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Harrison BH, Hundt E, Wiencek C. Use of the 3 Wishes Project to Help Individualize End-of-Life Care in a Medical Intensive Care Unit. Am J Crit Care 2024; 33:9-17. [PMID: 38161175 DOI: 10.4037/ajcc2024985] [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: 01/03/2024]
Abstract
BACKGROUND Multiple organizations recommend that individualized end-of-life (EOL) care should be standard practice. However, a standardized approach does not exist because EOL care should be individually tailored. The 3 Wishes Project is an EOL intervention that provides direction for individualized care with 3 goals: dignify death, celebrate the patient's life, and support family members and the intensive care unit clinicians caring for the patient. Patients and families are given the opportunity to choose 3 wishes during the dying process. OBJECTIVE To ascertain if the implementation of the 3 Wishes Project allowed the medical team to provide individualized EOL care. METHODS The Iowa Model was used for this evidence-based project. The project was implemented in the medical intensive care unit at an academic medical center. Outcomes were evaluated by the collection and analysis of qualitative and quantitative data. RESULTS From the 57 patients who died during the 2-month implementation period, 32 wish forms were collected; 31 patients participated and 1 declined. Overall participation among patients was 56%. The top 5 wishes were cloth hearts, blankets, heartbeat printouts, fingerprints and handprints, and music. The total cost was $992, and the average cost per wish was $6.98. Eighty-five percent (33 of 39) of the respondents to the medical team survey indicated that they either agreed or strongly agreed that the project allowed the medical team to consistently provide individualized EOL care. CONCLUSIONS The survey data support the 3 Wishes Project as a method that allowed the medical team to individualize EOL care and as a valuable tool for incorporation at the bedside.
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Affiliation(s)
- Brittany H Harrison
- Brittany H. Harrison completed her DNP at University of Virginia School of Nursing and is a nurse practitioner, University of Virginia Health, Charlottesville, Virginia
| | - Elizabeth Hundt
- Elizabeth Hundt is an assistant professor of nursing, University of Virginia School of Nursing, Charlottesville
| | - Clareen Wiencek
- Clareen Wiencek is a professor of nursing, University of Virginia School of Nursing, Charlottesville
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2
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MacEachen D, Johnston B, McGuire M. Memory making in critical care: A qualitative thematic synthesis. Nurs Crit Care 2023. [PMID: 37807724 DOI: 10.1111/nicc.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Caring for bereaved families is an important aspect of the nursing role in critical care. Memory making practices are one way in which dying, death and bereavement can be acknowledged and supported within critical care. Memory making was introduced into the care of stillborn babies and neonatal deaths to improve parents' experiences of bereavement, and has since become common practice in adult critical care. AIMS The aim of this qualitative thematic synthesis was to explore families' experiences of memory making in critical care, with a view of gaining greater understanding of the ways in which memory making impacts bereaved families. METHODS A systematic search strategy was developed, and five databases were searched (Medline, CINAHL, PsychINFO, Embase and ASSIA). Seven qualitative studies were included: four were conducted in adult and three in paediatric critical care settings in which memory making was initiated between 2014 and 2020. Memory making practices included, patient diaries, general keepsakes, word clouds and photography. RESULTS The thematic synthesis generated four main themes to describe families' experience of memory making in critical care: 'connection', 'compassion', 'engagement and creation' and 'continuation'. CONCLUSIONS Memory making is a meaningful activity for families whose loved one dies in critical care; it brings focus and meaning during a devastating process in a highly technical environment. Families rely heavily on nursing staff for support and guidance. The creation of memories and/or keepsakes can have a positive impact on the bereavement experience for families and can facilitate a continuing bond with their loved one. RELEVANCE TO CLINICAL PRACTICE Memory making is a worthwhile practice to support and guide family bereavement within critical care. It can provide structure and purpose during an emotionally challenging transition, by supporting families to focus on a meaningful activity during a devasting time.
