Health practices in Europe towards families of older patients with cancer: a scoping review

Building Family Interventions for Scalability and Impact

Family nursing researchers are charged with addressing the conceptual and methodological underpinnings of family research when developing family-focused interventions. Step-by-step guidance is needed that integrates current science of intervention development with family science and helps researchers progress from foundational work to experimental work with policy integration. The purpose of this manuscript is to provide pragmatic, evidence-based guidance for advancing family intervention research from foundational work through efficacy testing. Guidance regarding the development of family interventions is presented using the first three of Sidani's five-stage method: (a) foundational work to understand the problem targeted for change; (b) intervention development and assessment of acceptability and feasibility; and (c) efficacy testing. Each stage of family intervention development is described in terms of process, design considerations, and policy and practice implications. Examples are included to emphasize the family lens. This manuscript provides guidance to family scientists for intervention development and implementation to advance family nursing science and inform policy.

Involvement of family members of older patients with cancer in triadic decision-making processes during medical consultations on an outpatient ward - an observational exploratory study using quantitative and qualitative methods

INTRODUCTION

There is a growing interest in the involvement of family members of older patients with cancer in decision-making processes. The aim of this study is to identify how and to what extent family members, together with patients and physicians, are involved in triadic decision-making processes in clinical practice.

MATERIALS AND METHODS

This study was conducted using an exploratory observational design. The Observer Patient Involvement Scale for patients with Multiple Chronicle Conditions (OPTIONMCC) was used to assess the interaction in triadic decision-making between patients, family members, and physicians. Physicians' behaviour was scored on a Likert-scale ranging from 0 (not observed) to 4 (executed to a high standard), while the behaviour of patients and their family members was scored on a scale from 0 (no or minimum participation) to 2 (active participation). Atlas.ti software was used to facilitate coding, and the SPSS statistical analysis platform was used to explore correlations between the shared decision-making (SDM) skills of the physician and the participation of patients and their family members.

RESULTS

In total, ten physicians performed 25 consultations with older patients and 30 family members. Patients showed higher levels of participation in the SDM process than family members (OPTIONMCC mean scores 0.96 vs 0.61). Physicians' SDM skills were observed at a low or moderate skill level (OPTIONMCC mean score 1.81). Exploratory correlation analysis showed that higher physician scores were related to higher levels of both patients' and family members' involvement in the decision-making process. The level of family members' involvement in SDM varied from no involvement at all to active involvement. Qualitative analysis of family involvement revealed that relatives are likely to: emphasize patients' values and goals of care; inquire about different treatment options; assist in the deliberation process; and ask for clarification of the further medical process. Physicians showed responsive behaviour towards family members but seldom actively involved them in the SDM process.

DISCUSSION

The study findings suggest that there is a need to include strategies to facilitate family involvement in current SDM models for older patients with cancer. Healthcare professionals in geriatric oncology might benefit from additional training covering family dynamics and managing challenging situations.

End-of-life and bereavement support to families in cancer care: a cross-sectional survey with bereaved family members

BACKGROUND

Losing a close other to cancer is an incisive experience that occurs after a long course of illness and intense family caregiving. Despite an evident need for family engagement and support and guidance on this, patients and family members may not receive the attention and support they need when a family unit is experiencing a disruption by death. A clear understanding of the quality of care that is currently provided and its ability to address family needs is necessary to improve end-of-life and bereavement support to families affected by cancer. The purpose of this study is to investigate the quality of support of end-of-life and bereavement care to families, their (un)met needs, grief experiences, and self-perceived health outcomes.

METHODS

A multi-center, cross-sectional observational survey study with family members (n = 35) whose close other died of cancer in a health institution or their own home in German-speaking Switzerland.

RESULTS

Bereaved family members were mostly satisfied with end-of-life care. Information on the grief process and services, and acknowledgment of their grief was experienced as helpful. Most coped with their grief drawing on family resources and exhibited resilience, but they reported unmet needs in relation to family togetherness and caregiving.

CONCLUSION

This study with a small number of family members indicates that support provided to families across settings and illness trajectories is perceived as helpful, with specific needs related to family support. The findings suggest that improvements should focus on ensuring care that addresses the family as a unit and enables togetherness, mutual reflection, meaningful relationships, preparedness for death, resilience, and benefit-finding.

PROTOCOL REGISTRATION

https://osf.io/j4kfh .

Lost in the loop - a qualitative study on patient experiences of care in standardized cancer patient pathways

BACKGROUND

The Norwegian health authorities introduced standardized cancer patient pathways (CPPs) in 2015, aiming to reduce practice variations across hospitals and regions, and improve the continuity, coordination and overall quality of the health care service provided to cancer patients. There has been few studies investigating this change, and that have looked into the organisational and economic benefits of standardized pathways, however the element of care and the patient perspective has been especially neglected. This study explored the care element in cancer patient pathways through an in-depth study of patient experiences.

