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Kaasalainen S, Wickson-Griffiths A, Hunter P, Thompson G, Kruizinga J, McCleary L, Sussman T, Venturato L, Shaw S, Boamah SA, Bourgeois-Guérin V, Hadjistavropoulos T, Macdonald M, Martin-Misener R, McClement S, Parker D, Penner J, Ploeg J, Sinclair S, Fisher K. Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial. BMJ Open 2023; 13:e073585. [PMID: 37880170 PMCID: PMC10603462 DOI: 10.1136/bmjopen-2023-073585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme. METHODS AND ANALYSIS A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis. ETHICS AND DISSEMINATION The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals. TRIAL REGISTRATION NUMBER NCT039359.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Gladys Sharpe Chair in Nursing, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Julia Kruizinga
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Sally Shaw
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Sheila A Boamah
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Susan McClement
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Parker
- Aged Care, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Jamie Penner
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Virdun C, Garcia M, Phillips JL, Luckett T. Description of patient reported experience measures (PREMs) for hospitalised patients with palliative care needs and their families, and how these map to noted areas of importance for quality care: A systematic review. Palliat Med 2023; 37:898-914. [PMID: 37092501 PMCID: PMC10320712 DOI: 10.1177/02692163231169319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The global need for focused improvements in palliative care within the acute hospital setting is well noted. A large volume of evidence exists detailing what hospitalised patients with palliative care needs and their families note as important for high quality care. Patient Reported Experience Measures (PREMs) are one mechanism that hospitals could use to inform improvement work. To date there has not been a review of PREMs available for hospitalised patients with palliative care needs and/or their family, nor how they align with noted priorities for high quality care. AIM To identify and describe PREMs designed for hospitalised patients with palliative care needs and their families; and their alignment with patient and family identified domains for high quality care. DESIGN A systematic review. DATA SOURCES A systematic search of CINAHL, Medline and PsycInfo was conducted up to September 23, 2022 and supplemented by handsearching article reference lists and internet searches. PREMs written in English and designed for patients with palliative care needs in acute hospitals were eligible for inclusion. Included PREMs were described by: summarising key characteristics; and mapping their items to domains noted to be important to hospitalised patients with palliative care needs and their families informed by outcomes from a published study completed in 2021. Evidence for psychometric properties were reviewed. RESULTS Forty-four PREMs with 827 items were included. Items per PREM varied from 2 to 85 (median 25, IQR 13-42). Two-thirds (n = 534, 65%) of the items were designed for families and a third (n = 283, 34%) for hospitalised patients, and very few (n = 10, 1%) for both. Sixty-six percent of items measured person-centred care, 30% expert care and 4% environmental aspects of care. Available PREMs address between 1 and 11 of the 14 domains of importance for quality palliative care. PREMs had a median of 38% (IQR 25.4-56.3) of items >Grade 8 measured by the Flesch-Kincaid readability test, with Grade 8 or lower recommended to ensure health information is as accessible as possible across the population. CONCLUSIONS Whilst 44 PREMs are available for hospitalised patients with palliative care needs or their families, a varied number of items are available for some domains of care provision that are important, compared to others. Few are suitable for people with lower levels of literacy or limited cognitive capacity due to illness.
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Affiliation(s)
- Claudia Virdun
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Maja Garcia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Tim Luckett
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
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Fasse L, Roche N, Flahault C, Garrouste-Orgeas M, Ximenes M, Pages A, Evin A, Dauchy S, Scotte F, Le Provost JB, Blot F, Mateus C. The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death. BMC Palliat Care 2022; 21:217. [PMID: 36464684 PMCID: PMC9720978 DOI: 10.1186/s12904-022-01106-z] [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: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer. METHODS The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience. DISCUSSION The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted. TRIAL REGISTRATION This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.
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Affiliation(s)
- L Fasse
- DIOPP, Gustave Roussy Hospital, Villejuif, France.
- Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100, Boulogne- Billancourt, France.
| | - N Roche
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C Flahault
- DIOPP, Gustave Roussy Hospital, Villejuif, France
- Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100, Boulogne- Billancourt, France
| | - M Garrouste-Orgeas
- IAME, INSERM, Université de Paris, F-75018, Paris, France
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - M Ximenes
- Maison Médicale Marie Galène, Bordeaux, France
| | - A Pages
- Biostatistical Unit, Gustave Roussy Hospital, Villejuif, France
| | - A Evin
- Palliative Care unit, CHU, Nantes, France
| | - S Dauchy
- DMU Psychiatry and Addictology, AP-HP.Centre, Université de Paris, Paris, France
| | - F Scotte
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | | | - F Blot
- DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C Mateus
- DIOPP, Gustave Roussy Hospital, Villejuif, France
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Hoare S, Antunes B, Kelly MP, Barclay S. End-of-life care quality measures: beyond place of death. BMJ Support Palliat Care 2022:spcare-2022-003841. [PMID: 35859151 DOI: 10.1136/spcare-2022-003841] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quality in healthcare is measured shapes care provision, including how and what care is delivered. In end-of-life care, appropriate measurement can facilitate effective care and research, and when used in policy, highlight deficits and developments in provision and endorse the discipline necessity. The most prevalent end-of-life quality metric, place of death, is not a quality measure: it gives no indication of the quality of care or patient experience in the place of death. AIM To evaluate alternative measures to place of death for assessing quality of care in end-of-life provision in all settings. METHOD We examine current end-of-life care quality measures for use as metrics for quality in end-of-life care. We categorise approaches to measurement as either: clinical instruments, mortality follow-back surveys or organisational data. We review each category using four criteria: care setting, patient population, measure feasibility, care quality. RESULTS While many of the measure types were highly developed for their specific use, each had limitations for measuring quality of care for a population. Measures were deficient because they lacked potential for reporting end-of-life care for patients not in receipt of specialist palliative care, were reliant on patient-proxy accounts, or were not feasible across all care settings. CONCLUSION None of the current end-of-life care metric categories can currently be feasibly used to compare the quality of end-of-life care provision for all patients in all care settings. We recommend the development of a bespoke measure or judicious selection and combination of existing measures for reviewing end-of-life care quality.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Bárbara Antunes
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Michael P Kelly
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
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Stapleton RD, Ford DW, Sterba KR, Nadig NR, Ades S, Back AL, Carson SS, Cheung KL, Ely J, Kross EK, Macauley RC, Maguire JM, Marcy TW, McEntee JJ, Menon PR, Overstreet A, Ritchie CS, Wendlandt B, Ardren SS, Balassone M, Burns S, Choudhury S, Diehl S, McCown E, Nielsen EL, Paul SR, Rice C, Taylor KK, Engelberg RA. Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients. J Pain Symptom Manage 2022; 63:e621-e632. [PMID: 35595375 PMCID: PMC9179950 DOI: 10.1016/j.jpainsymman.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
CONTEXT Outcomes after cardiopulmonary resuscitation (CPR) remain poor. We have spent 10 years investigating an "informed assent" (IA) approach to discussing CPR with chronically ill patients/families. IA is a discussion framework whereby patients extremely unlikely to benefit from CPR are informed that unless they disagree, CPR will not be performed because it will not help achieve their goals, thus removing the burden of decision-making from the patient/family, while they retain an opportunity to disagree. OBJECTIVES Determine the acceptability and efficacy of IA discussions about CPR with older chronically ill patients/families. METHODS This multi-site research occurred in three stages. Stage I determined acceptability of the intervention through focus groups of patients with advanced COPD or malignancy, family members, and physicians. Stage II was an ambulatory pilot randomized controlled trial (RCT) of the IA discussion. Stage III is an ongoing phase 2 RCT of IA versus attention control in in patients with advanced chronic illness. RESULTS Our qualitative work found the IA approach was acceptable to most patients, families, and physicians. The pilot RCT demonstrated feasibility and showed an increase in participants in the intervention group changing from "full code" to "do not resuscitate" within two weeks after the intervention. However, Stages I and II found that IA is best suited to inpatients. Our phase 2 RCT in older hospitalized seriously ill patients is ongoing; results are pending. CONCLUSIONS IA is a feasible and reasonable approach to CPR discussions in selected patient populations.
