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Yan T, Yang M. Adult Children as Companions in Geriatric Consultations: An Interpersonal Perspective from China. HEALTH COMMUNICATION 2024:1-14. [PMID: 38862401 DOI: 10.1080/10410236.2024.2364442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Despite the prevalence of accompanied medical visits all over the world, most literature on triadic medical communication shares an Anglo-American background; little is known about non-dyadic medical interactions in Asian societies such as China. This article explores triadic interactions in Chinese geriatric outpatient consultations, focusing on the interpersonal dynamics between doctors, older patients, and the adult children who accompany them throughout the consultation. From an interpersonal pragmatic approach, we conduct a conversation analysis of the transcription of 36 audio-recorded encounters. Our findings demonstrate three patterns of companions' communicative actions during geriatric visits: enhancing rapport, mitigating face threats, and adding tension. These patterns reveal the multi-faceted nature of adult children's participation in geriatric care, highlighting their capacity to simultaneously facilitate a positive interpersonal atmosphere and pose challenges to their older parents' face. Delving into the nuanced mechanisms through which these patterns of engagement are triggered, warranted, and negotiated by all participants in the local contingencies, we further illuminate the institutional and cultural context that informs companions' intervention. Our analysis demonstrates that the influence of Chinese familial values and institutional constraints in Chinese tertiary hospitals, including restricted time and limited privacy within the clinic room, have shaped the interpersonal dynamic in triadic geriatric care. Our research calls for the development of nuanced and targeted interventions and training for healthcare professionals and companions of older patients alike.
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Affiliation(s)
- Tianxin Yan
- School of Foreign Languages, Renmin University of China
| | - Min Yang
- School of Foreign Languages, Renmin University of China
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Henderson NL, Padalkar T, Bourne G, Hendrix EK, Williams CP, Odom JN, Triebel K, Rocque GB. Assessing the association between quantity and quality of family caregiver participation in decision-making clinical encounters on patient activation in the metastatic breast cancer setting. Support Care Cancer 2024; 32:422. [PMID: 38858225 PMCID: PMC11164765 DOI: 10.1007/s00520-024-08593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/20/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Caregivers support individuals undergoing cancer treatment by assisting with activities, managing care, navigating healthcare systems, and communicating with care teams. We explored the quality and quantity of caregiver participation during recorded decision-making clinical appointments in women with metastatic breast cancer. METHODS This was a convergent parallel mixed methods study that utilized qualitative and quantitative data collection and analysis. Caregiver participation quality was operationalized using a summative thematic content analysis to identify and sum caregiver actions performed during appointments. Performance of a greater number of actions was considered greater quality of participation. Caregiver participation quantity was measured by calculating the proportion of speaking time. Participation quality and quantity were compared to patient activation, assessed using the Patient Activation Measure 1-month post decision-making appointment. RESULTS Fifty-three clinical encounters between patients with MBC, their caregivers, and oncologists were recorded. Identified caregiver actions included: General Support; Management of Treatment or Medication; Treatment History; Decision-Making; Insurance or Money; Pharmacy; Scheduling; Travel Concerns; General Cancer Understanding; Patient Specific Cancer Understanding; Caregiver-Initiated or Emphasis on Symptom Severity; and Caregiver Back-Up of Patient Symptom Description. Caregivers averaged 5 actions (SD 3): 48% of patient's caregivers had low quality (< 5 actions) and 52% had high quality (> 6 actions) participation. Regarding quantity, caregivers spoke on average for 4% of the encounter, with 60% of caregivers speaking less than 4% of the encounter (low quantity) and 40% of caregivers speaking more than 4% (high quantity). Greater quality and quantity of caregiver participation was associated with greater patient activation. CONCLUSIONS Caregivers perform a variety of actions during oncological decision-making visits aiding both patient and provider. Greater participation in terms of quantity and quality by the caregiver was associated with greater patient activism, indicating a need for better integration of the caregiver in clinical decision-making environments.
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Affiliation(s)
- Nicole L Henderson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Tanvi Padalkar
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garrett Bourne
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emma K Hendrix
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen Triebel
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Moore C, Gallagher P, Dunne S. Health literacy, eHealth literacy and their association with burden, distress, and self-efficacy among cancer caregivers. Front Psychol 2024; 15:1283227. [PMID: 38434952 PMCID: PMC10904647 DOI: 10.3389/fpsyg.2024.1283227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Health literacy skills are vital for cancer caregivers in helping cancer survivors to navigate their diagnosis, treatment, and recovery but little is known. This study explored health literacy and eHealth literacy among cancer caregivers and the relationship between health literacy/eHealth literacy and potential associated factors. Methods Informal caregivers who had cared for an individual with cancer completed a survey which collected demographic data and measured caregiver health literacy, eHealth literacy, self-efficacy, burden, and distress. Results Seven percent of caregivers had inadequate health literacy. Caregivers scored lowest on health literacy domains related to caregiver social support, information seeking and understanding care recipient preferences. eHealth literacy was associated with self-efficacy and burden while, different health literacy domains were associated with burden ('Understanding care recipient needs and preferences'), self-efficacy ('Cancer-related communication with the care recipient' and 'Understanding care recipients needs and preferences') and distress ('Proactivity and determination to seek information', 'Understanding care recipient needs and preferences', 'Understanding the healthcare system'). Conclusion Findings highlight key areas of need regarding cancer caregiver health literacy which future research can target. Given the observed relationship between aspects of health literacy and burden, distress and self-efficacy future work could be carried out on how to alleviate high levels of burden and distress and how to enhance self-efficacy among cancer caregivers by addressing health literacy skills. Implications for cancer survivors Findings from this study will inform the development of health literacy interventions to support caregivers to build their health literacy skills and enable this group to better support cancer survivors as a result.
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Affiliation(s)
- Chloe Moore
- School of Psychology, Dublin City University, Dublin, Ireland
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Liu X, Jiang L, Peng X, Xu L, Huang L, Wan Q. Evaluating the effects of dyadic intervention for informal caregivers of palliative patients with lung cancer: A systematic review and meta-analysis. Int J Nurs Pract 2023. [PMID: 37963770 DOI: 10.1111/ijn.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
AIM To investigate the effects of dyadic intervention on anxiety, depression, care burden and quality of life in informal caregivers of palliative patients with lung cancer. BACKGROUND Informal caregivers of palliative lung cancer patients bear a large number of negative emotions during the process of caring for the patients. Dyadic intervention has the potential for improving them but the overall effect is unclear. DESIGN A systematic review and meta-analysis. DATA SOURCES All randomized controlled trials were retrieved from the following databases until 4 May 2023: Web of Science, Embase Ovid, PubMed, Cochrane Central Register of Randomized Controlled Trials, Weipu, Wanfang and Chinese National Knowledge Infrastructure databases. REVIEW METHODS This review was performed by Stata 12.0 and Review Manager 5.3. RESULTS Thirteen randomized controlled trials were in accordance with the inclusion and exclusion criteria (n = 1807). The results revealed that dyadic intervention significantly improved family caregivers' anxiety, depression and caregiver burden of palliative patients with lung cancer. There was no significant difference in quality of life between the dyadic intervention group and family caregivers who did not receive the dyadic intervention. CONCLUSIONS Dyadic intervention positively impacts the experience of family caregivers of palliative patients with lung cancer.