METHODS

The patients were enrolled approximately three years after the introduction of standardized CPPs in Norway. Through a qualitative design with in-depth interviews, a total of 21 interviews were conducted with seven patients between 2018 and 2020. The first interview took place after the diagnosis was established and before treatment, the second interview during treatment, and the final interview approximately one year after the completion of active treatment. The empirical catchment area was eastern Norway. Data were analysed using a theoretical thematic analysis.

RESULTS

This study sheds light on the complex challenges patients' faces, while navigating CPPs, including the need for better transition support, improved coordination and continuity in care, and a more holistic approach that encompasses emotional well-being and family support. Three overarching themes were identified: [1] Navigating CPPs: patient care and transition challenges, [2] Fragmented cancer care: challenges in coordination and continuity [3] Unmet needs and overlooked opportunities in CPPs.

CONCLUSIONS

Patients experience that cancer patient pathways offer good medical treatment, but that the care element deserves more attention. Current CPPs are trapped in a logic of choice, preventing room for the element of care to receive the attention it requires for the patient to truly experience holistic person-centred care and continuous, well-coordinated services. Based in our study we argue there is a need to look into the missed opportunities for using the CPPs as points of departure for more holistic collaborative models for cancer care.

Implementation and efficacy of knowledge translation frameworks in family focused nursing care: A scoping review

AIM

To provide an overview of the characteristics, variety and outcomes of knowledge translation (KT) strategies used in nursing care involving adult patients and their family members.

BACKGROUND

The gap in providing family nursing practice could be due to a lack of explicit KT frameworks and understanding of ways to translate evidence-based knowledge into clinical practice.

DESIGN

A scoping review conducted according to the Joanna Briggs Institute.

METHODS

The review is reported according to PRISMA-ScR. Relevant studies were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, ProQuest Nursing & Allied Health Premium, PsycINFO, Social Work Abstracts, Social Services Abstracts and Scopus. Grey literature was searched in ProQuest Dissertations & Theses Global. Search results were imported into the web-based programme Covidence. Studies describing concepts of KT, strategies of implementation, involvement of families and nurses/family caregivers in adult health care and conducted within the last 15 years were included.

RESULTS

Eight studies met the inclusion criteria. Three studies used the KTA Framework to guide the implementation process. The remaining five studies used different frameworks/guidelines to translate a variety of family focused interventions into their clinical practice. Translation strategies were often targeted towards nurse education. Reported outcomes included nurses' attitudes towards and acceptance of involving families in health care. The outcomes were conceptualized and measured differently, showing inconclusive results on effectiveness on family focused care and family health.

CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE

The application of KT frameworks to implement evidence-based family nursing into clinical practice is limited. The process of KT mainly targets at nurses' adoption of family focused interventions with limited information about short-, intermediate- and long-term efficacy on family health. Clinical leaders should consider time and resources needed to implement family focused care KT strategies before putting it into practice.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. Data were obtained from other's literature.

Determinants of poor quality of life in older patients with cancer: A longitudinal mixed methods study (PROGNOSIS-Q)

INTRODUCTION

Patient-reported outcomes are becoming more employed in oncologic research because many older patients with cancer prioritize preserved health-related quality of life (HRQoL) over prolonged survival. However, few studies have examined the determinants of poor HRQoL in older patients with cancer. This study aims to determine whether HRQoL findings are truly reflective of cancer disease and treatment, as opposed to external factors.

MATERIALS AND METHODS

This longitudinal, mixed-methods study included outpatients, age 70 years or more, with a solid cancer, who reported poor HRQoL (EORTC QLQ-C30 Global health status/QoL (GHS) score ≤ 33.3), at treatment initiation. A convergent design was employed, in which HRQoL survey data and telephone interview data was collected in parallel at baseline and three-months follow-up. Survey and interview data was analyzed separately and subsequently compared. Thematic analysis of interview data was conducted according to Braun & Clarke, and changes in patients GHS score were calculated using mixed model regression.

RESULTS

Twenty-one patients with a mean age of 74.7 years were included (12 men and 9 women) and data saturation was achieved at both time intervals. Baseline interviews (n = 21) showed that poor HRQoL at cancer treatment initiation was primarily reflective of participants' initial shock upon receiving their cancer diagnosis and their change in circumstance and sudden functional independence. At three months, three participants were lost to follow-up and two provided only partial data. Most participants experienced an increase in HRQoL, with 60% showing a clinically significant improvement in GHS scores. Interviews showed that this was due to lessening functional dependency and disease acceptance achieved by mental and physical adjustment. HRQoL measures were less reflective of cancer disease and treatment in older patients with preexisting highly disabling comorbidity.

DISCUSSION

This study showed good alignment between survey responses and in-depth interviews, demonstrating that both methodologies are highly relevant measures during oncologic treatment. However, for patients with severe comorbidity, HRQoL findings are often more reflective of the steady state of their disabling comorbidity. Response shift may play a part in how participants adjusted to their new circumstances. Promoting caregiver involvement from the time of diagnosis may increase patients´ coping strategies.

