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Alfaro-Diaz C, Esandi N, Clausen AM, Canga-Armayor N, Pueyo-Garrigues M, Dieperink KB. Instruments for Assessing Family Functioning in Adults Patients with Cancer: A Systematic Review of Measurement Properties. Semin Oncol Nurs 2024:151729. [PMID: 39277506 DOI: 10.1016/j.soncn.2024.151729] [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: 04/25/2024] [Revised: 08/09/2024] [Accepted: 08/16/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES To identify instruments for assessing family functioning in adults patients with cancer and summarize their psychometric properties. METHODS Psychometric systematic literature review was conducted to June 2023 using four databases: PubMed, CINAHL, Psych INFO, and Web of Science. The psychometric properties of the instruments and the methodological quality of the studies were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. RESULTS Forty-four studies reporting 13 instruments were included. The instruments measured varied attributes of family functioning and the dimensions were heterogeneous. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) was rated the highest in terms of both methodological rigor and instrument quality. However, the Family Adaptability and Cohesion Evaluation Scale (FACES) and the Ice-Expressive Family Functioning Questionnaire (ICE-EFFQ) offer a more comprehensive measure of family functioning, since they assess multiple dimensions of family functioning and demonstrate high-quality measurement properties. CONCLUSIONS Instruments to assess family functioning were heterogeneous and exhibited limited reliability and validity. The FACES and the ICE-EFFQ seem to be the most suitable measures for adult cancer patients and their families. Future research should aim to refine the content of existing instruments and rigorously assess their psychometric properties. IMPLICATIONS FOR NURSING PRACTICE Given the profound impact of cancer on family functioning, the initial step in crafting effective interventions is providing valid and reliable instruments to measure the impact of these interventions. This paper could assist nursing professionals in making informed decisions regarding the most suitable instrument for assessing family functioning in adults patients living with life-threatening illness as is the case with cancer.
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Affiliation(s)
- Cristina Alfaro-Diaz
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Navarra, Spain; IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain
| | - Nuria Esandi
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Navarra, Spain; IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain.
| | - Anne Møller Clausen
- Department of Haematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark
| | - Navidad Canga-Armayor
- IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain; Department of Community, Maternity and Pediatric Nursing, School of Nursing, Universidad de Navarra, Navarra, Spain
| | - María Pueyo-Garrigues
- IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain; Department of Community, Maternity and Pediatric Nursing, School of Nursing, Universidad de Navarra, Navarra, Spain
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
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Doan TTT, Kim J, Kim H, An W, Seo E, Park M. Decision Regret and Decision-Making Process among Caregivers of Older Adults Receiving Home Care: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:105166. [PMID: 39043248 DOI: 10.1016/j.jamda.2024.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Family caregivers of older adults receiving home care often find themselves in situations in which they must make important and difficult decisions, which can cause conflict and regret. To tailor shared decision making in this context, we aimed to identify the most difficult decisions they faced, assess their levels of decision regret, and explore the associated factors. DESIGN This study used a cross-sectional design. SETTING AND PARTICIPANTS Participants included 165 caregivers of older adults who received home care services in Korea. METHODS We identified difficult decisions perceived by family caregivers of older adults and evaluated decision regret using the Decision Regret Scale (DRS), decisional conflict using the Decisional Conflict Scale (DCS), burden of care using the Short Zarit Burden Inventory, and Preference Control Scale (PCS). We then performed descriptive, bivariate, and multivariate linear regression analyses to identify factors predicting decision regret. RESULTS The most frequently reported difficult decisions were related to place of living (71.6%), management of health conditions (15.1%), and end-of-life decisions (13.3%). The mean DCS score was 37.09 (12.67), the DRS score was 32.33 (15.91), and the burden score was 21.81 (8.25). Matching decisions with preferences and aligning decision-making roles significantly reduced regret, while decision conflicts increased regret. CONCLUSIONS AND IMPLICATIONS The positive associations between decision regret, decision conflict, and the alignment of decision-making roles highlight the intricate dynamics involved in the decision-making process for family caregivers. These findings emphasize the need for tailored interventions that recognize and address the diverse factors influencing caregivers' decision-making experiences. Future research exploring the efficacy of targeted interventions such as decision-support programs or caregiver education initiatives could offer valuable insights into mitigating decision-related challenges and improving the overall well-being of both caregivers and care recipients.