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Affiliation(s)
- Xin Liu
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xi Peng
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Xu
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lingling Huang
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qunfang Wan
- Department of Respiratory and Critical Care Medicine, Huaxi Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Canzona MR, Murphy K, Victorson D, Harry O, Clayman ML, McLean TW, Golden SL, Patel B, Strom C, Little-Greene D, Saker S, Salsman JM. Fertility Preservation Decisional Turning Points for Adolescents and Young Adults With Cancer: Exploring Alignment and Divergence by Race and Ethnicity. JCO Oncol Pract 2023; 19:509-515. [PMID: 37058685 PMCID: PMC10337714 DOI: 10.1200/op.22.00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/06/2023] [Accepted: 03/01/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE For adolescents and young adults (AYAs) with cancer, fertility preservation (FP) decision making is complex and distressing. Racial/ethnic minority (REM) AYAs experience disparities in FP awareness, uptake, and outcomes. A turning point (TP) is a point of reflection, change, or decisive moment(s) resulting in changes in perspectives or trajectories. To enhance understanding of AYAs' diverse experiences, this study examined alignment and/or divergence of FP decisional TPs among non-Hispanic White (NHW) AYAs and REM AYAs. METHODS Qualitative semistructured interviews were conducted in person, by video, or phone with 36 AYAs (20 NHW and 16 REM [nine Hispanic and seven Black/multiracial Black). The constant comparative method was used to identify and analyze themes illustrating participants' conceptualization and/or experience of FP decisional TPs. RESULTS Seven thematic TPs emerged: (1) emotional reaction to discovering FP procedures exist; (2) encountering unclear or dismissive communication during initial fertility conversations with health care providers; (3) encountering direct and supportive communication during initial fertility conversations with health care providers; (4) participating in critical family conversations about pursuing FP; (5) weighing personal desire for a child against other priorities/circumstances; (6) realizing FP is not feasible, and (7) experiencing unanticipated changes in cancer diagnosis or treatment plans/procedures. TP variations include REM participants reported dismissive communication and suggested cost was prohibitive. NHW participants emphasized more forcefully that biological children may become a future priority. CONCLUSION Understanding how clinical communication and priorities/resources may vary for NHW and REM AYAs can inform future interventions aimed at reducing health disparities and enhancing patient-centered care.
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Affiliation(s)
- Mollie R. Canzona
- Department of Communication, Wake Forest University, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Karly Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - David Victorson
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Onengiya Harry
- Pediatrics—Rheumatology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Marla L. Clayman
- Department of Population and Quantitative Research, UMass Chan School of Medicine, Worcester, MA
| | - Thomas W. McLean
- Pediatrics—Hematology/and Oncology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Bonnie Patel
- Obstetrics and Gynecology, Reproductive Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Carla Strom
- Operations, Office of Cancer Health Equity, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Siba Saker
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
- Clinical Research in Adolescent and Young Adult Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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Tielemans LML, van Heugten KD, Hamaker ME, van Walree IC. Preferred and actual involvement of caregivers in oncologic treatment decision-making: A systematic review. J Geriatr Oncol 2023; 14:101525. [PMID: 37198027 DOI: 10.1016/j.jgo.2023.101525] [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: 12/21/2022] [Revised: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the importance of involving caregivers in the treatment decision-making process. We aimed to explore the preferred and actual involvement of caregivers in the decision-making process of patients with cancer and to see if there are age or cultural background related differences in caregiver involvement. MATERIALS AND METHODS A systematic review of Pubmed and Embase was performed on January 2, 2022. Studies containing numerical data regarding caregiver involvement were included, as were studies describing the agreement between patients and caregivers regarding treatment decisions. Studies assessing solely patients aged younger than 18 years old or terminally ill patients, and studies without extractable data were excluded. Risk of bias was assessed by two independent reviewers using an adapted version of the Newcastle-Ottawa scale. Results were analysed in two separate age groups, one <62 years and one ≥62 years. RESULTS Twenty-two studies with a total of 11,986 patients and 6,260 caregivers were included in this review. A median of 75% of patients preferred caregivers to be involved in decision-making and a median of 85% of caregivers preferred to be involved. With regards to age groups, the preferred involvement of caregivers was more frequent in the younger study populations. With regards to geographical differences, studies performed in Western countries showed a lower preference for caregiver's involvement compared to studies from Asian countries. A median of 72% of the patients reported the caregiver was actually involved in the treatment decision-making and a median of 78% of the caregivers reported they were actually involved. The most important role of caregivers was to listen and provide emotional support. DISCUSSION Patients and caregivers both want caregivers to be involved in the treatment decision-making process and most caregivers are actually involved. An ongoing dialogue between clinicians, patients and caregivers about decision-making is important to meet the individual patient's and caregiver's needs when involved in the decision-making process. Important limitations were a lack of studies in older patients and significant differences in outcome measures among studies.
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Affiliation(s)
- Laura M L Tielemans
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands.
| | - Kirsten D van Heugten
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | - Inez C van Walree
- Department of Geriatric Medicine, University Medical Centrum Utrecht, Utrecht, the Netherlands
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Bar-Sela G, Tur-Sinai A, Givon-Schaham N, Bentur N. Advance Care Planning and Attainment of Cancer Patients' End-of-Life Preferences: Relatives' Perspective. Am J Hosp Palliat Care 2023; 40:322-328. [PMID: 35587799 PMCID: PMC9941650 DOI: 10.1177/10499091221099921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine which element of advance care planning (ACP) - an advance directives (AD) document or an end-of-life discussion between patient and family (DwF), if any-improves the likelihood of cancer patients' attaining their preferences regarding treatments in the last month of life and dying in the place they prefer. METHODS First-degree relatives of deceased cancer patients, interviewed by telephone, were asked if the treatments the patients received in their last month of life and their place of death corresponded to the patients' preferences. Nominal logistic regression analyses were conducted in search of significant association between having an AD document and/or conducting a DwF and patients' treatment and place of death in accordance with their preferences. RESULTS 491 deceased patients were included in the study. Their average age was 68; 52% were women. According to 32% of the relatives, the patients' treatment in the last month of life was aligned with their preferences and 55% said the patients had died in their preferred place. Only 16.5% had an AD document, 58.5% only discussed their treatment preferences with relatives, and 25% did neither. DwF and ability to speak until last week of life were significantly related to receiving treatment consistent with patients' preferences. Dying where the patient prefers is significantly associated with having an AD and a DwF, with an AD yielding higher odds. CONCLUSION A multifaceted interconnection exists between the two elements of ACP in attaining cancer patients' wishes and abetting better end of life care.
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Affiliation(s)
- Gil Bar-Sela
- Oncology and Hematology Division, Emek Medical Center, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Jezreel Valley, Israel,School of Nursing, University of Rochester Medical Center, New York
| | - Noa Givon-Schaham
- The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Netta Bentur
- The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel,Netta Bentur, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Canzona MR, Fisher CL, Garcia DS, Dong T, Ledford CJW. Partner presence in clinical conversations about sexual health: Breast cancer survivors', partners', and providers' perspectives of triadic interactions. J Psychosoc Oncol 2023; 41:166-181. [PMID: 35587166 DOI: 10.1080/07347332.2022.2068397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective. Using a triadic approach, we evaluated BCSs' comfort discussing SH with partners present and identified factors that can contribute to their comfort level. DESIGN Qualitative approach using in-depth interviews. PARTICIPANTS 93 BCSs, partners, and providers involved in BCS care. METHODS In-depth interviews with BCSs, partners, and providers explored triadic perspectives to understand factors informing BCSs' comfort level. Thematic analysis was used to analyze data. FINDINGS Four themes characterize potential benefits of partner presence: 1) partner facilitates information exchange, 2) partner realizes BCS's SH concerns are "a real thing," 3) partner better understands SH challenges, and 4) partner presence encourages relational communication about SH. Five themes illustrate potential complications of partner presence: 1) partner feels/becomes embarrassed, 2) partner is/becomes defensive, 3) partner presence constrains BCS's agency in clinical conversations, 4) partner presence threatens partner's view of BCS as a sexual being, and 5) partner presence increases partner burden. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY Providers should (1) initiate conversations about BCS comfort with partner presence, (2) be aware of the interaction between BCS primary and secondary goals, (3) consider how BCS/partner goal conflicts obstruct BCS agency and sexual/relational health, and (4) offer opportunities to clarify goals and expectations, and coordinate therapeutic options.