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Affiliation(s)
- Doreen MacEachen
- Critical Care, Queen Elizabeth University Hospital, Glasgow, Scotland
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
| | - Bridget Johnston
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
- School of Medicine, Dentistry and Nursing, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Margaret McGuire
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
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Trahair ED, Mantri S. Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story. Neurol Clin Pract 2023; 13:e200150. [PMID: 37081942 PMCID: PMC10112858 DOI: 10.1212/cpj.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.
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Affiliation(s)
- Esme D Trahair
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
| | - Sneha Mantri
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
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4
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Reid JC, Dennis B, Hoad N, Clarke F, Hanmiah R, Vegas DB, Boyle A, Toledo F, Rudkowski JC, Soth M, Heels-Ansdell D, Cheung A, Willison K, Neville TH, Cheung J, Woods A, Cook D. Enhancing end of life care on general internal medical wards: the 3 Wishes Project. BMC Palliat Care 2023; 22:11. [PMID: 36788522 PMCID: PMC9925934 DOI: 10.1186/s12904-023-01133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital. METHODS From January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively. RESULTS From March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1st, 3rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1st, 3rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program. CONCLUSIONS The formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.
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Affiliation(s)
- Julie C. Reid
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Brittany Dennis
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Neala Hoad
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - France Clarke
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Rajendar Hanmiah
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Daniel Brandt Vegas
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Boyle
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Feli Toledo
- grid.416721.70000 0001 0742 7355Department of Spiritual Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jill C. Rudkowski
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Mark Soth
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Diane Heels-Ansdell
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Andrew Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Kathleen Willison
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada ,grid.25073.330000 0004 1936 8227School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Thanh H. Neville
- grid.19006.3e0000 0000 9632 6718Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Jason Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Woods
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Deborah Cook
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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Neville TH, Taich Z, Walling AM, Bear D, Cook DJ, Tseng CH, Wenger NS. The 3 Wishes Program Improves Families' Experience of Emotional and Spiritual Support at the End of Life. J Gen Intern Med 2023; 38:115-121. [PMID: 35581456 PMCID: PMC9113739 DOI: 10.1007/s11606-022-07638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/22/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL. AIM To assess whether the 3WP is associated with improved ratings of EOL care. PROGRAM DESCRIPTION In the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families. SETTING 2-hospital academic healthcare system. PARTICIPANTS Dying patients in the ICU and their families. PROGRAM EVALUATION A modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS-derived measures: Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care). RESULTS Of 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups. DISCUSSION The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.
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Affiliation(s)
- Thanh H Neville
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Zachary Taich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Anne M Walling
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Veteran Affairs, Los Angeles, USA
| | - Danielle Bear
- UCLA Office of the Patient Experience, UCLA Health, Los Angeles, CA, USA
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Borelli WV, Xavier LDL, Ornell F, Schuch JB, Von Diemen L. The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis. Aging Ment Health 2022; 26:881-889. [PMID: 33949899 DOI: 10.1080/13607863.2021.1910793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly. METHOD An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies. RESULTS A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided. CONCLUSION These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.