Functioning of structurally diverse families living with adolescents and children with chronic disease: A metasynthesis

PURPOSE

The diagnosis of children and adolescents with a chronic disease may affect the entire family system. When families have diverse structures, additional tensions can be present and affect the balance of family functioning. This metasynthesis aims to analyze and synthesize qualitative evidence on the functioning of structurally diverse families who live with adolescents and children with chronic disease.

DESIGN

Qualitative metasynthesis.

METHODS

Systematic searches up to 2021 were performed in PubMed, CINAHL, PsycINFO, SCOPUS, LILACS, and Web of Science and supplemented by manual search strategies. It followed guidelines from the statement in the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme. Data synthesis was conducted according to the thematic synthesis approach.

FINDINGS

Of a total of 6538 references identified, 9 studies were included in the metasynthesis. The thematic synthesis enabled the construction of three analytical themes: "Family structural changes and weakened co-parenting"; "Family rearrangements and the challenges faced by families"; and "Committed to healthy family functioning for the child's well-being: Searching for family homeostasis".

CONCLUSIONS

The themes showed that the causes of the rupture in the family unit interfere in family functioning, making it ineffective. In most families, family functioning is centered on the mothers. Faced with the need to care for children and adolescents and to control chronic disease, structurally diverse families need to adjust their family functioning and search for family homeostasis.

CLINICAL RELEVANCE

The results of this review can support nurses to target their care toward these families and formulate effective interventions that promote, strengthen, or maintain the healthy functioning of these families.

Co-Design and Validation of a Family Nursing Educational Intervention in Long-Term Cancer Survivorship Using Expert Judgement

The number of cancer survivors is increasing exponentially thanks to early screening, treatment, and cancer care. One of the main challenges for healthcare systems and professionals is the care of cancer survivors and their families, as they have specific needs that are often unmet. Nursing students, as future healthcare professionals, need education to face these new health demands. They will need to develop specific competencies to help them care for and empower this emerging population. The aim of the study was to co-design and validate an educational intervention on long-term cancer survivorship for nursing, through a multidisciplinary panel of experts. Group interviews were conducted with a panel of 11 experts, including eight professionals from different backgrounds (oncology, cancer nursing, pharmacology, and education), a long-term cancer survivor, a family member of a cancer survivor, and a nursing student. The experts validated a pioneer educational intervention to train nursing students in long-term cancer survival. The co-design and validation of the intervention from an interdisciplinary perspective and with the participation of long-term cancer survivors and their families was considered relevant as it included the vision of all the stakeholders involved in long-term cancer survivorship.

Personal and Contextual Factors to the Successful Implementation of a Family Nursing Approach in Oncology Care

The aim of this study was to explore nurses' attitudes and beliefs about the importance of families in nursing care, as well as the barriers and facilitators within the clinical context that influence the implementation offamily nursing in an in-patient oncology service. A cross-sectional study design, incorporating quantitative and qualitative measurements, was used with a sample of nurses in Spain from an oncology service (N = 39). In general, oncology nurses reported positive attitudes and beliefs about the importance of family in nursing care. However, they did not effectively involve the family in their daily clinical practice. This was due to the nurses' lack of clinical skills and competence to work with families as well as contextual factors such as the lack of time and workload that acted as barriers to the implementation of family-oriented care. This study identified areas of improvement that are needed to promote the effective and sustainable implementation of family nursing knowledge in clinical practice settings.

Effectiveness of Nursing Interventions for Patients With Cancer and their Family Members: A Systematic Review

Cancer diagnosis poses enormous physical and psychosocial challenges for both the affected person and their families. This systematic review identifies the characteristics and effectiveness of nursing interventions offered to adult patients with cancer and their families. Five databases were searched, and 19 studies published from 2009 to 2020 were included. Interventions were categorized as follows: (a) interventions with supporting and cognitive components (n = 3), (b) interventions that included skills training for the caregiver (n = 3), (c) interventions to enhance care through managing symptoms (n = 8), (d) interventions focusing on the dyad or family-patient relationship (n = 4), and (e) interventions targeted to the patient's condition (n = 1). The results of this review offer an overview from which to carry out new studies and are useful for providing future directions within family nursing practice, taking into account the impact that the family has on the disease and the consequences the condition may bring to the whole family.

Patient experiences with videoconferencing as social contact and in follow-up from oncology nurses in primary health care

Patients with various forms of cancer often have unmet psychosocial support needs. By interpretative phenomenological approach, this study aimed to acquire a deeper understanding of home-living patients with cancer’s experience and meaning from videoconferencing in oncological nursing follow-up in primary healthcare and contact with networks. Six patients from rural Norway participated. Three themes emerged: (1) From skepticism to videoconferencing-enthusiasm; (2) Oncology nurses ensured tablet mastery and delivered close follow-up; and (3) Oncology nurses helped ensure general social support using videoconferencing. Oncology follow-up care in rural areas using videoconferencing may enhance care availability and provision of psychosocial support meeting patients’ needs.