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Affiliation(s)
- Renee D Stapleton
- Pulmonary and Critical Medicine, HSRF 222 (R.D.S), University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
| | - Dee W Ford
- Division Director and Professor, Pulmonary, Critical Care, and Sleep Medicine, CSB 816, MSC 630 (D.W.F.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Public Health Sciences (K.R.S.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nandita R Nadig
- Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine (N.R.N.), Chicago, Illinois, USA
| | - Steven Ades
- Hematology and Oncology (S.A.), University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Anthony L Back
- Department of Medicine (A.L.B.), University of Washington, Seattle, Washington, USA
| | - Shannon S Carson
- Pulmonary and Critical Care Medicine (S.S.C.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katharine L Cheung
- Nephrology (K.L.C.), University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Janet Ely
- University of Vermont Cancer Center (J.E.), Burlington, Vermont, USA
| | - Erin K Kross
- Division of Pulmonary, Critical Care & Sleep Medicine, Co-Director of Cambia Palliative Care Center of Excellence at UW Medicine (E.K.K.), University of Washington, Seattle, Washington, USA
| | | | - Jennifer M Maguire
- Pulmonary and Critical Care Medicine (J.M.M.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Theodore W Marcy
- Pulmonary and Critical Care Medicine (T.W.M.), University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Jennifer J McEntee
- Internal Medicine and Pediatrics, Palliative Care and Hospice Medicine (J.J.M.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Prema R Menon
- Vertex Pharmaceuticals (P.R.M.), Boston, Massachusetts, USA
| | - Amanda Overstreet
- Geriatrics and Palliative Care (A.O.), Medical University of South Carolina, Charleston, SC
| | | | - Blair Wendlandt
- Pulmonary and Critical Care Medicine (B.W.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara S Ardren
- University of Vermont Larner College of Medicine (S.S.A.), Burlington, Vermont, USA
| | - Michael Balassone
- Division of Pulmonary and Critical Care Medicine (M.B.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie Burns
- University of Vermont Larner College of Medicine (S.B.), Burlington, Vermont, USA
| | - Summer Choudhury
- North Carolina Translational and Clinical Sciences Institute (S.C.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sandra Diehl
- University of Vermont Medical Center (S.D.), Burlington, Vermont, USA
| | - Ellen McCown
- Spiritual Care (E.M.), University of Washington Medical Center, Seattle, Washington, USA
| | - Elizabeth L Nielsen
- Cambia Palliative Care Center of Excellence at UW Medicine (E.L.N), University of Washington, Seattle, Washington, USA
| | - Sudiptho R Paul
- Pulmonary and Critical Care Medicine (S.R.P., C.R.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Colleen Rice
- Pulmonary and Critical Care Medicine (S.R.P., C.R.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine K Taylor
- Pulmonary, Critical Care, and Sleep Medicine (K.K.T), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ruth A Engelberg
- Pulmonary, Critical Care & Sleep Medicine, Cambia Palliative Care Center of Excellence at UW Medicine (R.A.E.), University of Washington, Seattle, Seattle, Washington, USA
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Frame A, Grant JB, Layard E, Scholz B, Law E, Ranse K, Mitchell I, Chapman M. Bereaved caregivers’ satisfaction with end-of-life care. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.2005756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Abbey Frame
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Elizabeth Layard
- Psychosocial Liaison, Palliative Care, The Canberra Hospital, Canberra, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Eleanor Law
- Division of Cancer, Ambulatory and Community Health Support (CACHS), The Canberra Hospital, Canberra, Australia
| | - Kristen Ranse
- School of Nursing & Midwifery, Griffith University, Griffith, Australia
| | - Imogen Mitchell
- ANU Medical School, The Australian National University, Canberra, Australia
| | - Michael Chapman
- ANU Medical School, The Australian National University, Canberra, Australia
- Palliative Care, The Canberra Hospital, Canberra, Australia
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Fien S, Plunkett E, Fien C, Greenaway S, Heyland DK, Clark J, Cardona M. Challenges and facilitators in delivering optimal care at the End of Life for older patients: a scoping review on the clinicians' perspective. Aging Clin Exp Res 2021; 33:2643-2656. [PMID: 33713331 DOI: 10.1007/s40520-021-01816-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/13/2021] [Indexed: 01/28/2023]
Abstract
The concepts and elements determining quality of care at the End of Life may vary across professional groups but there is consensus that high-quality care at the End of Life is beneficial for the patient, families, health systems and society at large. This scoping review aimed to elucidate gaps in the delivery of this specific type of care in older people from the clinicians' perspective, and to identify potential solutions to both improve this care and promote work satisfaction by the involved clinicians. Twelve studies published since 2010 with data from 18 countries identified four major gaps: (1) Core clinical competencies; (2) Shared decision-making; (3) Health care system, environmental context, and resources; and (4) Organisational leadership, culture and legislation. Multiple suggestions for staff communications training, multidisciplinary mentoring, and advance care planning alignment with patient wishes were identified. However, a clear picture arose of consistently unmet needs that have been previously highlighted in research for more than a decade. This indicates poor uptake of previous recommendations and highlights the difficulties in changing the service culture to ensure provision of optimal services at the End of Life. Future investigations on the reasons for poor uptake and identification of effective approaches to execute the agreed recommendations are warranted.