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Affiliation(s)
- Thao Thi-Thu Doan
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea; Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jinju Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Heejung Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Wonmi An
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eunkyung Seo
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Myonghwa Park
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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Lenko RA, Hoffman GJ, Robinson-Lane SG, Silveira MJ, Voepel-Lewis T. Achieving goal-concordant care: Formal and informal advance care planning for White, Black, and Hispanic older adults. J Am Geriatr Soc 2024; 72:2412-2422. [PMID: 38760957 PMCID: PMC11323214 DOI: 10.1111/jgs.18971] [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: 01/03/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Advance care planning (ACP) aims to ensure that patients receive goal-concordant care (GCC), which is especially important for racially or ethnically minoritized populations at greater risk of poor end-of-life outcomes. However, few studies have evaluated the impact of advance directives (i.e., formal ACP) or goals-of-care conversations (i.e., informal ACP) on such care. This study aimed to examine the relationship between each of formal and informal ACP and goal-concordant end-of-life care among older Americans and to determine whether their impact differed between individuals identified as White, Black, or Hispanic. METHODS We conducted a retrospective cohort study using 2012-2018 data from the biennial Health and Retirement Study. We examined the relationships of interest using two, separate multivariable logistic regression models. Model 1 regressed a proxy report of GCC on formal and informal ACP and sociodemographic and health-related covariates. Model 2 added interaction terms between race/ethnicity and the two types of ACP. RESULTS Our sample included 2048 older adults. There were differences in the proportions of White, Black, and Hispanic decedents who received GCC (83.1%, 75.3%, and 71.3%, respectively, p < 0.001) and in the use of each type of ACP by racial/ethnic group. In model 1, informal compared with no informal ACP was associated with higher odds of GCC (adjusted odds ratio = 1.38 [95% confidence interval, 1.05-1.82]). In model 2, Black decedents who had formal ACP were more likely to receive GCC than those who did not, but there were no statistically significant differences between decedents of different racial/ethnic groups who had no ACP, informal ACP only, or both types of ACP. CONCLUSIONS Our results build on previous work by indicating the importance of incorporating goals-of-care conversations into routine healthcare for older adults and encouraging ACP usage among racially and ethnically minoritized populations who use ACP tools at lower rates.
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Affiliation(s)
- Rachel A Lenko
- Department of Nursing, Calvin University School of Health, Grand Rapids, Michigan, USA
| | - Geoffrey J Hoffman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Maria J Silveira
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Terri Voepel-Lewis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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Mishkin AD, Allen NC, Cheung SG, Faccini MC, Flicker LS, Shalev D. The Stresses of Surrogate Decision-Making: Contributing Factors and Clinicians' Role in Mitigation. Am J Hosp Palliat Care 2024; 41:895-905. [PMID: 37704184 PMCID: PMC10932874 DOI: 10.1177/10499091231198750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation. METHODS An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience. RESULTS 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision (P = .003), Respondent Religion (P = .015), or religious or spiritual beliefs (P = .024), and having their own health problems (P = .008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful (P < .001), knew the patient's wishes (P = .0011), specifically discussed patient wishes (P < .001), or patient's wishes were documented (P < .001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P < .001), respectful (P = .007), honest (P < .001), and validating (P = .001). CONCLUSIONS Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress.
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Affiliation(s)
- Adrienne D. Mishkin
- Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Nicole C. Allen
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Stephanie G. Cheung
- Department of Psychiatry, New York University Langone Medical Center, New York, NY
| | | | - Lauren S. Flicker
- Montefiore Einstein Center for Bioethics, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell, New York, NY
- Department of Psychiatry, Cornell, New York, NY
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Wen FH, Hsieh CH, Su PJ, Shen WC, Hou MM, Chou WC, Chen JS, Chang WC, Tang ST. Factors Associated With Family Surrogate Decisional-Regret Trajectories. J Pain Symptom Manage 2024; 67:223-232.e2. [PMID: 38036113 DOI: 10.1016/j.jpainsymman.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT/OBJECTIVES The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the three decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care. METHODS This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the four preidentified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first two bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference. RESULTS Decision antecedent factors: Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more postloss depressive symptoms increased odds for the late-emerging trajectory. More pre- and postloss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anticancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anticancer or life-sustaining treatments increased odds for the late-emerging trajectory. CONCLUSION Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F.H.W.), Soochow University, Taipei, Taiwan
| | - Chia-Hsun Hsieh
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (C.H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Po-Jung Su
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; School of Nursing, Medical College (S.T.T.), Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.