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Affiliation(s)
- Mollie Rose Canzona
- Department of Communication, Wake Forest University, Department Social Sciences & Health Policy, Wake Forest School of Medicine, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, UF Health Cancer Center, Gainesville, Florida, USA
| | - David S Garcia
- Eglin Family Medicine Residency, Eglin Air Force Base, Okaloosa, Florida, USA
| | - Thrandia Dong
- Department of Communication, Wake Forest University, Winston-Salem, NC, USA
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Bylund CL, Eggly S, LeBlanc TW, Kurtin S, Gandee M, Medhekar R, Fu A, Khurana M, Delaney K, Divita A, McNamara M, Baile WF. Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma. Transl Behav Med 2023; 13:255-267. [PMID: 36688466 DOI: 10.1093/tbm/ibac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | - Rohan Medhekar
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Alan Fu
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Monica Khurana
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fenton ATHR, Fletcher KM, Kizildag D, Borstelmann NA, Kessler D, Cronin C, Revette AC, Wright AA, Frank E, Enzinger AC. Cancer Caregivers' Prognostic and End-of-Life Communication Needs and Experiences and their Impact. J Pain Symptom Manage 2023; 65:16-25. [PMID: 36198337 PMCID: PMC9790036 DOI: 10.1016/j.jpainsymman.2022.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Family caregivers of patients with advanced cancer are integrally involved in communications regarding prognosis and end-of-life (EOL) planning and care. Yet little research has examined caregivers' communication experiences or the impact of these experiences on patients and caregivers at EOL. OBJECTIVES Investigate cancer caregivers' communication experiences and potential impact on patient and caregiver outcomes. METHODS Semistructured interviews with bereaved family cancer caregivers (N=19) about their communication needs and experiences as their loved one approached EOL and died. Audiotaped interviews were transcribed and thematically analyzed for communication-related themes. RESULTS Caregivers described fulfilling many important communication roles including information gathering and sharing, advocating, and facilitating-often coordinating communication with multiple partners (e.g., patient, family, oncology team, hospital team). Caregivers reported that, among the many topics they communicated about, prognosis and EOL were the most consequential and challenging. These challenges arose for several reasons including caregivers' and patients' discordant communication needs, limited opportunity for caregivers to satisfy their personal communication needs, uncertainty regarding their communication needs and responsibilities, and feeling unacknowledged by the care team. These challenges negatively impacted caregivers' abilities to satisfy their patient-related communication responsibilities, which shaped many outcomes including end-of-life decisions, care satisfaction, and bereavement. CONCLUSION Caregivers often facilitate essential communication for patients with advanced cancers yet face challenges successfully fulfilling their own and patients' communication needs, particularly surrounding prognostic and end-of-life conversations. Future research and interventions should explore strategies to help caregivers navigate uncertainty, create space to ask sensitive questions, and facilitate patient-caregiver discussions about differing informational needs.
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Affiliation(s)
| | | | - Deniz Kizildag
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | - Anna C Revette
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alexi A Wright
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
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Pérez-Milena A, Zafra-Ramírez N, Ramos-Ruiz JA, Rodríguez-Bayón A, Zafra-Ramírez J. [Influence of the companion in Primary Care consultations on communication skills and interview time]. Aten Primaria 2022; 54:102388. [PMID: 35779367 PMCID: PMC9253964 DOI: 10.1016/j.aprim.2022.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022] Open
Abstract
OBJETIVES To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. DESIGN Cross-sectional descriptive study. LOCATION 10 Primary Care Centers. PARTICIPANTS Resident doctors of Family and Community Medicine. INTERVENTIONS Peer review of video recordings of clinical demand consultations. MAIN MEASUREMENTS CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. RESULTS 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]). CONCLUSIONS Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.
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Affiliation(s)
- Alejandro Pérez-Milena
- Centro de Salud El Valle, Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España.
| | - Natalia Zafra-Ramírez
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España
| | - Juan Andrés Ramos-Ruiz
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Jaén Norte-Nordeste, Servicio Andaluz de Salud, Jaén, España
| | - Antonina Rodríguez-Bayón
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Jaén Norte-Nordeste, Servicio Andaluz de Salud, Jaén, España
| | - Javier Zafra-Ramírez
- Centro de Salud El Valle, Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España
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Kogan N, Tolley M, Cohen R. Family caregivers support their patient's decision to participate in a phase 1 clinical trial: Weighing the pros and cons, bearing the costs. Psychooncology 2022; 31:1374-1380. [PMID: 35460308 DOI: 10.1002/pon.5942] [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: 11/03/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES When patients with advanced cancer pursue phase 1 clinical trials, family caregivers are impacted as they adopt new roles and responsibilities in time-pressured, uncertain circumstances. This study explored the nature of the caregivers' participation in patients' decision to pursue phase 1 clinical trials and the early impact of the decision on the caregiver. METHODS Semi-structured interviews were conducted with 19 family caregivers of advanced cancer patients who had agreed to participate in phase 1 clinical trials. They were coded for information about the caregiver's relationship with the patient, typical style of decision-making together, understanding of the patient's prognosis and trial, contributions to decision-making and the initial impacts of the trial on the caregiver. Codes illuminating the research questions were grouped into categories and themes, compared across transcripts and examined against the literature. RESULTS Caregivers unequivocally supported the patients' decision to pursue the phase 1 trial as they hoped that the patient would derive medical benefit from the trial. They withheld their opinions and fears about the trial from the patients to support patient autonomy during the decision-making process. The patient's decision to participate increased the caregivers' burdens and deprived them of time spent on pleasurable activities at end of life. CONCLUSIONS Respecting the patients' personal autonomy, caregivers supported the trial, despite the complex caregiving required. As the success of phase 1 trials relies on caregiver involvement, it is imperative that healthcare professionals be sensitized to the support needs of these caregivers.
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Affiliation(s)
- Naomi Kogan
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Research Institute, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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13
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Dealing with Family Conflicts in Decision-making in End-of-Life Care of Advanced Cancer Patients. Curr Oncol Rep 2021; 23:124. [PMID: 34448971 DOI: 10.1007/s11912-021-01122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The family plays a significant role in end-of-life care and decision-making with advanced cancer patients. This non-systematic review aims to summarize the family role and possible emerging conflicts and problems related to family involvement in decisions with advanced cancer patients. RECENT FINDINGS Four important domains were identified: (1) discordance between patients and caregivers' understanding of prognosis and goals of care; (2) internal family conflicts; (3) cultural differences regarding the role of the family in end-of life decision-making; (4) the burden on caregivers through caring for cancer patients. Based on the findings, we formulated some implications to consider for clinical practice. We suggest to involve the family in decision-making, to ascertain patients' wish for family involvement and if necessary, taking a mediator role between patients and their caregivers; to be aware of "invisible" family influence on patients' decisions; to assess systematically family burden and needs; to provide timely information, psychological support interventions and palliative care.
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14
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Lee JW, Lee J, Lee MH, Lee SK, Kim WS, Jung SY, Kim Z, Lee J, Youn HJ. Unmet needs and quality of life of caregivers of Korean breast cancer survivors: a cross-sectional study. Ann Surg Treat Res 2021; 101:69-78. [PMID: 34386455 PMCID: PMC8331555 DOI: 10.4174/astr.2021.101.2.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose As the survival rates of cancer patients have been increasing due to early diagnosis and technological advances in treatment, their caregiver burden has also emerged as an important issue. In view of this situation, this study aims to investigate the unmet needs and quality of life of caregivers of Korean breast cancer survivors. Methods A multicenter cross-sectional interview survey was performed among 160 caregivers of Korean breast cancer survivors. Caregivers who gave written informed consent to participate completed the Comprehensive Needs Assessment Tool for Cancer Caregivers and EuroQol-5 Dimensions. Results The mean age of the caregivers was 46.4 years, 44.4% (71 of 160) were spouses of patients, and 52.5% (84 of 160) were personally taking care of cancer survivors. Unmet needs were highest in the ‘healthcare staff’ domain and the item with the highest level of unmet needs was ‘needed information about the current status of the patient's illness and its future courses.’ Poorer quality of life was closely related to higher levels of unmet needs. In multiple regression analysis, older age, employment, the presence of religion, and higher levels of stress and despair in daily life were associated with higher levels of unmet needs. Conclusion The most prevalent unmet need in Korean breast cancer caregivers was found in the ‘healthcare staff’ domain, and their quality of life was closely related to unmet needs. Therefore, healthcare staff is required to make efforts to accurately identify breast cancer caregivers vulnerable in terms of unmet needs and address their unmet needs.