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Kobewka D, Heyland DK, Dodek P, Nijjar A, Bansback N, Howard M, Munene P, Kunkel E, Forster A, Brehaut J, You JJ. Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death. J Gen Intern Med 2021; 36:2593-2600. [PMID: 33528779 PMCID: PMC8390722 DOI: 10.1007/s11606-021-06605-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. OBJECTIVE To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. DESIGN Open-label randomized controlled trial. PATIENTS Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. INTERVENTION Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. MAIN MEASURE The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment. KEY RESULTS We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict). CONCLUSIONS Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. PRIMARY FUNDING SOURCE Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.
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Affiliation(s)
- Daniel Kobewka
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. .,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Aman Nijjar
- General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,David Braley Health Sciences Centre, Hamilton, ON, Canada
| | - Peter Munene
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elizabeth Kunkel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Department of National Defence, Ottawa, ON, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada
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Guirimand F, Bouleuc C, Sahut d'Izarn M, Martel-Samb P, Guy-Coichard C, Picard S, Devalois B, Ghadi V, Aegerter P. Development and Validation of the QUALI-PALLI-FAM Questionnaire for Assessing Relatives' Perception of Quality of Inpatient Palliative Care: A Prospective Cross-Sectional Survey. J Pain Symptom Manage 2021; 61:991-1001.e3. [PMID: 32979519 DOI: 10.1016/j.jpainsymman.2020.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022]
Abstract
CONTEXT Relatives of patients receiving palliative care are at risk for psychological and physical distress, and their perception of quality of care can influence patients' quality of life. OBJECTIVES The purpose of this study was to develop and validate the QUALI-PALLI-FAM questionnaire (QUAlity of PALLIative car from FAMilies' perspective) to measure families' perception of and satisfaction with palliative care. METHODS An exploratory factor analysis was conducted, and we evaluated the questionnaire's internal consistency using Cronbach's alpha, its stability across various strata, and the correlation between the QUALI-PALLI-FAM (factors, total score, and global satisfaction) and the total score of the FAMCARE (FAMily satisfaction with CARE) questionnaire. RESULTS This multicentric prospective cross-sectional survey was conducted in seven French hospitals, namely, three palliative care units and four standard medical units with a mobile palliative care team. The questionnaire was completed by 170 relatives of patients (more than 90% of patients had advanced cancer). The final questionnaire included 14 items across three domains: organization of care and availability of caregivers, medical information provision, and confidence and involvement of relatives. Internal consistency was good for all subscales (Cronbach's α = 0.74-0.86). Our questionnaire was stable across various strata: age and gender (patients and relatives), Palliative Performance Scale scores, and care settings. The QUALI-PALLI-FAM total score was correlated with the total FAMCARE score. CONCLUSION The QUALI-PALLI-FAM appears to be a valid, reliable, and well-accepted tool to explore relatives' perception of quality of inpatient palliative care and complements the QUALI-PALLI-PAT questionnaire. Further testing is required in various settings and countries.
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Affiliation(s)
- Frédéric Guirimand
- Pôle Recherche SPES 'Soins Palliatifs en Société' Maison Médicale Jeanne Garnier, Paris and Université Paris-Saclay, UVSQ, Versailles, France.