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Lu SJ, Ku SC, Liu KF, Chien CH. Decision Self-Efficacy and Decisional Conflict on Reintubation among Surrogates of Ventilated Patients Undergoing Planned Extubation. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:235-244. [PMID: 37838098 DOI: 10.1016/j.anr.2023.10.001] [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: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE Although the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified. METHODS This study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients' background information was also collected. Univariate and multivariate analyses were performed to model the data. RESULTS The mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates' negative affect on decisional conflict was fully mediated by decision self-efficacy. CONCLUSIONS Surrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.
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Affiliation(s)
- Shu-Ju Lu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuei-Fen Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ching-Hui Chien
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Wen FH, Hsieh CH, Hou MM, Su PJ, Shen WC, Chou WC, Chen JS, Chang WC, Tang ST. Decisional-Regret Trajectories From End-of-Life Decision Making Through Bereavement. J Pain Symptom Manage 2023; 66:44-53.e1. [PMID: 36889452 DOI: 10.1016/j.jpainsymman.2023.02.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
CONTEXT Regret plays a central role in surrogate decision making. Research on decisional regret in family surrogates is scarce and lacks longitudinal studies to illustrate the heterogenous, dynamic evolution of decisional regret. OBJECTIVES To identify distinct decisional-regret trajectories from end-of-life (EOL) decision making through the first two bereavement years among surrogates of cancer patients. METHODS A prospective, longitudinal, observational study was conducted on a convenience sample of 377 surrogates of terminally ill cancer patients. Decisional regret was measured by the five-item Decision Regret Scale monthly during the patient's last six months and 1, 3, 6, 13, 18, and 24 months post loss. Decisional-regret trajectories were identified using latent-class growth analysis. RESULTS Surrogates reported substantially high decisional regret (pre- and postloss mean [SD] as 32.20 [11.47] and 29.90 [12.47], respectively). Four decisional-regret trajectories were identified. The resilient trajectory (prevalence: 25.6%) showed a general low decisional-regret level with mild and transient perturbations around the time of patient death only. Decisional regret for the delayed-recovery trajectory (56.3%) accelerated before the patient's death and decreased slowly throughout bereavement. Surrogates in the late-emerging (10.2%) trajectory reported a low decisional-regret level before loss but their decisional regret increased gradually thereafter. The increasing-prolonged trajectory (6.9%) rapidly increased in decisional-regret levels during EOL decision making, peaked one-month post loss, then declined steadily but without a complete resolution. CONCLUSION Surrogates heterogeneously suffered decisional regret from EOL decision making through bereavement as evident by four identified distinct decisional-regret trajectories. Early identification and prevention of increasing/prolonged decisional-regret trajectories is warranted.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F-H.W.), Soochow University, Taipei, Taiwan, R.O.C
| | - Chia-Hsun Hsieh
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (C-H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, R.O.C
| | - Ming-Mo Hou
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC; School of Nursing (S.T.T.), Medical College, Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan, R.O.C.; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C..
