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Lewis-Norman C, Vidrine J, Thistlethwayte E. Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services. Curr Opin Support Palliat Care 2024; 18:86-91. [PMID: 38652458 DOI: 10.1097/spc.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Adolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. RECENT FINDINGS Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. SUMMARY Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.
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Ullrich A, Goldbach S, Hollburg W, Wagener B, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Schulz H, Bokemeyer C, Oechsle K. Specialist palliative care until the very end of life - reports of family caregivers and the multiprofessional team. BMC Palliat Care 2023; 22:153. [PMID: 37814271 PMCID: PMC10563273 DOI: 10.1186/s12904-023-01266-6] [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: 06/30/2022] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Specialist palliative care (SPC) includes care for incurably ill patients and their family caregivers at home or on a palliative care ward until the very end of life. However, in the last days of life, patients can rarely express their needs and little is known about SPC outcomes as reported by multiprofessional SPC teams and family caregivers. METHODS Using the Palliative Care Outcome Scale (POS; Score 0-40), proxy assessments of SPC outcomes in the patient's last 3 days of life were performed by SPC teams and primary family caregivers of three home care and three inpatient services. Additional questions were asked about problems solved 'particularly well' or 'inadequately' (last 7 days), which were content analyzed and quantified. RESULTS Proxy assessments by SPC teams were available in 142 patients (of whom 51% had died at home). Family caregiver assessments exist for a subgroup of 60 of these patients. SPC teams (POS total score: mean 13.8, SD 6.3) reported SPC outcomes slightly better than family caregivers (mean 16.7, SD 6.8). The POS items consistently rated as least affected (= 0) by both, SPC teams and family caregivers, were 'not wasted time' (team 99%/family caregivers 87%), 'information' (84%/47%) and 'support' (53%/31%). Items rated as most affected (= 4) were 'patient anxiety' (31%/51%), 'life not worthwhile' (26%/35%) and 'no self-worth' (19%/30%). Both groups indicated more problems solved 'particularly well' than 'inadequately'; the latter concerned mainly clinically well-known challenges during end-of-life care and family caregiver care. CONCLUSIONS This study shows the range and type of symptoms and other concerns reported in the patient's last days. Starting points for further improvements in family caregiver care and psychosocial and spiritual issues were identified.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany.
| | - Sven Goldbach
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Wiebke Hollburg
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Bettina Wagener
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Annette Rommel
- Specialist outpatient palliative care team 'Das Palliativteam', Hamburg, Germany
| | - Marten Müller
- Palliative care ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist outpatient palliative care team 'PCT Hamburg-West', Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
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Neves S, Rebelo Botelho MA, Oliveira C. Accompaniment of young adult at end-of-life: The spouse's lived experience. Eur J Oncol Nurs 2022; 61:102208. [DOI: 10.1016/j.ejon.2022.102208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 09/05/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022]
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Berger I, Krishnasamy M, Thompson K, Celeste T, Joubert L. Service Needs of Parent Caregivers of Adolescents and Young Adults with Incurable Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2022; 12:133-146. [PMID: 35787154 DOI: 10.1089/jayao.2022.0033] [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: 11/12/2022] Open
Abstract
Adolescent and Young Adult (AYA) oncology is an internationally recognized established subspecialty in cancer care. Dedicated programs tailored to local environments endeavor to address unique medical, psychological, cognitive, and social needs that historically, health services have been challenged to meet. In recent years there has been a growing appreciation of the challenges facing AYA with incurable cancer and their parent caregivers. While health care professionals recognize the importance of parents' involvement in the care trajectory, there is less understanding of the services needed for support. This scoping review set out to identify and describe evidence available to better understand the services and approaches required from hospital teams to address the needs of parent caregivers and to identify gaps in knowledge to inform areas for further research. The question guiding this review is: What are the service needs of parent carers of AYA with incurable cancer. Using the Arksey and O'Malley scoping review framework, 1009 studies were identified from a broad search of relevant online databases, gray literature, and reference lists of published studies. After removing duplicates and ineligible studies, 492 abstracts were screened. Of these, 421 were ineligible, and 71 articles underwent full-text review. Eight studies were included in the final review. No single study was focused exclusively on parent caregivers of AYA with incurable cancer, demonstrating a paucity of quantitative and qualitative evidence to inform practice and a need for further research in the field.
