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Crooms RC, Nnemnbeng JF, Taylor JW, Goldstein NE, Gorbenko K, Vickrey BG. Clinician perspectives on integrating neuro-oncology and palliative care for patients with high-grade glioma. Neurooncol Pract 2024; 11:404-412. [PMID: 39006519 PMCID: PMC11241354 DOI: 10.1093/nop/npae022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background Patients with high-grade glioma have high palliative care needs, yet few receive palliative care consultation. This study aims to explore themes on (1) benefits of primary (delivered by neuro-oncologists) and specialty palliative care (SPC) and (2) barriers to SPC referral, according to a diverse sample of clinicians. Methods From September 2021 to May 2023, 10 palliative physicians and 10 neuro-oncologists were recruited via purposive sampling for diversity in geographic setting, seniority, and practice structure. Semistructured, 45-minute interviews were audio-recorded, professionally transcribed, and coded by 2 investigators. A qualitative, phenomenological approach to thematic analysis was used. Results Regarding primary palliative care, (1) neuro-oncologists have primary ownership of cancer-directed treatment and palliative management and (2) the neuro-oncology clinic is glioma patients' medical home. Regarding SPC, (1) palliative specialists' approach is beneficial even without disease-specific expertise; (2) palliative specialists have time to comprehensively address palliative needs; and (3) earlier SPC enhances its benefits. For referral barriers, (1) appointment burden can be mitigated with telehealth, home-based, and embedded palliative care; (2) heightened stigma associating SPC with hospice in a population with high death anxiety can be mitigated with earlier referral to promote rapport-building; and (3) lack of neuro-oncologic expertise among palliative specialists can be mitigated by emphasizing their role in managing nonneurologic symptoms, coping support, and anticipatory guidance. Conclusions These themes emphasize the central role of neuro-oncologists in addressing palliative care needs in glioma, without obviating the need for or benefits of SPC. Tailored models may be needed to optimize the balance of primary and specialty palliative care in glioma.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeannys F Nnemnbeng
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennie W Taylor
- Departments of Neurology and Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Clarke JJ, Halkett GKB, McDougall E, Dhillon HM, Lobb E, Phillips JL, Hudson P, Nowak AK. What do carers of people with high-grade glioma perceive could improve their preparedness to care, and what additional support do they require? Neurooncol Pract 2024; 11:296-306. [PMID: 38737602 PMCID: PMC11085844 DOI: 10.1093/nop/npae015] [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] [Indexed: 05/14/2024] Open
Abstract
Background Concerning levels of stress, strain, and poorer mental health are observed in family carers of patients diagnosed with high-grade glioma (HGG). Understanding the reported unmet needs of these carers will enable future interventions to address such needs to improve their preparedness for care and well-being. In this secondary analysis, we aimed to explore: (i) what carers of people with HGG perceive could improve their preparedness to care; and (ii) what needs carers reported they required additional support with. Methods Responses from 188 carers of patients with HGG participating in a randomized controlled trial of the Care-IS intervention were analyzed to identify reported unmet needs. Of this larger sample, 92 participants answered a qualitative question seeking to identify perceived unmet needs in carer preparedness over 12 months. These responses comprised the data for the current secondary analysis. Content analysis was used to analyze the qualitative data and observe trends across participant responses. Results Five overarching themes were identified: carer needs, providing emotional and practical care, coping with uncertainty, coping with the consequences of illness progression, and processing and supporting end-of-life care. Notably, the content analysis identified differences in response numbers between groups in the Care-IS trial, particularly with the control group having more needs regarding illness progression and end-of-life care. Conclusions Future interventions aimed at improving the well-being and preparedness of carers of people with HGG should consider providing better support centered on carer needs, their changed circumstances, living with uncertainty, and care transition.