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Wilson DM, Bykowski KA, Banamwana G, Bryenton FM, Dou Q, Errasti-Ibarrondo B. Intra-Family End-Of-Life Conflict: Findings of a Research Investigation to Identify Its Incidence, Cause, and Impact. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133504. [PMID: 36216497 DOI: 10.1177/00302228221133504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With few investigations of intra-family end-of-life conflict, this study sought to identify its incidence, cause, and impacts. A questionnaire was completed by 102 hospice/palliative nurses, physicians, and other care providers in Alberta, a Canadian province. Participants reported on how often they had observed intra-family conflict when someone in the family was dying, and the impacts of that conflict. 12 survey participants were then interviewed about the intra-family conflict that they had encountered, with interviews focused on why conflict occurred and what the impacts (if any) were. Nearly 80% of families were thought to experience end-of-life conflict, periodically or continuously, among various family members. The interviews confirmed three reasons for intra-family end-of-life conflict and three conflict outcomes that were revealed in a recent literature review. The findings indicate routine assessments for intra-family end-of-life conflict are advisable. Attention should be paid to preventing or mitigating this conflict for the good of all.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | | | | | | | - Qinqin Dou
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | - Begoña Errasti-Ibarrondo
- Faculty of Nursing, University of Navarra and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Associations of surrogates' death-preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life. Psychooncology 2022; 31:1502-1509. [PMID: 35793436 DOI: 10.1002/pon.5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Preparing family surrogates for patient death and end-of-life (EOL) decision making may reduce surrogate decisional conflict and regret. Preparedness for patient death involves cognitive and emotional preparedness. We assessed the associations of surrogates' death-preparedness states (that integrate both cognitive and emotional preparedness for patient death) with surrogates' decisional conflict and regret. METHODS Associations of 173 surrogates' death-preparedness states (no, cognitive-only, emotional-only, and sufficient preparedness states) with decisional conflict (measured by the Decision Conflict Scale) and heightened decisional regret (Decision Regret Scale scores >25) were evaluated using hierarchical linear modeling and hierarchical generalized linear modeling, respectively, during a longitudinal observational study at a medical center over cancer patients' last 6 months. RESULTS Surrogates reported high decisional conflict (mean [standard deviation] = 41.48 [6.05]), and 52.7% of assessments exceeded the threshold for heightened decisional regret. Surrogates in the cognitive-only preparedness state reported a significantly higher level of decisional conflict (β = 3.010 [95% CI = 1.124, 4.896]) than those in the sufficient preparedness state. Surrogates in the no (adjusted odds ratio [AOR] [95% CI] = 0.293 [0.113, 0.733]) and emotional-only (AOR [95% CI] = 0.359 [0.149, 0.866]) preparedness states were less likely to suffer heightened decisional regret than those in the sufficient preparedness state. CONCLUSIONS Surrogates' decisional conflict and heightened decisional regret are associated with their death-preparedness states. Improving emotional preparedness for the patient's death among surrogates in the cognitive-only preparedness state and meeting the specific needs of those in the no, emotional-only, and sufficient preparedness states are actionable high-quality EOL-care interventions that may lessen decisional conflict and decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, China
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10
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Wilson DM, Anafi F, Roh SJ, Errasti-Ibarrondo B. A Scoping Research Literature Review to Identify Contemporary Evidence on the Incidence, Causes, and Impacts of End-of-Life Intra-Family Conflict. HEALTH COMMUNICATION 2021; 36:1616-1622. [PMID: 32519565 DOI: 10.1080/10410236.2020.1775448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
When someone is terminally ill, it is often a very stressful time for the dying person and their family. It would not be unusual for intra-family conflict, involving one or more family members and even the dying person, to occur. However, this type of conflict has not been identified as an end-of-life issue needing to be noticed and addressed or prevented when possible. This lack of attention could be because it is not known how common or how impactful this type of conflict is. A scoping research literature review was conducted for available 2004-2019 evidence on the incidence or prevalence of intra-family conflict, factors contributing to it or causing it, and the outcomes or impact of it. A search for published peer-review articles identified 18 research reports for a scoping review. The 18 studies, all conducted in developed countries, revealed intra-family conflict is often present; and with a range of harmful effects for the dying person, the family as a whole or individual family members, and other persons and organizations. The identified factors contributing to or predisposing intra-family conflict were grouped into three categories: (a) family disagreements over curative treatment and/or end-of-life care and decisions, (b) previous family conflict and other family dynamic matters, and (c) the dying process itself. The evidence identified through this scoping review, although relatively minimal, should be useful for planning future research and for raising awareness of end-of-life intra-family conflict to improve social services and palliative programs or services.