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Affiliation(s)
- Ilana Berger
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Center, Melbourne, Australia.,Research and Education Lead-Nursing, Victorian Comprehensive Cancer Center Alliance, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Tania Celeste
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
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Lowe H, Brown L, Ahmad A, Daruwalla N, Gram L, Osrin D, Panchal K, Watson D, Zimmerman C, Mannell J. Mechanisms for community prevention of violence against women in low- and middle-income countries: A realist approach to a comparative analysis of qualitative data. Soc Sci Med 2022; 305:115064. [PMID: 35653892 PMCID: PMC7614855 DOI: 10.1016/j.socscimed.2022.115064] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/03/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Growing evidence suggests that community-based interventions in low- and middle-income countries (LMICs) can effectively address harmful social norms that promote or sustain gender inequality and drive violence against women (VAW). However, understanding what actions communities are already taking to address harmful social norms and prevent VAW is an essential first step for intervention development. Towards this goal, drawing on collective action theory, we conducted a realist analysis of secondary qualitative data collected with communities in India, Afghanistan, Peru and Rwanda. We coded interview and focus-group data from 232 participants to identify the contexts, mechanisms and outcomes (CMO) relevant for community action. We synthesized CMO configurations from each dataset into a conceptual framework composed of three middle-range theories of mechanisms driving community action to prevent VAW in LMICs. Our results highlight the importance of dedicated spaces for discussing VAW, VAW leaders as positive role models, and community perceptions of VAW as a problem worthy of intervention. In Rwanda and Peru, there was strong evidence to support the operation of these mechanisms. Contextual factors, including national and local policy and programmes targeting VAW, activated mechanisms that led to community action. In India and Afghanistan, evidence for the presence of these mechanisms was weaker, with social norms about women's position and violence being a private family matter preventing communities from addressing violence. Despite contextual differences, our data demonstrated communities in all four settings were somewhere along a pathway of change towards VAW prevention. This supports the need to build future prevention interventions on pre-existing mechanisms that trigger community action, rather than implementing existing interventions without local adaptation. Our conceptual framework serves as a tool for assessing these mechanisms of community action as part of intervention development research, centring community knowledge and fostering local ownership for more relevant and sustainable VAW prevention interventions.
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, UK.
| | - Laura Brown
- Institute for Global Health, University College London, UK
| | | | - Nayreen Daruwalla
- SNEHA (Society for Nutrition, Education and Health Action), Mumbai, India
| | - Lu Gram
- Institute for Global Health, University College London, UK
| | - David Osrin
- Institute for Global Health, University College London, UK
| | - Krishna Panchal
- SNEHA (Society for Nutrition, Education and Health Action), Mumbai, India
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Burgers V, van den Bent M, Darlington AS, Gualthérie van Weezel A, Compter A, Tromp J, Lalisang R, Kouwenhoven M, Dirven L, Harthoorn N, Troost-Heijboer C, Husson O, van der Graaf W. A qualitative study on the challenges health care professionals face when caring for adolescents and young adults with an uncertain and/or poor cancer prognosis. ESMO Open 2022; 7:100476. [PMID: 35533426 PMCID: PMC9271469 DOI: 10.1016/j.esmoop.2022.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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Gibson F, Fern LA, Phillips B, Gravestock H, Malik S, Callaghan A, Dyker K, Groszmann M, Hamrang L, Hough R, McGeachy D, Morgan S, Smith S, Upadhyaya S, Veitch H, Williamson M, Whelan J, Aldiss S. Reporting the whole story: Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey. Health Expect 2021; 24:1593-1606. [PMID: 34247435 PMCID: PMC8483195 DOI: 10.1111/hex.13276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective We conducted a UK‐wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were ‘out‐of‐scope’ of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer. Design James Lind Alliance Priority Setting Partnership. Participants Young people aged 13‐24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population. Methods Eight hundred and fifty‐five potential research questions were submitted, and 326 were classified as ‘out‐of‐scope’. These questions, along with 49 ‘free‐text’ comments, were analysed using thematic analysis. Results The 375 out‐of‐scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long‐term effects and aftercare support; family support; financial impact; end‐of life care; and research methods and current research. Conclusions The need to tailor services, information and communication is a striking thread evidenced across the ‘out‐of‐scope’ questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes. Patient/public contributions Patients and carers were equal stakeholders throughout.