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Affiliation(s)
- Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Sung Kim
- Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Juhyung Lee
- Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Hyun Jo Youn
- Department of Surgery, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University and Biomedical Research Institute, Jeonju, Korea
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15
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Koreli A, Briassoulis G, Sideris M, Philalithis A, Papagrigoriadis S. Transanal Endoscopic Microsurgery (TEMS) for Rectal Cancer: Patient Decision-making, Postoperative Experience and Quality of Life. In Vivo 2021; 35:1235-1245. [PMID: 33622926 DOI: 10.21873/invivo.12374] [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: 01/02/2021] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Transanal endoscopic microsurgery (TEMS) is a form of minimally invasive surgery for selected rectal cancers. The aim of this study was to explore the factors affecting patients' decision-making concerning the choice of surgical treatment as well as to measure the Quality of Life (QoL) post-TEMS. PATIENTS AND METHODS Thirty-four patients with rectal cancer stage T1/T2-N0-M0 that underwent TEMS were studied. The questionnaires used included the Short Form SF12v2, Wexner Score (CCF-FIS) and the Sexual Function Questionnaire (SFQ). The patients' views on experience and treatment decision were obtained with a custom-designed questionnaire. Questionnaires were completed at a mean of 6.9 years following treatment. RESULTS The factors that influenced the patients' decisions were: experience satisfaction (p=0.003), postoperative bowel function (p<0.001), lower incontinence score (p=0.020) and agreement of TEMS experience with preoperative information (p=0.049). Treatment experience satisfaction was associated with family support (p=0.034) and agreement with preoperative information (p=0.047), better bowel function (p=0.026) and mental QoL (MCS) (p=0.003). CONCLUSION factors important to patients when reflecting on treatment experience are adequate and reliable information, a good QoL and the presence of family support. Clinicians should incorporate those parameters in their practice when assisting patients in making a surgical treatment choice and provide informed consent on TEMS for rectal cancer.
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Affiliation(s)
- Alexandra Koreli
- Medical School, University of Crete, Heraklion, Greece; .,Nursing Department, University of West Attica, Athens, Greece
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16
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Fatigante M, Zucchermaglio C, Alby F. Being in Place: A Multimodal Analysis of the Contribution of the Patient's Companion to "First Time" Oncological Visits. Front Psychol 2021; 12:664747. [PMID: 34149558 PMCID: PMC8209470 DOI: 10.3389/fpsyg.2021.664747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Companions to medical visits have been alternatively viewed as members who “support” or “inhibit” and “interfere” with the doctor-patient interaction. One way of looking at the companions' contribution to medical visits is by coding roles or functions of their communicative behavior. Our paper aims at reconsidering these findings and analyzing how the companion participation is a local and sequential accomplishment, changing from time to time in the consultation. The paper relies upon an overall collection of 58 videorecordings of first oncological visits. Visits were conducted in two different hospitals, one of which a University hospital, and by different oncologists, including both senior professionals and (in the second setting) medical students in oncology. Visits were fully transcribed according to the Jeffersonian conventions and authors examined the transcripts and video according to the methodology of Conversation Analysis. The aim of the paper focused on how patient's companions orient and contribute to the accomplishment of the different aims and activities at different stages of the visit as an institutional speech event. The multimodal analysis of turns and actions (such as, gaze shifts, prosodic modulation, bodily arrangements), and the close examination of the sequential and temporal arrangements of companions' and their co-participants' turns revealed that companions finely attune to the multiparty framework of the encounter and the institutional constraints that govern the oncological first visit. Overall, results show two relevant features: that companions act as to preserve the doctor-patient interaction and to maintain the patient as the most responsible and legitimate agent in the interaction; that companions' contributions are relevant to the activities that sequentially unfold at different stages in the consultation (e.g., history taking, problem presentation, treatment recommendation etc.). The study complements earlier findings on the companion's roles, showing how these are highly mobile, multimodal and multiparty accomplishments, and they are tied to the specific contingencies of the visit. The results solicit to consider the value of multimodal analysis in understanding the complexity of multiparty communication in medical setting, and make it usable also in medical education.
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Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Alby
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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Sobota A, Ozakinci G. "Will It Affect Our Chances of Having Children?" and Feeling "Like a Ticking Bomb" -The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer. Front Psychol 2021; 12:632162. [PMID: 34149518 PMCID: PMC8206503 DOI: 10.3389/fpsyg.2021.632162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence. Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses. Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important. Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.
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Affiliation(s)
- Aleksandra Sobota
- University of St Andrews, School of Medicine, St Andrews, United Kingdom
| | - Gozde Ozakinci
- University of St Andrews, School of Medicine, St Andrews, United Kingdom
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18
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Melis P, Galletta M, Aviles Gonzalez CI, Contu P, Jimenez Herrera MF. Experiencing communication related to knowing the cancer diagnosis and prognosis: A multi-perspective interpretative phenomenological study. Eur J Oncol Nurs 2021; 51:101904. [PMID: 33578333 DOI: 10.1016/j.ejon.2021.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/12/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the phenomenon of communication related to knowing the diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses. METHODS Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) -who were linked by a carer-cared relationship-were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants' narratives. RESULTS Two overarching themes were identified: The first theme "the «what is it?» and the «what will happen to me?»" illustrates the two different paths of communication of diagnosis and prognosis. The second theme "Matching and mismatching in identifying the others as speakers" shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions. CONCLUSIONS Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses' perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
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Affiliation(s)
- Paola Melis
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | | | - Paolo Contu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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19
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Moore C, Hassett D, Dunne S. Health literacy in cancer caregivers: a systematic review. J Cancer Surviv 2021; 15:825-836. [PMID: 33409857 DOI: 10.1007/s11764-020-00975-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Cancer caregivers play a vital role in the care and health decision-making of cancer survivors. Consequently, their health literacy levels may be particularly important, as low levels may impede adequate care provision. As such, the current review aimed to systematically examine the literature on health literacy amongst cancer caregivers. METHODS We systematically searched the following databases using controlled vocabulary and free-text terms: PsychINFO, MEDLINE, EMBASE, CINAHL and Web of Science. Peer-reviewed empirical studies that explicitly measured and reported cancer caregiver health literacy levels were included. RESULTS The search yielded six articles consisting of 593 cancer caregivers exploring health literacy and eHealth literacy. There was substantial variation in health literacy measurement tools used across included studies, precluding the possibility of conducting a meta-analysis. The included articles reported significant associations (limited to single studies) between caregiver health/eHealth literacy and (i) cancer survivor demographics, (ii) caregivers' communication style, (iii) caregiver Internet access and (iv) caregiver coping strategies. CONCLUSIONS Findings highlight a need for future longitudinal research regarding cancer caregiver health literacy incorporating more standardized and population-specific measurement approaches. In particular, there is a pressing need to investigate factors associated with cancer caregiver health literacy to inform the development/delivery of future interventions. IMPLICATIONS FOR CANCER SURVIVORS Future high-quality research which investigates the factors which contribute towards sub-optimal health literacy amongst cancer caregivers would aid in the development of appropriate and effective health literacy interventions in these groups. Such interventions would allow this important group to provide appropriate support to cancer survivors and enhance survivors' engagement in their health and wellbeing.