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11
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Thiede E, Levi BH, Lipnick D, Johnson R, Seo La I, Lehman EB, Smith T, Wiegand D, Green M, Van Scoy LJ. Effect of Advance Care Planning on Surrogate Decision Makers' Preparedness for Decision Making: Results of a Mixed-Methods Randomized Controlled Trial. J Palliat Med 2020; 24:982-993. [PMID: 33373538 DOI: 10.1089/jpm.2020.0238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Advance care planning (ACP) is intended to help patients and their spokespersons prepare for end-of-life decision making, yet little is known about what factors influence the extent to which spokespersons feel prepared for that role. Objective: To examine spokespersons' perceived preparedness for surrogate decision making after engaging in ACP. Design: Mixed methods experimental design with qualitative thematic analysis and data transformation (creating categorical data from rich qualitative data) of interviews collected during a randomized controlled trial (2012-2017). Setting/Participants: Two tertiary care medical centers (Hershey, PA and Boston, MA). Of 285 dyads (patients with advanced illness and their spokespersons) enrolled in the trial, 200 spokesperson interviews were purposively sampled and 198 included in the analyses. Main Outcomes and Measures: Interviews with spokespersons (four weeks post-intervention) explored spokespersons' perceived preparedness for surrogate decision making, occurrence of ACP conversations, and spokespersons' intentions regarding future surrogate decisions. Data transformation was used to categorize participants' responses into three categories: Very Prepared, Very Unprepared, or In Between Prepared and Unprepared. Themes and categories were compared across arms. Results: About 72.72% of spokespersons (144/198) reported being Very Prepared and 27.28% (54/198) reported being Very Unprepared or In Between with no differences in preparedness across study arms. Occurrence of post-intervention ACP conversations did not influence perceived preparedness; however, spokespersons who used an ACP decision aid reported more conversations. Four themes emerged to explain spokespersons' perceived preparedness: (1) perceptions about ACP; (2) level of comfort with uncertainty; (3) relational issues; and (4) personal characteristics. Regarding future intentions, it emerged that spokespersons believed their knowledge of patient wishes, as well as other personal, relational, situational, and emotional factors would influence their surrogate decisions. Conclusions: Factors extrinsic to specific ACP interventions influence how prepared spokespersons feel to act as spokespersons. Understanding these factors is important for understanding how to improve concordance between patients' stated end-of-life wishes and surrogate decisions. Trial Registration: NCT02429479.
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Affiliation(s)
- Elizabeth Thiede
- College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Benjamin H Levi
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Humanities and College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Pediatrics, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Daniella Lipnick
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Rhonda Johnson
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Humanities and College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - In Seo La
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Erik B Lehman
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Theresa Smith
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Humanities and College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Pediatrics, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Debra Wiegand
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Michael Green
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Humanities and College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Lauren Jodi Van Scoy
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Humanities and College of Medicine, Penn State University, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
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12
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Abshire MA, Nolan MT, Dy SM, Gallo JJ. What matters when doctors die: A qualitative study of family perspectives. PLoS One 2020; 15:e0235138. [PMID: 32574209 PMCID: PMC7310709 DOI: 10.1371/journal.pone.0235138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
Background The challenges of supporting the end-of-life preferences of patients and their families have often been attributed to poor understanding of the patient’s condition. Understanding how physicians, as patients, communicate their end-of-life care preferences to their families may inform shared decision making at end of life. Objectives The purpose of this study was to understand what matters to families of physicians when decision making with and for a physician who is approaching the end of life. Design Cross-sectional qualitative design. Participants We conducted interviews with family members of deceased physicians. Approach We analyzed the data using the constant comparison method to identify themes. Key results Family members (N = 26) rarely were unclear about the treatment preferences of physicians who died. Three overarching themes emerged about what matters most to physicians’ families: (1) honoring preferences for the context of end-of-life care; (2) supporting the patient’s control and dignity in care; and, (3) developing a shared understanding of preferences. Families struggled to make decisions and provide the care needed by the physicians at the end of life, often encountering significant challenges from the healthcare system. Conclusions Even when disease and prognosis are well understood as in this group of physicians, families still experienced difficulties in end-of-life decision making. These findings highlight the need to specifically address preferences for caregiver, care setting and symptom management in shared end-of-life decision making conversations with patients and families.
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Affiliation(s)
- Martha A. Abshire
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- * E-mail:
| | - Marie T. Nolan
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Sydney M. Dy
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph J. Gallo
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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