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Affiliation(s)
- Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
| | - Helen Gravestock
- Policy, Influencing and Voice, Young Lives vs Cancer, London, UK
| | - Sonia Malik
- Policy and Influencing, Young Lives vs Cancer, London, UK
| | - Amy Callaghan
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Karen Dyker
- Clinical Oncology Department, Clinical Oncology Department, St James's University Hospital, Leeds, UK
| | - Mike Groszmann
- Psychological Medicine Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leila Hamrang
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Manchester, UK
| | - Rachael Hough
- Department of Adolescent Haematology, Children and Young People's Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Demi McGeachy
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Ward L33, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sheela Upadhyaya
- Trials and Studies Coordinating Centre, The James Lind Alliance, National Institute for Health Research Evaluation, University of Southampton, Southampton, UK
| | | | - Max Williamson
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Jeremy Whelan
- Division of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
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9
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Murray H, Pettitt N, Tomas J. Advance Care Planning for Adolescents and Young Adults with Cancer: A Retrospective Case Note Audit from a Regional Specialist Center in the United Kingdom. J Adolesc Young Adult Oncol 2020; 10:493-496. [PMID: 33347382 DOI: 10.1089/jayao.2020.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The extent of Advance Care Planning (ACP) among Adolescent and Young Adult (AYA) cancer patients is not well characterized. This retrospective case note audit scrutinized the records of all AYA patients (aged 16-25 years) known to a regional specialist center in the United Kingdom, and who died between 2013 and 2019, for evidence of ACP. Eighty-four patients were included. ACP was identified for 67% of patients. Sixty-four percent expressed a preferred place of death; actual place of death reflected this in 65% of cases. Creation of a bespoke document may help to standardize ACP and improve end-of-life care.
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Affiliation(s)
- Hazel Murray
- Medcial Student, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Nicola Pettitt
- Nurse Consultant, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jon Tomas
- Consultant in Palliative Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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10
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Documentation of Palliative and End-of-Life Care Process Measures Among Young Adults Who Died of Cancer: A Natural Language Processing Approach. J Adolesc Young Adult Oncol 2020; 9:100-104. [DOI: 10.1089/jayao.2019.0040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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11
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Pearce S, Whelan J, Kelly D, Gibson F. Renegotiation of identity in young adults with cancer: A longitudinal narrative study. Int J Nurs Stud 2019; 102:103465. [PMID: 31841739 DOI: 10.1016/j.ijnurstu.2019.103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite increasing international awareness of the impact of cancer on young adults, to date there has been limited in-depth research to understand their experiences following a diagnosis using a qualitative and longitudinal perspective. OBJECTIVES To explore the impact of cancer on young adults' evolving sense of self and identity over one year from the time of diagnosis. In addition, to contribute further to an understanding of innovative research methods used to examine this experience. DESIGN This was a longitudinal narrative study using visual methods and a psychosocial lens. Narrative was used to re-present experiences over time. SETTING AND SAMPLE Recruitment was from a Principal Treatment Centre for Teenagers and Young Adults with Cancer and a Cancer Centre for Adults in the United Kingdom. Total population sampling was used over a six-month period, recruiting 18 young adults aged between 16 and 30, one to three months from a diagnosis of bone cancer, lymphoma or leukaemia. METHODS In depth, free association narrative interviews at three-time points over a year were undertaken. Photographs were used to help with story-telling. Extensive reflexive field notes, debriefing and the use of a psychosocial research group, also formed data sources. Forty interviews were conducted with 18 participants: eight took part in three interviews, six in two interviews and four in one interview. Analysis focused on the holistic 'case' of the individual temporally. In-depth, visual images were analysed from discussion in the narrative text. Through memoing, coding and comparison, themes were developed across all cases and a conceptual framework developed. RESULTS The conceptual framework illustrates the renegotiation of self over time through narrative. This was 'biographically' during young adult development and across 'cancer time'; through the core components of: the inner world, (psyche, emotion and coping); self as embodied; self as relating to others, and self as relating to place. Stories indicated that there was a constant inter- relationship over time between the renegotiation of identity and adaption of biography. CONCLUSIONS The focus in this paper is on 'the temporality of cancer' through the first year from diagnosis, and the juxtaposed process of managing biographical and developmental milestones. The importance of developing health care and research which enables narrative and the patient's voice has been highlighted. It emphasises the need for professionals to 'be with' and 'walk alongside' through the intensity of a biographically and identity changing illness. Using longitudinal narrative, visual & psychosocial methods to describe the impact of a diagnosis of cancer on young adults' sense of biography and identity.
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Affiliation(s)
- S Pearce
- School of Nursing and Midwifery, University of Plymouth, Room 204, 10 Portland Villas, Plymouth PL4 8AA, Devon, UK; Torbay and South Devon Clinical School, Torbay and South Devon NHS Foundation Trust, UK.
| | - J Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - D Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - F Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust and School of Health Science, University of Surrey, Guilford, Surrey, UK.
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