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Affiliation(s)
- Chloe Moore
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Simon Dunne
- School of Psychology, Dublin City University, Dublin, Ireland.
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20
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Lawhon VM, England RE, Wallace AS, Williams CP, Williams BR, Niranjan SJ, Ingram SA, Rocque GB. "It's important to me": A qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer. Psychooncology 2020; 30:167-175. [PMID: 32964517 DOI: 10.1002/pon.5545] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 08/25/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Shared decision-making (SDM) occurs when physicians and patients jointly select treatment that aligns with patient care goals. Incorporating patient preferences into the decision-making process is integral to successful decision-making. This study explores factors influencing treatment selection in older patients with early-stage breast cancer (EBC). METHODS This qualitative study included women age ≥65 years with EBC. To understand role preferences, patients completed the Control Preferences Scale. Semi-structured interviews were conducted to explore patients' treatment selection rationale. Interview transcripts were analyzed using a constant comparative method identifying major themes related to treatment selection. RESULTS Of 33 patients, the majority (48%) desired shared responsibility in treatment decision-making. Interviews revealed that EBC treatment incorporated three domains: Intrinsic and extrinsic influences, clinical characteristics, and patient values. Patients considered 19 treatment selection themes, the most prioritized including physician trust and physical side effects. CONCLUSIONS Because preferences and approach to treatment selection varied widely in this sample of older, EBC patients, more research is needed to determine best practices for preference incorporation to optimize SDM at the time of treatment decisions.
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Affiliation(s)
- Valerie M Lawhon
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca E England
- School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Courtney P Williams
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beverly R Williams
- Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soumya J Niranjan
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stacey A Ingram
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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21
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Keast R, Butow PN, Juraskova I, Laidsaar-Powell R. Online resources for family caregivers of cognitively competent patients: A review of user-driven reputable health website content on caregiver communication with health professionals. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30235-4. [PMID: 32739067 DOI: 10.1016/j.pec.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Most patients want their family involved in consultations and decisions, however some family caregivers report feeling overwhelmed and unsure of their role. As caregivers are increasingly looking to medical websites for guidance, this study aimed to review reputable web-resources available to inform family caregivers on how to be involved in medical consultations and decisions. METHODS Google searches were performed using lay search strings, to imitate how a cancer caregiver may locate information. Relevant webpages were included if they were directed at caregivers and from a reputable health organisation. Qualitative content analyses were performed on the included webpages. RESULTS 22 webpages were included and 8 were directed at caregivers of cancer patients. Six key categories of information were identified: preparing for consultations, helping during consultations, advocating for the patient, decision-making, communicating in hospital settings, and communicating with family and friends. CONCLUSION A range of online resources were found to guide family caregivers, particularly cancer caregivers, on involvement in consultations. However, few provided information to caregivers on complex situations such as treatment decision-making, advocating for patient's needs, and communicating in a hospital setting. PRACTICE IMPLICATIONS Clinicians can actively refer family caregivers to online resources that support caregiver communication in medical settings.
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Affiliation(s)
- Rachael Keast
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
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Bracher M, Stewart S, Reidy C, Allen C, Townsend K, Brindle L. Partner involvement in treatment-related decision making in triadic clinical consultations - A systematic review of qualitative and quantitative studies. PATIENT EDUCATION AND COUNSELING 2020; 103:245-253. [PMID: 31477515 DOI: 10.1016/j.pec.2019.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/25/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Explore how partners are involved in treatment-related decision-making within triadic clinical encounters. METHODS Studies were identified via database searches and reference lists. One author assessed eligibility of studies, which were verified by an additional co-author. Data were extracted by one author and cross-checked for accuracy by a second. Quality of articles was assessed using Qualsyst. Retrieved studies were categorised by one author, and agreed through discussion. RESULTS From 2442 records, 14 studies were included and categorised as: (1) Descriptions of partner role and behaviour; (2) Role intentions of partners; (3) Relationship between partner and patient behaviour; (4) HCP-Partner interactions. CONCLUSION Partners are often involved in triadic clinical consultations that have implications for treatment-related decision making. Most studies offered general descriptions but lacked detailed investigation of communicative processes in triads and how these may operate with partners vs. other companions. PRACTICE IMPLICATIONS Existing studies lack detailed investigation through direct observation of the processes of partner involvement. Research in other areas of clinical communication suggests that future interventions could be informed by attention to the following areas: partner behaviour vs. other companion types in triads; relationships between partner involvement and decision-making processes; partner involvement in triads vs. other groups (e.g. quadratic).
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Affiliation(s)
- Mike Bracher
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Simon Stewart
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Claire Reidy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Chris Allen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Kay Townsend
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Lucy Brindle
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
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Gray TF, Nolan MT, Clayman ML, Wenzel JA. The decision partner in healthcare decision-making: A concept analysis. Int J Nurs Stud 2019; 92:79-89. [PMID: 30743199 DOI: 10.1016/j.ijnurstu.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The decision partner concept emerged to describe someone who contributes to healthcare decision-making with a patient. There is a need for greater precision and consensus surrounding its conceptual definition and use in broader populations. OBJECTIVE To define and describe the decision partner concept within the context of healthcare decision-making. DESIGN A concept analysis. DATA SOURCES We searched the following databases for articles published between 1990-2017: PsychINFO, PubMed, Embase, and CINAHL. We included qualitative, quantitative, or mixed methods studies that used the term decision partner in the context of healthcare decision-making. METHODS We applied the Walker and Avant method to identify the antecedents, attributes, related concepts, consequences, and empirical referents of the concept, with major themes identified. RESULTS From the 112 articles included in this concept analysis, 6 defining attributes of decision partner were identified: (1) has a relationship with the patient, (2) demonstrates a willingness to participate in decision-making, (3) articulates a clear understanding of both the patient's health condition and the decisions that must be made, (4) demonstrates decision-making self-efficacy; (5) exemplifies an emotional capacity to participate in decision-making, and (6) willing to fulfill several supportive roles including patient advocate and the "hub of information". CONCLUSIONS A unifying definition and discussion of the decision partner concept has been developed. Our findings: (1) offer insights into refining the concept across various diseases and healthcare encounters, (2) contribute to developing theoretical models and empirical research to refine antecedents, attributes, consequences, (3) serve as a foundation to develop instruments to measure the concept and (4) highlight the need to design interventions that include and support decision partners in healthcare decision-making.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.
| | - Marie T Nolan
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
| | - Marla L Clayman
- American Institutes for Research, Chicago, IL, United States
| | - Jennifer A Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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24
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Asiedu GB, Ridgeway JL, Carroll K, Jatoi A, Radecki Breitkopf C. "Ultimately, mom has the call": Viewing clinical trial decision making among patients with ovarian cancer through the lens of relational autonomy. Health Expect 2018; 21:981-989. [PMID: 29655265 PMCID: PMC6250882 DOI: 10.1111/hex.12691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study employs the concept of relational autonomy to understand how relational encounters with family members (FMs) and care providers may shape decisions around ovarian cancer patients' clinical trial (CT) participation. The study also offers unique insights into how FMs view patients' decision making. METHODS In-depth interviews were conducted with 33 patients with ovarian cancer who had been offered a CT and 39 FMs. Data were inductively analysed using a thematic approach and deductively informed by constructs derived from the theory of relational autonomy (RA). RESULTS Patients' relationships, experiences and social status were significant resources that shaped their decisions. Patients did not give equal weight to all relationships and created boundaries around whom to include in decision making. Doctors' recommendations and perceived enthusiasm were described as influential in CT decisions. Both patients with ovarian cancer and their FMs maintained that patients have the "final say," indicating an individualistic autonomy. However, maintaining the "final say" in the decision-making process is constitutive of patients' relationships, emphasizing a relational approach to autonomy. FMs support patients' autonomy and they do so particularly when they believe the patient is capable of making the right choices. CONCLUSIONS Although ethical principles underlying informed consent for CT participation emphasize individual autonomy, greater attention to relational autonomy is warranted for a more comprehensive understanding of CT decision making.