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Affiliation(s)
- James J Clarke
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Faculty of Health Sciences, Curtin School of Population Health/Curtin EnAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Haryana M Dhillon
- Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-based Decision-making, Sydney, Australia
| | - Elizabeth Lobb
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane L Phillips
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- End of LIfe Research Department, Vrije University Brussels, Brussels, Belgium
| | - Anna K Nowak
- University of Western Australia, Crawley, Western Australia, Australia
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Haydon HM, Blackler A, Nowak AK, Langbecker D, Collier J, Halkett G. Exploratory multi-methods evaluation of an online intervention for carers of people with high-grade glioma. Neurooncol Pract 2023; 10:544-554. [PMID: 38026580 PMCID: PMC10666811 DOI: 10.1093/nop/npad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Inadequate knowledge and skills and a lack of confidence to provide care have been identified as major unmet needs for carers of people with brain cancer. An online intervention was developed to address the unmet needs of carers of people with high-grade glioma. Methods Ten carers evaluated the intervention through multiple methods. Acceptability and usability were measured through online data analytics (unique page views, time on page), surveys, and interviews. Questionnaires measured potential impacts on distress (Distress Thermometer), depression, anxiety (Hospital Anxiety and Depression Scale), carer competence (Carer Competence Scale), carer preparedness (Caregiving Preparedness Scale), unmet needs (Supportive Care Needs Scale - Brain Tumor Specific for carers), usability and acceptability (USE). Results Results suggested the intervention had high levels of usability (usability scales' means range = 5.1 to 6.7 out of 7) and acceptability (M = 76.3/100). Correlations indicated the potential to impact depression. Qualitative findings highlighted benefits of the intervention as a comprehensive reliable resource that could validate and normalize carer experiences. Interview findings guided further improvements (eg, additional carer videos, content organization). Conclusions The study indicated high acceptability and usability of an online intervention for carers of people with high-grade glioma. This exploratory study also provided preliminary indications of a potential to decrease depression. However, a more robust, potentially longitudinal, investigation is needed with a larger and broader sample. Informed by this study, the intervention has been amended and a randomized controlled trial will further evaluate the enhanced intervention.
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Affiliation(s)
- Helen M Haydon
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Alethea Blackler
- School of Design, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Anna K Nowak
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Danette Langbecker
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Justin Collier
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Georgia Halkett
- School of Nursing, Curtin University, Bently Western Australia, Australia
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Lin D, Ying W, Zhang H, Xiu Y, Li E, Zheng R, Wu Y. Comprehensive Need as a Mediator Between Psychological Stress and Quality of Life Among Caregivers of Patients With Cancer. Cancer Nurs 2023:00002820-990000000-00191. [PMID: 37976150 DOI: 10.1097/ncc.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Caregivers of patients with cancer are susceptible to profound psychological distress and low quality of life owing to the substantial demands of caregiving. The comprehensive needs of caregivers are closely linked to their quality of life. However, little is known about the relationship between these factors. OBJECTIVE This study aimed to determine whether comprehensive needs mediate the relationships between psychological stress and quality of life in caregivers of patients with cancer. METHODS A cross-sectional design was used to recruit 382 participants through convenience sampling. Psychological stress, comprehensive needs, and quality of life were measured using a questionnaire. RESULTS Psychological stress was associated with higher comprehensive needs (r = 0.30, P < .01) and lower quality of life (r = -0.20, P < .01). Comprehensive needs were negatively associated with quality of life (r = -0.28, P < .01). Mediation analysis findings revealed that both the indirect effect of psychological stress on quality of life via comprehensive needs (β = -0.10; P < .001) and its direct effect on quality of life (β = -0.16; P < .01) were statistically significant, suggesting a partial mediatory effect of comprehensive needs between psychological stress and quality of life. CONCLUSIONS Our findings suggest that reducing psychological stress can improve quality of life by promoting satisfaction with comprehensive needs. IMPLICATIONS FOR PRACTICE Interventions that help reduce psychological stress and meet the comprehensive needs of caregivers of patients with cancer can improve their quality of life.