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Affiliation(s)
| | - Laura de Lima Xavier
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Psiquiatria e Ciências Do Comportamento, Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline Bohrer Schuch
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Lisia Von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
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Miller-Lewis LR, Lewis TW, Tieman J, Rawlings D, Parker D, Sanderson CR. Words describing feelings about death: A comparison of sentiment for self and others and changes over time. PLoS One 2021; 16:e0242848. [PMID: 33406081 PMCID: PMC7787376 DOI: 10.1371/journal.pone.0242848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Understanding public attitudes towards death is needed to inform health policies to foster community death awareness and preparedness. Linguistic sentiment analysis of how people describe their feelings about death can add to knowledge gained from traditional self-reports. This study provided the first description of emotive attitudes expressed towards death utilising textual sentiment analysis for the dimensions of valence, arousal and dominance. A linguistic lexicon of sentiment norms was applied to activities conducted in an online course for the general-public designed to generate discussion about death. We analysed the sentiment of words people chose to describe feelings about death, for themselves, for perceptions of the feelings of ‘others’, and for longitudinal changes over the time-period of exposure to a course about death (n = 1491). The results demonstrated that sadness pervades affective responses to death, and that inevitability, peace, and fear were also frequent reactions. However, words chosen to represent perceptions of others’ feelings towards death suggested that participants perceived others as feeling more negative about death than they do themselves. Analysis of valence, arousal and dominance dimensions of sentiment pre-to-post course participation demonstrated that participants chose significantly happier (more positive) valence words, less arousing (calmer) words, and more dominant (in-control) words to express their feelings about death by the course end. This suggests that the course may have been helpful in participants becoming more emotionally accepting in their feelings and attitude towards death. Furthermore, the change over time appeared greater for younger participants, who showed more increase in the dominance (power/control) and pleasantness (valence) in words chosen at course completion. Sentiment analysis of words to describe death usefully extended our understanding of community death attitudes and emotions. Future application of sentiment analysis to other related areas of health policy interest such as attitudes towards Advance Care Planning and palliative care may prove fruitful.
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Affiliation(s)
- Lauren R. Miller-Lewis
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Psychology and Public Health, School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, South Australia, Australia
- * E-mail:
| | - Trent W. Lewis
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Deb Rawlings
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine R. Sanderson
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Palliative Medicine, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia
- Territory Palliative Care–Central Australia, Alice Springs Hospital, The Gap, Northern Territory, Australia
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8
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Azad MA, Swinton M, Clarke FJ, Takaoka A, Vanstone M, Woods A, Boyle A, Hoad N, Toledo F, Piticaru J, Cook DJ. Experiences of Bereaved Family Members Receiving Commemorative Paintings: A Qualitative Study. JAMA Netw Open 2020; 3:e2027259. [PMID: 33346843 PMCID: PMC7753900 DOI: 10.1001/jamanetworkopen.2020.27259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored. OBJECTIVE To explore the influence of personalized paintings created to honor deceased critically ill patients on family members' bereavement experience. DESIGN, SETTING, AND PARTICIPANTS A qualitative descriptive analysis was conducted of semistructured interviews of grieving relatives who received a painting after the death of their loved one. The deceased patients were from a 21-bed medical-surgical intensive care unit. Eleven families were invited to receive a painting, of whom 1 family declined. A total of 22 family members of 10 patients who died in the intensive care unit were interviewed in the study between July 11, 2017, and May 19, 2019. INTERVENTIONS Patients were enrolled in an end-of-life care program that elicits and implements wishes of patients and their families to bring peace during the dying process. Selected families of 10 decedents were invited to receive a painting to honor their loved one 1 to 10 months after the patient's death. Using details about the patient's life story, the artist created individualized paintings to commemorate each patient. MAIN OUTCOMES AND MEASURES The experiences of family members receiving a personalized painting and its reported influence on their grieving experience. RESULTS The family members of 10 decedents (mean [SD] age, 60 [14] years; 5 women [50%]; 8 White patients [80%]) were interviewed. The central theme of art to facilitate healing was illustrated through the following domains: the cocreation process, painting narratives, postmortem connections, and legacy. The process of cocreating the paintings with the artist and family members involved reminiscing, storytelling, and creativity. Family members emphasized the role of art to facilitate healing, exemplified through connections with images portrayed that deeply resonated with memories of their loved one. Participants indicated that the paintings validated that the patient was remembered, helped families feel less alone during a time of grief, honored the loved one's life, and enhanced connections between family members and clinicians. CONCLUSIONS AND RELEVANCE This qualitative study's findings suggest that the creation of personalized paintings commemorating the lives of patients may help foster legacy and postmortem connections with clinicians and may help family members in their healing process.