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Affiliation(s)
- Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Jennifer L. Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
| | - Katherine Carroll
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
- College of Arts and Social SciencesAustralian National UniversityCanberraACTAustralia
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Vadaparampil ST, Cragun D. Shared decision making: Implications for return of results from whole-exome and whole-genome sequencing. Transl Behav Med 2018; 8:80-84. [PMID: 29385585 DOI: 10.1093/tbm/ibx048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this issue, Kaphingst and colleagues report on young breast cancer patient's preferences for learning about various results from genomic sequencing. In our commentary, we discuss the results in light of the burgeoning clinical use of whole-exome and whole-genome sequencing (WES/WGS). In particular, we consider findings in the context of a Shared Decision Making approach to return of results. We also identify additional important factors to consider that may influence patient preferences that were largely absent from the paper by Kaphingst and colleagues, including cultural context, costs of testing, and provider factors.
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Affiliation(s)
- Susan T Vadaparampil
- Moffitt Cancer Center, Division of Population Science, Health Outcomes and Behavior Program, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Deborah Cragun
- Moffitt Cancer Center, Division of Population Science, Health Outcomes and Behavior Program, Tampa, FL, USA.,Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
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Witham G, Haigh C, Mitchell D, Beddow A. Carer Experience Supporting Someone With Dementia and Cancer: A Narrative Approach. QUALITATIVE HEALTH RESEARCH 2018; 28:813-823. [PMID: 29082800 PMCID: PMC5871020 DOI: 10.1177/1049732317736285] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we examine the challenges of informal carers supporting someone with dementia and cancer within the United Kingdom. Interviews were conducted with seven informal carers using a narrative approach to examine the construction of their experiences. Our findings demonstrate how informal carers navigate a path through complex cancer treatments and support their relative. A cancer diagnosis often requires multiple treatment visits to an oncology center, and this can be challenging for carers. They find that they need to coordinate and manage both health professionals and their relative in terms of getting access to appropriate services and support. This process can be particularly challenging in the presence of a cognitive impairment that often demands effective communication with different agencies. Carers frequently experienced multiple challenges including dealing with the stigma that is characteristic of the dementia experience and the added complexity of negotiating this within a cancer care context.
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Affiliation(s)
- Gary Witham
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Carol Haigh
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Duncan Mitchell
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Anna Beddow
- The University of Manchester, Manchester, United Kingdom
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Molassiotis A, Roberts S, Cheng HL, To HKF, Ko PS, Lam W, Lam YF, Abbott J, Kiefer D, Sanmugarajah J, Marshall AP. Partnering with families to promote nutrition in cancer care: feasibility and acceptability of the PIcNIC intervention. BMC Palliat Care 2018; 17:50. [PMID: 29558917 PMCID: PMC5859412 DOI: 10.1186/s12904-018-0306-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background Malnutrition is frequent in patients with cancer, particularly those in advanced stages of the disease. The aim of the present study was to test the feasibility of a family-centred nutritional intervention, based on the Family Systems theory and past research. Methods This was a single-arm trial assessing feasibility (eligibility, recruitment and retention rates); acceptability by patients, family caregivers and health professionals; intervention fidelity, and energy/protein intake (in one site only). Two sites were involved; one each in Australia (AUS) and Hong Kong (HK), with one site delivering the intervention to oncology patients receiving curative treatments in the hospital, and the other to advanced cancer patients in the home. Results The sample included 53 patients (23 from AUS and 30 from HK), 22 caregivers (3 from AUS and 19 from HK) and 30 health professionals (20 from AUS and 10 from HK). Recruitment was difficult in the acute inpatient oncology care setting (AUS) and feasibility criteria were not met. Sufficient recruitment took place in the home care setting with advanced cancer patients in HK. Patients, family members and health professionals found the intervention helpful and acceptable, and patients and families indicated they would take part in the future in a similar study. Energy and protein intake improved from baseline to end of intervention (mean 22 kcal/kg/day to 26 and 0.9 g/kg/day to 1.0 respectively). Conclusion The new intervention is feasible in a home setting when delivered to patients with advanced cancer, acceptable to patients and families, and has the potential to improve nutritional status in patients. A large randomised trial is warranted in the future. Electronic supplementary material The online version of this article (10.1186/s12904-018-0306-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Shelley Roberts
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Cost, Australia
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Henry K F To
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Po Shan Ko
- Department of Medicine, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Wang Lam
- Dietetics Department, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Yuk Fong Lam
- Department of Medicine, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Jessica Abbott
- Gold Coast University Hospital, Gold Coast Health, Southport, Australia
| | - Deborah Kiefer
- Gold Coast University Hospital, Gold Coast Health, Southport, Australia
| | | | - Andrea P Marshall
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Cost, Australia.,Gold Coast University Hospital, Gold Coast Health, Southport, Australia
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Partanen E, Lemetti T, Haavisto E. Participation of relatives in the care of cancer patients in hospital-A scoping review. Eur J Cancer Care (Engl) 2018; 27:e12821. [PMID: 29337413 DOI: 10.1111/ecc.12821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
Abstract
The purpose of the review was to describe what kind of research has been conducted concerning relatives' participation in the care of cancer patients in hospital and how relatives have participated in the care. Data (n = 9) were identified through a manual search and by searching the electronic databases (n = 8) Cinahl, PubMed and Cochrane Library and analysed with deductive content analysis. According to the review, participation in the concrete care appeared as taking care of comprehensive care and the quality of care, helping with daily activities and helping the healthcare professionals. Emotional support appeared as protecting, supporting and visiting the patient and discussing with the patient. Participation in decision-making appeared as acting as an advocate for the patient, participating in the discussion concerning the decision-making and participating in the discussion concerning the decisions of end of life. According to the review, research concerning this topic seems to be rare. While hospital periods are shortening and homecare is increasing, the role of relatives as a supporter of the cancer patient is becoming even stronger. In the future, more research should be conducted how the patients experience participation and what are their wishes.
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Affiliation(s)
- E Partanen
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - T Lemetti
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - E Haavisto
- Department of Nursing Science, Hospital District of Satakunta, University of Turku, Turku, Finland
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Lamore K, Montalescot L, Untas A. Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:2172-2181. [PMID: 28838630 DOI: 10.1016/j.pec.2017.08.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. METHODOLOGY A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. RESULTS Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. CONCLUSION FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. PRACTICE IMPLICATIONS Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included.
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Affiliation(s)
- Kristopher Lamore
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
| | - Lucile Montalescot
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
| | - Aurélie Untas
- Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cité, 71, Avenue Edouard-Vaillant, 92100, Boulogne-Billancourt, France.
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A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder. Community Ment Health J 2017; 53:958-971. [PMID: 28102459 DOI: 10.1007/s10597-016-0077-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023]
Abstract
This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.
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Gad KT, Lassen U, Mau-Søerensen M, Høybye MT, Johansen C. Patient information in phase 1 trials: A systematic review. Psychooncology 2017; 27:768-780. [DOI: 10.1002/pon.4559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Katrine Toubro Gad
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Ulrik Lassen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Morten Mau-Søerensen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Mette Terp Høybye
- Interdisciplinary Research Unit; Elective Surgery Center; Silkeborg Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Unit of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
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Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study. Oncotarget 2017; 8:22113-22122. [PMID: 27769072 PMCID: PMC5400651 DOI: 10.18632/oncotarget.12770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose Patients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives. Methods Multicenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once). Results Our analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians difficulty in coping with patients suffering may limit their access to elements that can improve patients capacity to live as well as possible. Conclusions During cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.
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Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases. Brain Sci 2017; 7:brainsci7100122. [PMID: 28946652 PMCID: PMC5664049 DOI: 10.3390/brainsci7100122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient’s ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients’ ability to consent to future medical treatment and make decisions related to everyday activities.