| | - Carole Bouleuc
- Institut Curie, Département interdisciplinaire des Soins de Support, Paris, France
| | - Marine Sahut d'Izarn
- AP-HP, Hôpital Ambroise Paré, Equipe Mobile de Soins Palliatifs, Boulogne, France
| | - Patricia Martel-Samb
- AP-HP, Unité de Recherche Clinique URC HU PIFO, Hôpital Ambroise Paré, Boulogne, France
| | | | - Stéphane Picard
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Unité de Soins Palliatifs, Paris, France
| | - Bernard Devalois
- Centre de Recherche et d'Enseignement interprofessionnel Bientraitance et fin de vie and AGORA (EA7892) université CY Cergy Paris Université, Cergy, France
| | | | - Philippe Aegerter
- GIRCI-IDF, Cellule Méthodologie, Paris, France et Université Paris-Saclay, UVSQ, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP - Centre de recherche en Epidémiologie et Santé des Populations U1018 INSERM UPS UVSQ, 94807, Villejuif, France
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. THE GERONTOLOGIST 2021; 61:e23-e38. [PMID: 31942997 PMCID: PMC8023359 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal
- Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- Sahlgrenska Academy, University of Gothenburg, Sweden
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Saunders CH, Durand MA, Scalia P, Kirkland KB, MacMartin MA, Barnato AE, Milne DW, Collison J, Jaggars A, Butt T, Wasp G, Nelson E, Elwyn G. User-Centered Design of the consideRATE Questions, a Measure of People's Experiences When They Are Seriously Ill. J Pain Symptom Manage 2021; 61:555-565.e5. [PMID: 32814165 PMCID: PMC9162500 DOI: 10.1016/j.jpainsymman.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/22/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT No brief patient-reported experience measure focuses on the most significant concerns of seriously ill individuals. OBJECTIVES The objective of the study was to develop the consideRATE questions. METHODS This user-centered design study had three phases. We reviewed the literature and consulted stakeholders, including caregivers, clinicians, and researchers, to identify the elements of care most important to patients (Phase 1). We refined items based on cognitive interviews with patients, families, and clinicians (Phase 2). We piloted the measure with patients and families (Phase 3). RESULTS Phase 1 resulted in seven questions addressing the following elements: 1) care team attention to patients' physical symptoms, 2) emotional symptoms, 3) environment of care, 4) respect for patients' priorities, 5) communication about future plans, 6) communication about financial and similar affairs, and 7) communication about illness trajectory. Phase 2 participants included eight patients, eight family members, and seven clinicians. We added an open-text comment option. We did not identify any other issues that were important enough to participants to include. Response choices ranged from one (very bad) to four (very good), with a not applicable option (does not apply). Phase 3 involved 15 patients and 16 family members and demonstrated the acceptability of the consideRATE questions. Most reported that the questions were not distressing, disruptive, or confusing. Completion time averaged 2.4 minutes (range 1-5). CONCLUSION Our brief patient-reported serious illness experience measure is based on what matters most to patients, families, and clinicians. It was acceptable to patients and families in a regional sample. It has promise for use in clinical settings.
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Affiliation(s)
- Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - David W Milne
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joan Collison
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ashleigh Jaggars
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Tanya Butt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Garrett Wasp
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eugene Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
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Laranjeira C, Dixe MDA, Gueifão L, Caetano L, Passadouro R, Gabriel T, Querido A. Development and psychometric properties of the general public's attitudes toward advance care directives scale in Portugal. J Public Health Res 2021; 10:1881. [PMID: 33681087 PMCID: PMC7922370 DOI: 10.4081/jphr.2021.1881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022] Open
Abstract
Background: To date, no instrument in Portugal has evaluated the attitudes of the population about advance care directives. This paper describes the development and testing of the General Public's Attitudes Toward Advance Care Directives (GPATACD) Scale. Design and Methods: Methodological study. The development of the instrument was based on a literature review, updated in 2018. Face and content validity were verified by an expert panel and piloted among six participants. Data were collected in an online survey of 1024 Portuguese adults. The obtained data were analyzed using Varimax rotation, while the reliability was evaluated by calculating Cronbach's alpha. Results: The scale achieves good Item-Content Validity Index (I-CVI) values, between 0.89 and 1.00, and scale-CVI values of 0.91. A principal component analysis generated four dimensions with 26 items as a final scale, with overall Cronbach's alpha of 0.848. Conclusions: The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of the general public's attitudes toward advance care directives.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences of Polytechnic Institute of Leiria; Research in Education and Community Intervention (RECI), Piaget Institute; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria
| | - Maria Dos Anjos Dixe
- School of Health Sciences of Polytechnic of Leiria; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria
| | - Luís Gueifão
- Intensive Care Unit, Leiria Hospital Center, Leiria
| | | | - Rui Passadouro