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Affiliation(s)
- Marisa A. Azad
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - France J. Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne Woods
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Department of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Anne Boyle
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Department of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Neala Hoad
- Critical Care Research, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Feli Toledo
- Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Joshua Piticaru
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J. Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Critical Care Research, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Neville TH, Clarke F, Takaoka A, Sadik M, Vanstone M, Phung P, Hjelmhaug K, Hainje J, Smith OM, LeBlanc A, Hoad N, Tam B, Reeve B, Cook DJ. Keepsakes at the End of Life. J Pain Symptom Manage 2020; 60:941-947. [PMID: 32574658 DOI: 10.1016/j.jpainsymman.2020.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Keepsakes are a relatively unexplored form of bereavement support that is frequently provided as part of the 3 Wishes Project (3WP). The 3WP is a palliative care intervention in which individualized wishes are implemented in the adult intensive care unit for dying patients and their families. OBJECTIVES We aimed to characterize and enumerate the keepsakes that were created as part of the 3WP and to understand their value from the perspective of bereaved family members. METHODS We performed a secondary analysis of family interviews during a multicenter study on the 3WP and characterized all wishes that involved keepsakes. Sixty interviews with family members regarding the 3WP were reanalyzed using qualitative analysis to identify substantive themes related to keepsakes. RESULTS Of 730 patients, 345 (47%) received keepsakes as part of their participation in 3WP. Most keepsakes were either tangible items that served as reminders of the patient's presence (thumbprints and locks of hair) or technology-assisted items (photographs and word clouds). The median cost per keepsake wish was $8.50 (interquartile range $2.00-$25.00). Qualitative analysis revealed two major themes: keepsakes are tangible items that are highly valued by family members; and the creation of the keepsake with clinical staff is valued and viewed as a gesture of compassion. CONCLUSION Keepsakes are common wishes that clinicians in the intensive care unit are able to provide and sometimes cocreate with families when patients are dying. Both the offering to create the keepsake and receipt of the final product are perceived by family members as helpful.
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Affiliation(s)
- Thanh H Neville
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California, USA.
| | - France Clarke
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marina Sadik
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter Phung
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, California, USA
| | | | - Jessica Hainje
- UCLA Department of Nursing, Los Angeles, California, USA
| | - Orla M Smith
- Critical Care Department, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Allana LeBlanc
- Department of Nursing, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Neala Hoad
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Benjamin Tam
- Department of Critical Care Medicine, Niagara Health, St. Catharine's, Ontario, Canada
| | - Brenda Reeve
- Department of Critical Care Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | - Deborah J Cook
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Takaoka A, Vanstone M, Neville TH, Goksoyr S, Swinton M, Clarke FJ, Smith OM, LeBlanc A, Foster D, Kao Y, Xu X, Hoad N, Toledo F, Cook DJ. Family and Clinician Experiences of Sympathy Cards in the 3 Wishes Project. Am J Crit Care 2020; 29:422-428. [PMID: 33130860 DOI: 10.4037/ajcc2020733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters. OBJECTIVES To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project. METHODS Interviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis. RESULTS Sympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient's death. CONCLUSIONS Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.