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Affiliation(s)
- Danna Lin
- Author Affiliations: School of Nursing, Shantou University Medical College (Mss Lin and Xiu); The First Affiliated Hospital of Shantou University Medical College (Drs Ying and Wu and Mss Zhang and Li); and Longhu Hospital, The First Affiliated Hospital of Shantou University Medical College (Ms Zheng), Shantou, Guangdong, China
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Lobb EA, Halkett GKB, McDougall E, Campbell R, Dhillon HM, Phillips JL, Nowak AK. Bereavement outcomes of carers of patients with high grade glioma: Experiences of support before and after the death. DEATH STUDIES 2023:1-10. [PMID: 36786747 DOI: 10.1080/07481187.2023.2167888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Carers of people with High Grade Glioma (HGG) completed a survey assessing their anxiety, depression, and grief in addition to open-ended questions exploring their experiences of support pre- and post-death (N = 25). One-third reported borderline or clinical levels of anxiety, depression, and grief related distress. Given the poor prognosis and rapid deterioration of patients with HGG, the findings highlight the importance of sensitive communication about prognosis early in the disease trajectory, information tailored to disease stage, the initiation of a referral to psychological support services, and timely discussions about the preferred place of care and death.
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Affiliation(s)
- Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Nedlands, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
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Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [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] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
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Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
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Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers. Curr Oncol 2022; 29:9928-9955. [PMID: 36547195 PMCID: PMC9777470 DOI: 10.3390/curroncol29120781] [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: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.
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Solberg M, Berg GV, Andreassen HK. An emotional roller coaster - family members' experiences of being a caregiver throughout a cancer trajectory. Int J Qual Stud Health Well-being 2022; 17:2137965. [PMID: 36264025 PMCID: PMC9586637 DOI: 10.1080/17482631.2022.2137965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose To explore family members’ experiences of caregiving throughout a cancer trajectory from diagnosis until around one year after chemotherapy and radiation treatment ended. Method We conducted a longitudinal qualitative study using in-depth interviews with 13 family members at one to three points of time: before, during, and after treatment. To analyse the interviews, we leaned on Braun and Clark procedure for thematic analysis. Result The analysis revealed three themes in family members’ experiences of being a caregiver to a cancer patient throughout a cancer trajectory. These were: (1) From the time of diagnosis—overwhelming and uncertain; (2) During and after treatment—invisible and not involved; (3) Throughout the cancer trajectory—an emotional roller coaster. Conclusion The results indicated that the family members felt invisible and not involved and they experienced being a caregiver throughout the cancer trajectory as an emotional roller coaster. Our empirical findings thus indicate that in cancer care, family perspectives are yet to be implemented in daily practice. This is in contrast to explicit goals in current health policies underlining support and involvement of family members as a core aspect in cancer care.
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Affiliation(s)
- Monica Solberg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway,CONTACT Monica Solberg Norwegian University of Science and Technology and Innlandet Hospital Trust
| | - Geir Vegard Berg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway
| | - Hege Kristin Andreassen
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Technoligy and the Artic University of Norway, Tromsø, Norway
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The Clinical Value of High-Quality Nursing in Concurrent Radiotherapy and Chemotherapy after Glioma Surgery and Its Influence on the Stress Indicators Cor, ACTH, and CRP. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8335400. [PMID: 35126950 PMCID: PMC8808127 DOI: 10.1155/2022/8335400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/31/2021] [Indexed: 12/30/2022]
Abstract