- ACES do Pinhal Litoral, Leiria; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria
| | | | - Ana Querido
- School of Health Sciences of Polytechnic of Leiria; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Center for Research in Health and Information Systems (CINTESIS), NursID, University of Porto, Portugal
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McEwan K, Minou L, Moore H, Gilbert P. Engaging with distress: Training in the compassionate approach. J Psychiatr Ment Health Nurs 2020; 27:718-727. [PMID: 32187418 DOI: 10.1111/jpm.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health nurses provide care within an environment that is often threatening. The environment is often threatening because: (a) patients' needs are complex and highly emotional, (b) nurses often do not have the time and resources they would wish for and (c) caring for patients can be emotionally exhausting and distressing. Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there is no study evaluating compassion interventions for the high-threat profession of mental health nursing and no study qualitatively evaluating compassion training and implementation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study looked at what happens if compassion training delivered by the originator of Gilbert's model of compassion is given to mental health nurses. Nurses were interviewed 1 year later to see how relevant and useful the training was, and whether they had been able to use it in their daily work. Consistent with previous studies, the study found a reduction in professionals' self-criticism and an increase in self-compassion, which in this study extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying the training directly to reduce patient self-criticism. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses felt that more training and supervision was needed to build the confidence to use the training regularly at work. They felt it had been difficult to use the training because of the threatening environment in which they worked. Nurses recommended that the whole organization would need the training to make it part of their everyday work. ABSTRACT: Introduction Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there has not been a study evaluating compassion interventions for the high-threat profession of mental health nursing. Neither has there been a study providing an in-depth qualitative evaluation of training and implementation. The current study aims to address these gaps in the literature. Aim The aims were to evaluate Compassionate Mind Training-CMT for mental health nurses and to assess implementation. Method Focus groups were conducted (N = 28) 1 year later to evaluate CMT and implementation. Results Content analysis revealed four training themes: (a) Useful framework; (b) Thought-provoking and exciting; (c) Appreciation of person-centred approach; and (d) Need for ongoing training and supervision. Three implementation themes emerged: (a) Applied approach with patients and staff themselves; (b) Environmental challenges to implementation; and (c) Attitudinal challenges to implementation. Discussion Consistent with previous studies, professionals experienced reduced self-criticism and an increased self-compassion, which extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying training directly to reduce patient self-criticism. Implications For successful implementation, formal adoption of compassion approaches is needed with strategic integration at all levels.
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Affiliation(s)
- Kirsten McEwan
- College of Health and Social Care, University of Derby, Derby, UK
| | - Lina Minou
- College of Health and Social Care, University of Derby, Derby, UK
| | | | - Paul Gilbert
- College of Health and Social Care, University of Derby, Derby, UK
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14
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Allen D, Spencer G, McEwan K, Catarino F, Evans R, Crooks S, Gilbert P. The Schwartz Centre Rounds: Supporting mental health workers with the emotional impact of their work. Int J Ment Health Nurs 2020; 29:942-952. [PMID: 32413204 DOI: 10.1111/inm.12729] [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] [Received: 10/17/2019] [Revised: 03/23/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022]
Abstract
In healthcare settings, there is an emotional cost to caring which can result in compassion fatigue, burnout, secondary trauma, and compromised patient care. Innovative workplace interventions such as the Schwartz Rounds offer a group reflective practice forum for clinical and non-clinical professionals to reflect on the emotional aspects of working in health care. Whilst the Rounds are established in medical health practice, this study presents an evaluation of the Rounds offered to mental health services. The Rounds were piloted amongst 150 mental health professionals for 6 months and evaluated using a mixed-methods approach with standardized evaluation forms completed after each Round and a focus group (n = 9) at one-month follow-up. This paper also offers a unique six-year follow-up of the evaluation of the Rounds. Rounds were rated as helpful, insightful, and relevant, and at six years follow-up, Rounds were still rated as valuable and viewed as embedded. Focus groups indicated that Rounds were valued because of the opportunity to express emotions (in particular negative emotions towards patients that conflict with the professional care-role), share experiences, and feel validated and supported by colleagues. The findings indicate that Schwartz Rounds offer a positive application in mental healthcare settings. The study supports the use of interventions which provide an ongoing forum in which to discuss emotions, develop emotional literacy, provide peer support and set an intention for becoming a more compassionate organization in which to work.