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Affiliation(s)
- Alyson Takaoka
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thanh H. Neville
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Sophia Goksoyr
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marilyn Swinton
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - France J. Clarke
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Orla M. Smith
- Orla M. Smith is a registered nurse and associate scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Allana LeBlanc
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Denise Foster
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Yuhan Kao
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Xueqing Xu
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Neala Hoad
- Neala Hoad is a registered nurse and research coordinator, Department of Critical Care, and Feli Toledo is a chaplain and registered psychotherapist, Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Feli Toledo
- Neala Hoad is a registered nurse and research coordinator, Department of Critical Care, and Feli Toledo is a chaplain and registered psychotherapist, Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Deborah J. Cook
- Deborah J. Cook is a critical care physician, Department of Critical Care, St Joseph’s Healthcare Hamilton, and a distinguished professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University
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11
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Vanstone M, Sadik M, Smith O, Neville TH, LeBlanc A, Boyle A, Clarke FJ, Swinton ME, Takaoka A, Toledo F, Baker AJ, Phung P, Cook DJ. Building organizational compassion among teams delivering end-of-life care in the intensive care unit: The 3 Wishes Project. Palliat Med 2020; 34:1263-1273. [PMID: 32519615 DOI: 10.1177/0269216320929538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The 3 Wishes Project is a semistructured program that improves the quality of care for patients dying in the intensive care unit by eliciting and implementing wishes. This simple intervention honors the legacy of patients and eases family grief, forging human connections between family members and clinicians. AIM To examine how the 3 Wishes Project enables collective patterns of compassion between patients, families, clinicians, and managerial leaders in the intensive care unit. DESIGN Using a qualitative descriptive approach, interviews and focus groups were used to collect data from family members of dying patients, clinicians, and institutional leaders. Unconstrained directed qualitative content analysis was performed using Organizational Compassion as the analytic framework. SETTING/PARTICIPANTS Four North American intensive care units, participants were 74 family members of dying patients, 72 frontline clinicians, and 20 managerial leaders. RESULTS The policies and processes of the 3 Wishes Project exemplify organizational compassion by supporting individuals in the intensive care unit to collectively notice, feel, and respond to suffering. As an intervention that enables and empowers clinicians to engage in acts of kindness to enhance end-of-life care, the 3 Wishes Project is particularly well situated to encourage collective responses to suffering and promote compassion between patients, family members, and clinicians. CONCLUSIONS Examining the 3 Wishes Project through the lens of organizational compassion reveals the potential of this program to cultivate the capacity for people to collectively notice, feel, and respond to suffering. Our data document multidirectional demonstrations of compassion between clinicians and family members, forging the type of human connections that may foster resilience.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Marina Sadik
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Orla Smith
- Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada
| | - Thanh H Neville
- Division of Pulmonary & Critical Care, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Allana LeBlanc
- Department of Nursing, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Anne Boyle
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Palliative Care, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - France J Clarke
- Department of Critical Care, St. Joseph's Healthcare, Hamilton, ON, Canada.,Departments Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Marilyn E Swinton
- Departments Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alyson Takaoka
- Department of Critical Care, St. Joseph's Healthcare, Hamilton, ON, Canada.,Departments Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Feli Toledo
- Department of Spiritual Care, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Andrew J Baker
- Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada
| | - Peter Phung
- Division of General Internal Medicine, Department of Medicine, Palliative Care Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Deborah J Cook
- Department of Critical Care, St. Joseph's Healthcare, Hamilton, ON, Canada.,Departments Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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12
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Vanstone M, Neville TH, Swinton ME, Sadik M, Clarke FJ, LeBlanc A, Tam B, Takaoka A, Hoad N, Hancock J, McMullen S, Reeve B, Dechert W, Smith OM, Sandhu G, Lockington J, Cook DJ. Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations. BMC Palliat Care 2020; 19:93. [PMID: 32605623 PMCID: PMC7325646 DOI: 10.1186/s12904-020-00601-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. METHODS Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. RESULTS Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. CONCLUSIONS The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. TRIAL REGISTRATION NCT04147169 , retrospectively registered with clinicaltrials.gov on October 31, 2019.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thanh H Neville
- Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, California, Los Angeles, USA
| | - Marilyn E Swinton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marina Sadik
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - France J Clarke
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Allana LeBlanc
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Benjamin Tam
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Sarah McMullen
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Brenda Reeve
- Department of Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | | | - Orla M Smith
- Critical Care Department, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gyan Sandhu
- Critical Care Department, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Deborah J Cook
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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13
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Philip RK. Word cloud analysis and single word summarisation as a new paediatric educational tool: Results of a neonatal application. J Paediatr Child Health 2020; 56:873-877. [PMID: 31898377 DOI: 10.1111/jpc.14760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 11/30/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
Abstract
AIMS To analyse the value of computerised 'word cloud' (WC) generated from spontaneously articulated 'single word summarisation' (SWS) by medical students to assist their learning during the neonatal intensive care unit placement. To highlight WC as a potential new tool in paediatric teaching, improving student engagement and reflective feedback. METHODS An observational study was conducted in the neonatal intensive care unit of University Maternity Hospital Limerick, Ireland for 5 years (October 2012 to September 2017). One faculty member prospectively recorded SWS in neonatology by graduate entry medical students. An online 'WC generator' under an open-source licence was used to compute the WC. Hospital audit committee approved the study. RESULTS A total of 268 SWS were recorded consecutively from 268 medical students towards the WC generation. Structured multi-response student feedback showed SWS and WC as stimulating, unique and creative. Powerpoint presentation of the computed WC prompted students to reflect on their chosen words and that of peers. CONCLUSIONS Visualisation of medical student-generated SWS as a WC could stimulate interaction, reflection and clinical discussion, thus assisting teachers to foster better student engagement. This innovative educational tool equips students to 'convey more with fewer words' and has the potential transferability to other clinical disciplines.
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Affiliation(s)
- Roy K Philip
- Division of Neonatology, Department of Paediatrics, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
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14
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Yeganeh L, Boyle JA, Gibson-Helm M, Teede H, Vincent AJ. Women’s perspectives of early menopause: development of a word cloud. Climacteric 2020; 23:417-420. [DOI: 10.1080/13697137.2020.1730318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L. Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J. A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menopause Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, VIC, Australia
| | - M. Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - H. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology, Monash Health, Monash University, Melbourne, VIC, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Monash University, Melbourne, VIC, Australia
| | - A. J. Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menopause Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology, Monash Health, Monash University, Melbourne, VIC, Australia
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15
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Takaoka A, Honarmand K, Vanstone M, Tam B, Smith OM, Baker A, LeBlanc A, Swinton M, Neville TH, Clarke FJ, Hancock J, McMullen S, Meade MO, Rose T, Arora S, Cook DJ. Organ Donation at the End of Life: Experiences From the 3 Wishes Project. J Intensive Care Med 2020; 36:404-412. [PMID: 31960743 DOI: 10.1177/0885066619900125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ donation as experienced by families, clinicians, and organ donation coordinators. METHODS In a multicenter evaluation of the 3WP in 4 Canadian ICUs, we conducted a thematic analysis of transcripts from interviews and focus groups with clinicians, organ donation coordinators, and families of dying or died patients for whom donation was considered. RESULTS We analyzed transcripts from 26 interviews and 2 focus groups with 18 family members, 17 clinicians, and 6 organ donation coordinators. The central theme describes the mutual goals of the 3WP and organ donation-emphasizing personhood and agency across the temporal continuum of care. During family decision-making, conversations encouraged by the 3WP can facilitate preliminary discussions about donation. During preparation for donation, memory-making activities supported by the 3WP redirect focus toward personhood. During postmortem family care, the 3WP supports families, including when donation is unsuccessful, and highlights aspirational pursuits of donation while encouraging reflections on other fulfilled wishes. CONCLUSIONS Organ donation and the 3WP provide complementary opportunities to engage in value-based conversations during the dying process. The shared values of these programs may help to incorporate organ donation and death into a person's life narrative and incorporate new life into a person's death narrative.