Objective The purpose of this study is to explore the clinical value of high-quality nursing in concurrent radiotherapy and chemotherapy after glioma surgery and its influence on the stress indicators such as cortisol (Cor), adrenocorticotrophic hormone (ACTH), and C-reactive protein (CRP). Methods A total of 94 glioma patients diagnosed and treated in our hospital were randomly divided into a research group and a control group, with 47 cases in each group. Both groups of patients were given concurrent radiotherapy and chemotherapy. On this basis, patients in the control group were given basic care, while patients in the research group were given a combination of basic care and high-quality care. The nursing satisfaction and adverse reactions of the two groups were compared. The pain degree and the levels of stress indicators Cor, ACTH, and CRP at different time points were compared between the two groups. The sleep quality, bad mood, and quality of life before and after nursing were compared between the two groups. Results After nursing, the nursing satisfaction of the research group (95.74%) was higher than that of the control group (80.85%), and the difference between the two groups was statistically significant (X2 = 11.678, P < 0.05). There was no significant difference between patients in the Visual Analogue Scale (VAS) score and the levels of stress indicators Cor, ACTH, and CRP at the T1 time point between the two groups (P > 0.05). With the passage of time, the levels of Cor and ACTH of the two groups showed an upward trend. At T4, the increased levels of Cor and ACTH in the research group were less than those in the control group, and the difference was statistically significant (P < 0.05). The VAS scores and CRP levels of the two groups showed an upward trend at T1 and T2 and a downward trend at T3 and T4. And, at T4, the decrease in CRP level of the research group was greater than that in the control group, and the difference was statistically significant (P < 0.05). Before nursing, there was no statistically significant difference between two groups of patients in the time to fall asleep, sleep time, number of awakenings, SAS score, self-rating depression scale (SDS) score, quality of life index scores, and total scores (P > 0.05). After nursing, the time to fall asleep and the number of awakenings in the two groups of patients showed an upward trend, and the increase in the control group was higher (P < 0.05). The sleep time of the two groups showed a downward trend, and the degree of decline in the control group was higher (P < 0.05). After nursing, the SAS score and SDS score of the two groups of patients decreased (∗P < 0.05), and the decrease in the research group was more obvious (#P < 0.05). After nursing, the scores of all indicators of the quality of life and the total score of the two groups increased and the score of the research group increased more significantly (P < 0.05). After nursing, the control group had 5 cases of gastrointestinal reactions, 7 cases of bone marrow suppression, 6 cases of leukopenia, 6 cases of thrombocytopenia, and 10 cases of dizziness and nausea. In the research group, there were 1 case of gastrointestinal reaction, 2 cases of bone marrow suppression, 1 case of leukopenia, 1 case of thrombocytopenia, and 2 cases of dizziness and nausea. The difference between the two groups was statistically significant (P < 0.05). Conclusion Glioma patients are given high-quality care during the course of concurrent radiotherapy and chemotherapy, which can reduce the pain and bad mood of the patient, reduce the stress response of the patient, and improve the quality of sleep and the quality of life of the patient, thereby improving nursing satisfaction and patients compliance, reducing adverse reactions, and having a good prognosis.
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Benefits of supportive strategies for carers of people with high-grade glioma: a systematic review : Strategies for addressing the needs of high-grade glioma carers. Support Care Cancer 2022; 30:10359-10378. [PMID: 36282336 PMCID: PMC9715523 DOI: 10.1007/s00520-022-07419-2] [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: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To systematically review and examine current evidence for the carer-reported benefits of supportive care strategies for carers of adults with high-grade glioma (HGG). METHODS Four databases (CINAHL, EMBASE, PubMed, PsycINFO) were searched for articles published between January 2005 and April 2022 that assessed strategies for addressing the supportive care needs of carers of adults with HGG (WHO grade 3-4). Study selection and critical appraisal were conducted independently by three authors (DJ/MC, 2021; DJ/RJ 2022). Data extraction was conducted by one author (DJ) and checked by a second author (RJ). Results were synthesised narratively. RESULTS Twenty-one studies involving 1377 caregivers were included, targeting the carer directly (n = 10), the patient-carer dyad (n = 3), or focused on people with HGG + / - their carers (n = 8). A paucity of high-quality evidence exists for effective and comprehensive support directly addressing outcomes for carers of adults with HGG. Strategies that demonstrated some benefits included those that built carer knowledge or provided emotional support, delivered by health professionals or through peer support. Supportive and early palliative care programmes have potential to reduce unmet carer needs while providing ongoing carer support. CONCLUSION Strategies incorporating an educational component, emotional support, and a regular needs assessment with corresponding tailored support are most valued by carers. Future practice development research should adopt a value-based approach and exceed evaluation of efficacy outcomes to incorporate evaluation of the experience of patients, carers, and staff, as well as costs.