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Affiliation(s)
- Deborah Allen
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | | | | | | | - Rachael Evans
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Sarah Crooks
- College of Life and Natural Sciences College of Life and Natural, Derby, UK
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Rolnick JA, Oredeko F, Cooney-Zingman E, Asch DA, Halpern SD. Comparison of Web-Based and Paper Advance Directives: A Pilot Randomized Clinical Trial. Am J Hosp Palliat Care 2020; 38:230-237. [PMID: 32648476 DOI: 10.1177/1049909120940210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital tools to document care preferences in serious illnesses are increasingly common, but their impact is unknown. We developed a web-based advance directive (AD) featuring (1) modular content eliciting detailed care preferences, (2) the ability to electronically transmit ADs to the electronic health record (EHR), and (3) use of nudges to promote document transmission and sharing. OBJECTIVE To compare a web-based, EHR-transmissible AD to a paper AD. METHODS Patients with gastrointestinal and lung malignancies were randomized to the web or paper AD. The primary outcome was the proportion of patients with newly documented advance care plans in the EHR at 8 weeks. Secondary outcomes assessed through an e-mail survey included the change in satisfaction with end-of-life plans, AD acceptability, and self-reported sharing with a surrogate. RESULTS Ninety-one participants were enrolled: 46 randomly allocated to the web AD and 45 to paper. Thirteen patients assigned to web AD (28%) had new documentation versus 7 (16%) assigned to paper (P = .14). Adjusted for demographic factors and primary diagnosis, the odds ratio of new documentation with web AD was 3.7 (95% CI: 0.8-17.0, P = .10). Satisfaction with advance care planning and AD acceptability were high in both groups and not significantly different. Among patients completing web ADs, 79% reported sharing plans with their caregivers, compared with 65% of those completing paper ADs (P = .40). CONCLUSION Web-based ADs hold promise for promoting documentation and sharing of preferences, but larger studies are needed to quantify effects on these intermediate end points and on patient-centered outcomes.
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Affiliation(s)
- Joshua A Rolnick
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,National Clinician Scholars Program, 14640University of Pennsylvania, PA, USA
| | - Francisca Oredeko
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Cooney-Zingman
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Center for Health Care Innovation, Penn Medicine, Philadelphia PA, USA
| | - Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Demiris G, DeKeyser Ganz F, Han CJ, Pike K, Parker Oliver D, Washington K. Design and Preliminary Testing of the Caregiver-Centered Communication Questionnaire (CCCQ). J Palliat Care 2020; 35:154-160. [PMID: 31696787 PMCID: PMC7202953 DOI: 10.1177/0825859719887239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study objective was to develop and test a new survey instrument that measures caregiver-centered communication. We developed a questionnaire inspired by the National Cancer Institute framework on patient-centered communication, focusing on family caregiver communication for this tool. The questionnaire includes 5 subscales: exchange of information, relationship with team, emotions, managing care, and decision-making. The initial questionnaire was reviewed by domain experts for face validity and edited further to include 30 items. We administered the modified questionnaire to 115 family caregivers of patients with serious illness in various settings. Cronbach α for the entire scale was 0.97 and ranged from 0.82 to 0.93 for the 5 subscales. Participants found that the survey addressed important concepts and that items were in most cases easy to understand. This instrument provides a structured way to assess caregiver-centered communication, addressing a pressing need for tools that measure the extent to which communication is responsive to the needs and preferences of family caregivers. Further testing and refinement are needed to improve the ease of use and examine the reliability and validity of this measure.
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Affiliation(s)
- George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Freda DeKeyser Ganz
- Henrietta Szold Hadassah-Hebrew, University School of Nursing, Hashmonaim, Israel
| | - Claire J. Han
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Washington, DC, USA
| | - Kenneth Pike
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Washington, DC, USA
| | - Debra Parker Oliver
- Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Karla Washington
- Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Sandsdalen T, Grøndahl VA, Wilde-Larsson B. Development of a Short Form of the Questionnaire Quality from the Patient's Perspective for Palliative Care (QPP-PC). J Multidiscip Healthc 2020; 13:495-506. [PMID: 32606721 PMCID: PMC7297322 DOI: 10.2147/jmdh.s246184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Patients' views on quality are important to improve person-centered palliative care. There is a lack of short, validated instruments incorporating patients' perspectives of the multidisciplinary palliative care services. The aim of this study was to develop a short form of the instrument Quality from the Patient's Perspective for Palliative Care (QPP-PC) and to describe and compare patients' perceptions of the subjective importance (SI) of care aspects and their perceptions of care received (PR). METHODS A cross-sectional study was conducted in Norway including 128 patients (67% response rate) in four palliative care contexts. The QPP-PC, based on a person-centered theoretical framework, incorporating the multidisciplinary palliative care, comprises 4 dimensions; medical-technical competence, physical-technical conditions, identity-oriented approach and sociocultural atmosphere, 12 factors (49 items) and 3 single items. The instrument measures SI and PR. Development of the short form of the QPP-PC was inspired by previously published methodological guidelines. Descriptive statistics, paired t-tests, confirmatory factor analysis and Cronbach's α were used. RESULTS The short form of QPP-PC consists of 4 dimensions, 20 items and 4 single items. Psychometric evaluation showed a root-mean-square error of approximation (RMSEA) value of 0.109 (SI). Cronbach's α values ranged between 0.64 and 0.85 for most dimensions on SI scales. Scores on SI and PR scales were mostly high. Significantly higher scores for SI than PR were present for the identity-oriented approach dimension, especially on items about information. CONCLUSION RMSEA value was slightly above the recommended level. Cronbach's α was acceptable for most dimensions. The short form of QPP-PC shows promising results and may be used with caution as an indicator of person-centered patient-reported experience measures evaluating the multidisciplinary palliative care for patients in a late palliative phase. However, the short version of QPP-PC needs to be further validated using new samples of patients.