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Affiliation(s)
- Alyson Takaoka
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada.,Co-primary authors
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western Ontario, London, Canada.,Co-primary authors
| | - Meredith Vanstone
- McMaster program for Education Research Innovation & Theory, Department of Family Medicine, 3710McMaster University, Hamilton, Canada
| | - Benjamin Tam
- Division of Critical Care, Department of Medicine, 37195Niagara Health, St. Catharines, Canada
| | - Orla M Smith
- Critical Care Department, Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
| | - Andrew Baker
- Department of Anesthesia, 10071St Michael's Hospital, Toronto, Canada.,Department of Critical Care, 10071St Michael's Hospital, Toronto, Canada
| | - Allana LeBlanc
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Marilyn Swinton
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada
| | - Thanh H Neville
- Division of Pulmonary & Critical Care, Department of Medicine, 8783University of California, Los Angeles, CA, USA
| | - France J Clarke
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jennifer Hancock
- Department of Critical Care, 3688University of Dalhousie, Halifax, Canada
| | - Sarah McMullen
- Department of Critical Care, 3688University of Dalhousie, Halifax, Canada
| | - Maureen O Meade
- Faculty of Health Sciences, Department of Medicine, Faculty, 3710McMaster University, Hamilton, Canada
| | - Trudy Rose
- Department of Spiritual Care, Grand River Hospital, Kitchener, Canada
| | - Samantha Arora
- Department of Medicine, 3710McMaster University, Hamilton, Canada
| | - Deborah J Cook
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada.,Faculty of Health Sciences, Department of Medicine, Faculty, 3710McMaster University, Hamilton, Canada
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16
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Riegel M, Randall S, Buckley T. Memory making in end-of-life care in the adult intensive care unit: A scoping review of the research literature. Aust Crit Care 2019; 32:442-447. [DOI: 10.1016/j.aucc.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022] Open
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17
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Bradfield Z, Hauck Y, Kelly M, Duggan R. "It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model. BMC Pregnancy Childbirth 2019; 19:29. [PMID: 30642287 PMCID: PMC6332887 DOI: 10.1186/s12884-018-2144-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/11/2018] [Indexed: 11/12/2022] Open
Abstract
Background The phenomenon of being ‘with woman’ is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the ‘with woman’ phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being ‘with woman’ during labour and birth from the perspective of midwives’ working in a model where care is provided by a known midwife. Methods A descriptive phenomenological design was employed with ten midwives working in a ‘known midwife’ model who described their experiences of being ‘with woman’ during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience. Results Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being ‘with woman’, confirming that this relationship extends beyond the woman – midwife relationship to include the woman’s support people and family. Being ‘with woman’ during labour and birth in the context of the relationship facilitates woman-centred care. Being ‘with woman’ influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being ‘with woman’ in the known midwife model are shared by midwives. Conclusions Findings offer valuable insight into midwives’ experiences of being ‘with woman’ in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being ‘with woman’ which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being ‘with woman’ provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being ‘with woman’ in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.
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Affiliation(s)
- Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University King Edward Memorial Hospital, Subiaco, Australia
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia
| | - Ravani Duggan
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Bentley, WA, 6845, Australia
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18
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Florijn BW, der Graaf HV, Schoones JW, Kaptein AA. Narrative medicine: A comparison of terminal cancer patients' stories from a Dutch hospice with those of Anatole Broyard and Christopher Hitchens. DEATH STUDIES 2018; 43:570-581. [PMID: 30265841 DOI: 10.1080/07481187.2018.1504350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
Not all physicians readily discuss death with their terminal patients. To explore whether physicians discuss dying with their terminal patients and to pursue an in-depth understanding of patients' perceptions of death, we interviewed terminal cancer patients in a Dutch hospice and compared their stories to quotes from two autobiographies on dying from cancer, Christopher Hitchens' Mortality and Anatole Broyard's Intoxicated by my illness. This narrative medicine study could potentially teach physicians they should discuss impending death to prevent the use of an invasive medical treatment that typically extends the quantity, but not the quality, of life.
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Affiliation(s)
- B W Florijn
- Department of Internal Medicine, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| | | | - J W Schoones
- Walaeus Library, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
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