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11
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Correlation between preoperative psychological personality traits of glioma patients and psychological distress in their primary caregivers. Clin Neurol Neurosurg 2022; 214:107144. [DOI: 10.1016/j.clineuro.2022.107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
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Ownsworth T, Chan RJ, Jones S, Robertson J, Pinkham MB. Use of telehealth platforms for delivering supportive care to adults with primary brain tumors and their family caregivers: A systematic review. Psychooncology 2020; 30:16-26. [PMID: 32915517 DOI: 10.1002/pon.5549] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Telehealth platforms have potential utility for providing remote access to supportive care to people with brain tumour. This systematic review aimed to evaluate the feasibility, acceptability and efficacy of delivering supportive care via telehealth platforms to adults with primary brain tumour and family caregivers. METHODS A systematic search of PsycINFO, MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was conducted from 1980 to 1st June 2020 to identify eligible studies. Methodological quality was assessed by two independent reviewers. RESULTS Seventeen articles, reporting on 16 studies, evaluated telephone-based support (5 studies), videoconferencing (3 studies), web-based programs and resources (7 studies) or combined use of videoconferencing and web-based modules (1 study) to deliver supportive care remotely. Caregivers were involved in 31% of interventions. Mean rates of accrual (68%) and adherence (74%) were moderate, whereas acceptability or satisfaction for those completing the interventions was typically high (M satisfied or very satisfied = 81%). Adherence rates were generally higher and clinical gains were more evident for interventions involving real-time interaction as opposed to self-guided interventions. CONCLUSIONS Telehealth delivery of supportive care is feasible and acceptable to a high proportion of individuals with primary brain tumour and their caregivers. It is recommended that future research focuses on implementation outcomes, including factors influencing the uptake and sustainability of telehealth platforms in practice.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Raymond J Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Julia Robertson
- School of Medicine, Griffith University, South Port, Australia
| | - Mark B Pinkham
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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Boele FW, Rooney AG, Bulbeck H, Sherwood P. Interventions to help support caregivers of people with a brain or spinal cord tumour. Cochrane Database Syst Rev 2019; 7:CD012582. [PMID: 31264707 PMCID: PMC6604115 DOI: 10.1002/14651858.cd012582.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The diagnosis and treatment of a brain or spinal cord tumour can have a huge impact on the lives of patients and their families with family caregiving often resulting in considerable burden and distress. Meeting the support needs of family caregivers is critical to maintain their emotional and physical health. Although support for caregivers is becoming more widely available, large-scale implementation is hindered by a lack of high-quality evidence for its effectiveness in the neuro-oncology caregiver population. OBJECTIVES To assess the effectiveness of supportive interventions at improving the well-being of caregivers of people with a brain or spinal cord tumour. To assess the effects of supportive interventions for caregivers in improving the physical and emotional well-being of people with a brain or spinal cord tumour and to evaluate the health economic benefits of supportive interventions for caregivers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), MEDLINE via Ovid, and Embase via Ovid. We also handsearched relevant published conference abstracts (previous five years), publications in the two main journals in the field (previous year), searched for ongoing trials via ClinicalTrials.gov, and contacted research groups in the field. The initial search was in March 2017 with an update in August 2018 (handsearches completed in January 2019). SELECTION CRITERIA We included all randomised controlled trials (RCTs) where caregivers of neuro-oncology patients constituted more than 20% of the sample and which evaluated changes in caregiver well-being following any supportive intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and carried out risk of bias assessments. We aimed to extract data on the outcomes of psychological distress, burden, mastery, quality of patient-caregiver relationship, quality of life, and physical functioning. MAIN RESULTS In total, the search identified 2102 records, of which we reviewed 144 in full text. We included eight studies. Four interventions focused on patient-caregiver dyads and four were aimed specifically at the caregiver. Heterogeneity of populations and methodologies precluded meta-analysis. Risk of bias varied, and all studies included only small numbers of neuro-oncology caregivers (13 to 56 participants). There was some evidence for positive effects of caregiver support on psychological distress, mastery, and quality of life (low to very low certainty of evidence). No studies reported significant effects on caregiver burden or quality of patient-caregiver relationship (low to very low certainty of evidence). None of the studies assessed caregiver physical functioning. For secondary outcomes (patient emotional or physical well-being; health economic effects), we found very little to no evidence for the effectiveness of caregiver support. We identified five ongoing trials. AUTHORS' CONCLUSIONS The eight small-scale studies included employed different methodologies across different populations, with low certainty of evidence overall. It is not currently possible to draw reliable conclusions regarding the effectiveness of supportive interventions aimed at improving neuro-oncology caregiver well-being. More high-quality research is needed on support for family caregivers of people diagnosed, and living, with a brain or spinal cord tumour.