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Hedden L, Wassersug R, Mahovlich S, Pollock P, Sundar M, Bell RH, Goldenberg L, Higano CS. Evaluating an educational intervention to alleviate distress amongst men with newly diagnosed prostate cancer and their partners. BJU Int 2017; 120:E21-E29. [DOI: 10.1111/bju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lindsay Hedden
- Centre for Clinical Epidemiology and Evaluation; University of British Columbia; Vancouver General Hospital; Vancouver BC Canada
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
- School of Population and Public Health; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Richard Wassersug
- Department of Urologic Sciences; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Sarah Mahovlich
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
| | - Phil Pollock
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
| | - Monita Sundar
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
| | - Robert H. Bell
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
| | - Larry Goldenberg
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
- Department of Urologic Sciences; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Celestia S. Higano
- Vancouver Prostate Centre; Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital; Vancouver BC Canada
- Department of Urologic Sciences; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- Seattle Cancer Care Alliance; University of Washington; Seattle WA USA
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Sipples R, Taylor R, Kirk-Walker D, Bagcivan G, Dionne-Odom JN, Bakitas M. Perioperative Palliative Care Considerations for Surgical Oncology Nurses. Semin Oncol Nurs 2017; 33:9-22. [DOI: 10.1016/j.soncn.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ng H, Griva K, Lim H, Tan J, Mahendran R. The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore. Psychol Health 2016; 31:1293-310. [DOI: 10.1080/08870446.2016.1204450] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Laidsaar-Powell R, Butow P, Bu S, Charles C, Gafni A, Fisher A, Juraskova I. Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences. PATIENT EDUCATION AND COUNSELING 2016; 99:1146-1155. [PMID: 26873544 DOI: 10.1016/j.pec.2016.01.014] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. METHODS Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. RESULTS Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. CONCLUSION This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. PRACTICE IMPLICATIONS Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia.
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Stella Bu
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Cathy Charles
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Alana Fisher
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
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Balfe M, O'Brien K, Timmons A, Butow P, O' Sullivan E, Gooberman-Hill R, Sharp L. The unmet supportive care needs of long-term head and neck cancer caregivers in the extended survivorship period. J Clin Nurs 2016; 25:1576-86. [DOI: 10.1111/jocn.13140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Katie O'Brien
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Aileen Timmons
- National Cancer Registry of Ireland; Cork Airport Business Park; Cork Ireland
| | - Phyllis Butow
- Centre for Medical Psychology; University of Sydney; Sydney NSW Australia
| | | | | | - Linda Sharp
- Newcastle University; Professor of Cancer Epidemiology; Cork Ireland
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Wittenberg E, Goldsmith J, Ferrell B, Ragan SL. Promoting improved family caregiver health literacy: evaluation of caregiver communication resources. Psychooncology 2016; 26:935-942. [PMID: 26990206 DOI: 10.1002/pon.4117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/13/2016] [Accepted: 02/16/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Family caregivers of cancer patients have a vital role in facilitating and sharing information about cancer, revealing a need to develop caregiver health literacy skills to support caregiver communication. The goal of this study was to investigate caregiver print materials and develop and assess a new caregiver communication resource titled A Communication Guide for CaregiversTM . METHODS Using a model of six domains of caregiver health literacy skills, print cancer education materials were collected and evaluated for caregiver communication support. A new caregiver communication resource was also developed and assessed by caregivers and healthcare providers. Caregivers reviewed content and assessed utility, relatability, and reading quality. Healthcare providers also assessed whether the material would be understandable and usable for cancer caregivers. RESULTS Only three of the 28 print materials evaluated were written at the recommended sixth grade reading level and only five addressed all six caregiver health literacy skills. Readability scores for A Communication Guide for CaregiversTM were at the sixth grade level, and caregivers reported its contents were relatable, useful, and easy to read. Healthcare providers also rated the material as easy for patient/family members of diverse backgrounds and varying levels of literacy to understand and use. CONCLUSIONS Existing print-based caregiver education materials do not address caregivers' health literacy skill needs and are aimed at a highly literate caregiving population. A Communication Guide for CaregiversTM meets health literacy standards and family caregiver and provider communication needs. The findings are relevant for healthcare professionals who provide cancer education. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elaine Wittenberg
- City of Hope, Nursing Research and Education, Duarte, CA, 91010, United States
| | - Joy Goldsmith
- University of Memphis-Department of Communication, Memphis, TN, 38152, United States
| | - Betty Ferrell
- City of Hope, Nursing Research, Duarte, CA, 91010, United States
| | - Sandra L Ragan
- University of Oklahoma, Department of Communication, Norman, OK, United States
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Mahendran R, Tan JYS, Griva K, Lim HA, Ng HY, Chua J, Lim SE, Kua EH. A pilot, quasi-experimental, mixed methods investigation into the efficacy of a group psychotherapy intervention for caregivers of outpatients with cancer: the COPE study protocol. BMJ Open 2015; 5:e008527. [PMID: 26586322 PMCID: PMC4654340 DOI: 10.1136/bmjopen-2015-008527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the rising trend of cancer prevalence and increase in family caregiving, little attention has been paid to the efficacy of psychosocial interventions among Asian caregiver samples, particularly support groups, given the benefits that have been shown in studies on Western populations. This trial aims to evaluate the effectiveness of a pilot 4-week group psychotherapy for Singaporean family caregivers of patients receiving outpatient care. METHODS AND ANALYSIS Facilitated by a clinical psychologist, this intervention is primarily based on the brief integrative psychological therapy with a supportive-expressive intent. Participants will be recruited while they are accompanying their care recipients for outpatient consultations. Since this is a pilot study, a sample size of 120 participants is targeted on the basis of sample sizes of previous studies. The study adopts a quasi-experimental design, as participants are assigned the intervention or control arms based on their availability to attend the intervention. A mixed methods approach is used to evaluate the outcomes of the intervention. A self-administered battery of tests is completed at four time points: baseline, postintervention and follow-up at 1-month and 2-month postinterventions; semi-structured interviews are conducted at baseline and post-intervention. Primary outcomes are quality of life and anxious and depressive symptoms; secondary outcomes are stress and basic psychological needs. Analysis using analysis of covariance would be conducted to determine the effectiveness of the intervention. ETHICS AND DISSEMINATION This study protocol has ethics approval from the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref: 2013/00662). Written informed consent is obtained from every participant. Results will be disseminated through journals and conferences, and will be particularly relevant for clinicians intending to implement similar support groups to address the psychosocial concerns of caregivers, as well as for researchers seeking to refine the structure and evaluate the effectiveness of such programmes. TRIAL REGISTRATION NUMBER Current Controlled Trials NCT02120183 (https://clinicaltrials.gov/show/NCT02120183).
