Social Science Research, Herluf Trollesgade 11, 1052, København K, Denmark.
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