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Affiliation(s)
- Florien W Boele
- University of Leeds and Leeds Cancer CentreLeeds Institute of Health Sciences and Leeds Institute of Cancer and PathologyPOG, Level 3, Bexley WingSt James's Institute of OncologyLeedsUKLS9 7TF
| | - Alasdair G Rooney
- Edinburgh Centre for Neuro‐Oncology (ECNO)Department of Psychological MedicineWestern General HospitalCrewe Road SouthEdinburghScotlandUKEH4 2XU
| | - Helen Bulbeck
- brainstrustDirector of Services4 Yvery CourtCastle RoadCowesIsle of WightUKPO31 7QG
| | - Paula Sherwood
- University of PittsburghDepartment of Acute and Tertiary Care336 Victoria Building3500 Victoria StreetPittsburghMAUSA15261
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Halkett GKB, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK. Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:967-975. [PMID: 28190236 DOI: 10.1007/s13187-017-1175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.
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Affiliation(s)
- Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Thérèse Shaw
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne King
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Jenny Clarke
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | | | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
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15
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Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 2018; 17:96. [PMID: 30037346 PMCID: PMC6057056 DOI: 10.1186/s12904-018-0346-9] [Citation(s) in RCA: 343] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/25/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment. METHODS Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes. RESULTS Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies. CONCLUSION Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
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Affiliation(s)
- Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Betty Pui Man Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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16
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Philip J, Collins A, Staker J, Murphy M. I-CoPE: A pilot study of structured supportive care delivery to people with newly diagnosed high-grade glioma and their carers. Neurooncol Pract 2018; 6:61-70. [PMID: 31385998 DOI: 10.1093/nop/npy010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background There is limited evidence to guide best approaches to supportive care delivery to patients with high-grade glioma. I-CoPE (Information, Coordination, Preparation and Emotional) is a structured supportive care approach for people with newly diagnosed high-grade glioma and their family carers. Delivered by a cancer care coordinator, I-CoPE consists of (1) staged information, (2) regular screening for needs, (3) communication and coordination, and (4) family carer engagement. This pilot study tested acceptability and preliminary effectiveness of I-CoPE, delivered over 3 transitions in the illness course, for people newly diagnosed with high-grade glioma and their carers. Methods I-CoPE was delivered at the identified transition times (at diagnosis, following the diagnostic hospitalization, following radiotherapy), with associated data collection (enrollment, 2 weeks, 12 weeks). Outcomes of interest included: acceptability/feasibility (primary); quality of life; needs for support; disease-related information needs; and carer preparedness to care (secondary). Descriptive statistics were used to assess acceptability outcomes, while patient and carer outcomes were assessed using repeated measures ANOVA. Results Thirty-two patients (53% male, mean age 60) and 31 carers (42% male) participated. I-CoPE was highly acceptable: 86% of eligible patients enrolled, and of these 88% completed the study. Following I-CoPE patients and carers reported fewer information needs (P < .001), while carers reported fewer unmet supportive care needs (P < .01) and increased preparedness to care (P = .04). Quality of life did not significantly change. Conclusion A model of supportive care delivered based upon illness transitions is feasible, acceptable, and suggests preliminary efficacy in some areas. Formal randomized studies are now required.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Australia.,Palliative Care Service, St Vincent's Hospital Melbourne, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Jane Staker
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Australia
| | - Michael Murphy
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Australia
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Do carer’s levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress? Support Care Cancer 2017; 26:275-286. [DOI: 10.1007/s00520-017-3846-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/24/2017] [Indexed: 12/27/2022]
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18
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Boele FW, Grant R, Sherwood P. Challenges and support for family caregivers of glioma patients. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjnn.2017.13.1.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Robin Grant
- Consultant neurologist, Edinburgh Centre for Neuro-Oncology
| | - Paula Sherwood
- Professor, University of Pittsburgh (Acute and Tertiary Care, School of Nursing)
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