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Affiliation(s)
- Rathi Mahendran
- Department of Psychological Medicine, National University Hospital, Singapore
- Department of Psychological Medicine, National University of Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joyce Yi Siang Tan
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
| | - Haikel Asyraf Lim
- Department of Psychological Medicine, National University of Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Hui Ying Ng
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Joanne Chua
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Siew Eng Lim
- National University Cancer Institute, Singapore, National University Health System, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, National University Hospital, Singapore
- Department of Psychological Medicine, National University of Singapore, Singapore
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Laidsaar-Powell R, Butow P, Bu S, Dear R, Fisher A, Coll J, Juraskova I. Exploring the communication of oncologists, patients and family members in cancer consultations: development and application of a coding system capturing family-relevant behaviours (KINcode). Psychooncology 2015; 25:787-94. [DOI: 10.1002/pon.4003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
- Psycho-Oncology Co-operative Research Group (PoCoG); The University of Sydney; Sydney New South Wales Australia
| | - Stella Bu
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Rachel Dear
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Alana Fisher
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Joseph Coll
- Psycho-Oncology Co-operative Research Group (PoCoG); The University of Sydney; Sydney New South Wales Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
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Affiliation(s)
- Barry Main
- NIHR Doctoral Research Fellow, School of Social and Community Medicine, University of Bristol, Bristol
| | - Glyn Elwyn
- Professor and Senior Scientist, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH 03755, USA
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43
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Yuen EYN, Dodson S, Batterham RW, Knight T, Chirgwin J, Livingston PM. Development of a conceptual model of cancer caregiver health literacy. Eur J Cancer Care (Engl) 2015; 25:294-306. [PMID: 25630765 DOI: 10.1111/ecc.12284] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/28/2022]
Abstract
Caregivers play a vital role in caring for people diagnosed with cancer. However, little is understood about caregivers' capacity to find, understand, appraise and use information to improve health outcomes. The study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy. Six concept mapping workshops were conducted with 13 caregivers, 13 people with cancer and 11 healthcare providers/policymakers. An iterative, mixed methods approach was used to analyse and synthesise workshop data and to generate the conceptual model. Six major themes and 17 subthemes were identified from 279 statements generated by participants during concept mapping workshops. Major themes included: access to information, understanding of information, relationship with healthcare providers, relationship with the care recipient, managing challenges of caregiving and support systems. The study extends conceptualisations of health literacy by identifying factors specific to caregiving within the cancer context. The findings demonstrate that caregiver health literacy is multidimensional, includes a broad range of individual and interpersonal elements, and is influenced by broader healthcare system and community factors. These results provide guidance for the development of: caregiver health literacy measurement tools; strategies for improving health service delivery, and; interventions to improve caregiver health literacy.
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Affiliation(s)
- E Y N Yuen
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, Victoria, Australia
| | - S Dodson
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, Victoria, Australia
| | - R W Batterham
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, Victoria, Australia
| | - T Knight
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - J Chirgwin
- Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia
| | - P M Livingston
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
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Yuen EYN, Knight T, Dodson S, Ricciardelli L, Burney S, Livingston PM. Development of the Health Literacy of Caregivers Scale - Cancer (HLCS-C): item generation and content validity testing. BMC FAMILY PRACTICE 2014; 15:202. [PMID: 25491883 PMCID: PMC4269846 DOI: 10.1186/s12875-014-0202-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/24/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Health literacy refers to an individual's ability to engage with health information and services. Cancer caregivers play a vital role in the care of people with cancer, and their capacity to find, understand, appraise and use health information and services influences how effectively they are able to undertake this role. The aim of this study was to develop an instrument to measure health literacy of cancer caregivers. METHOD Content areas for the new instrument were identified from a conceptual model of cancer caregiver health literacy. Item content was guided by statements provided by key stakeholders during consultation activities and selected to be representative across the range of cancer caregiver experiences. Content validity of items was assessed through expert review (n = 7) and cognitive interviews with caregivers (n = 16). RESULTS An initial pool of 82 items was generated across 10 domains. Two categories of response options were developed for these items: agreement with statements, and difficulty undertaking presented tasks. Expert review revealed that the majority of items were relevant and clear (Content Validity Index > 0.78). Cognitive interviews with caregivers suggested that all except three items were well understood. CONCLUSION A resultant 88 item questionnaire was developed to assess cancer caregiver health literacy. Further work is required to assess the construct validity and reliability of the new measure, and to remove poorly performing and redundant items, which will result in a shorter, final measure. The new measure has the potential to inform the development and evaluation of interventions and the improvement of health service delivery to cancer caregivers.
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Affiliation(s)
- Eva Y N Yuen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Tess Knight
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Sarity Dodson
- Public Health Innovation, Deakin University, Melbourne, Australia.
| | - Lina Ricciardelli
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Susan Burney
- School of Psychological Sciences, Monash University, Melbourne, Australia.
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The interaction between informal cancer caregivers and health care professionals: a survey of caregivers’ experiences of problems and unmet needs. Support Care Cancer 2014; 23:1719-33. [DOI: 10.1007/s00520-014-2529-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/17/2014] [Indexed: 11/26/2022]
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Kane HL, Halpern MT, Squiers LB, Treiman KA, McCormack LA. Implementing and evaluating shared decision making in oncology practice. CA Cancer J Clin 2014; 64:377-88. [PMID: 25200391 DOI: 10.3322/caac.21245] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice.
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Affiliation(s)
- Heather L Kane
- Health Services Analyst, Primary Prevention Research and Evaluation Program, RTI International, Research Triangle Park, North Carolina
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Shin DW, Shin J, Kim SY, Park B, Yang HK, Cho J, Lee ES, Kim JH, Park JH. Cross-cultural validation of Cancer Communication Assessment Tool in Korea. Psychooncology 2014; 24:197-203. [DOI: 10.1002/pon.3629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center; Seoul National University Hospital; Seoul Korea
- Cancer Survivorship Clinic; Seoul National University Cancer Hospital; Seoul Korea
| | - Jooyeon Shin
- Institute for Human Behavior Research; Department of Psychology, Yonsei University; Seoul Korea
| | - So Young Kim
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
| | - Boram Park
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Juhee Cho
- Department of Health Sciences and Technology, SAHIST and School of Medicine; Sungkyunkwan University; Seoul Korea
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Eun Sook Lee
- Research Institute; National Cancer Center; Goyang Korea
- Center for Breast Cancer; National Cancer Center; Goyang Korea
| | - Jong Heun Kim
- Mental Health Clinic, Center for Clinical Specialty; National Cancer Center; Goyang Korea
| | - Jong-Hyock Park
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
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Del Piccolo L, Goss C, Bottacini A, Rigoni V, Mazzi MA, Deledda G, Ballarin M, Molino A, Fiorio E, Zimmermann C. Asking questions during breast cancer consultations: does being alone or being accompanied make a difference? Eur J Oncol Nurs 2014; 18:299-304. [PMID: 24629501 DOI: 10.1016/j.ejon.2014.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Companions often accompany patients to cancer consultations. The number of questions asked by patients and companions is an indicator of their active participation. The present study aims to provide first descriptive evidence on the characteristics of unaccompanied and accompanied Italian breast cancer patients that attend the first consultation after surgery and to analyse companions contribution to the type and quantity of questions asked during the consultation. METHOD Seventy consultations of female patients with breast cancer were audio taped. Questions were transcribed and coded by content. Companion's questions were also classified in terms of function. Socio-demographic and clinical data, patients' role preference and confidence in decision making measures were gathered for each patient. Post consultation satisfaction with decision and the perceived level of shared decision making were collected either for the patient and the companion. RESULTS 69% of patients were accompanied, usually by one close family member, either husband or adult child. Non employed or retired patients and those with a preference for passive role in decision making were more likely to be accompanied. Unaccompanied patients and accompanied patients had comparable levels of anxiety, emotional distress and depression and were equally active in asking questions. These levels were far greater than those reported for other cancer patients in the literature. Companions did not increase significantly the number of questions per consultation. CONCLUSION Accompanied and non accompanied patients differed more in socio-demographic than clinical characteristics. Companions sustained the patient and shared information without reducing the level of patient involvement.
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Affiliation(s)
- L Del Piccolo
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - C Goss
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - A Bottacini
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - V Rigoni
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - M A Mazzi
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - G Deledda
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - M Ballarin
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - A Molino
- O.U. of Oncology d.O., Ospedale Civile Maggiore, Hospital Trust of Verona, Italy
| | - E Fiorio
- O.U. of Oncology d.O., Ospedale Civile Maggiore, Hospital Trust of Verona, Italy
| | - C Zimmermann
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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Hogden A, Greenfield D, Nugus P, Kiernan MC. Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care. Health Expect 2013; 18:1769-82. [PMID: 24372800 DOI: 10.1111/hex.12169] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . OBJECTIVE The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? SETTING AND PARTICIPANTS Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. RESULTS Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. DISCUSSION Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. CONCLUSIONS The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia.,Centre for Medical Education and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Matthew C Kiernan
- Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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