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Affiliation(s)
- Tuva Sandsdalen
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | | | - Bodil Wilde-Larsson
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Faculty of Health, Science and Technology, Department of Health Science, Discipline of Nursing Science, Karlstad University, Karlstad, Sweden
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Siu HY, Elston D, Arora N, Vahrmeyer A, Kaasalainen S, Chidwick P, Borhan S, Howard M, Heyland DK. The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care. Can Geriatr J 2020; 23:172-183. [PMID: 32494333 PMCID: PMC7259921 DOI: 10.5770/cgj.23.386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The impact of prior advance care planning (ACP) documentation on substitute decision-makers' (SDMs) knowledge of values for end-of-life (EOL) care, and its correlation with SDM satisfaction with EOL care provision, have not been assessed in long-term care (LTC). METHODS A cross-sectional survey of 2,595 SDMs from 27 LTC homes assessed: 1) knowledge of pre-existing ACP documentation and values for EOL care, and 2) the importance and satisfaction of EOL care provision in LTC. Knowledge of values for EOL care was compared to administrative documentation. Importance and satisfaction were plotted on a performance-importance grid. Multiple linear regression assessed whether knowledge of pre-existing ACP documentation correlated with satisfaction. RESULTS The response rate was 25% (658/2,595); 69% of LTC residents had pre-existing ACP documentation. Discordance was noted between SDMs' knowledge of values for EOL care and administrative documentation. Pre-existing knowledge of ACP documentation was not correlated with EOL care provision satisfaction. Priority areas for increasing satisfaction include illness management, SDM communication, and relationships with LTC clinicians. CONCLUSIONS The discordance between SDMs' knowledge of values for EOL care and formal documentation needs to be addressed. Although pre-existing ACP documentation does not impact satisfaction, EOL care provision could be improved by targeting illness management, SDM communication, and relationships with LTC clinicians.
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Affiliation(s)
- Henry Y.H. Siu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Neha Arora
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amie Vahrmeyer
- Extendicare Assist, (a division of Extendicare), Markham, ON, Canada
| | | | | | - Sayem Borhan
- Department of Health Research Methods, Evidence, and Impact, McMaster University Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
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Halpern SD, Small DS, Troxel AB, Cooney E, Bayes B, Chowdhury M, Tomko HE, Angus DC, Arnold RM, Loewenstein G, Volpp KG, White DB, Bryce CL. Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e201742. [PMID: 32227179 PMCID: PMC7315782 DOI: 10.1001/jamanetworkopen.2020.1742] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care. OBJECTIVE To examine whether default options in ADs influence care choices and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 515 patients who met criteria for having serious illness and agreed to participate. Patients were enrolled at 20 outpatient clinics affiliated with the University of Pennsylvania Health System and the University of Pittsburgh Medical Center from February 2014 to April 2016 and had a median follow-up of 18 months. Data analysis was conducted from November 2018 to April 2019. INTERVENTIONS Patients were randomly assigned to complete 1 of the 3 following ADs: (1) a comfort-promoting plan of care and nonreceipt of potentially life-sustaining therapies were selected by default (comfort AD), (2) a life-extending plan of care and receipt of potentially life-sustaining therapies were selected by default (life-extending AD), or (3) no choices were preselected (standard AD). MAIN OUTCOMES AND MEASURES This trial was powered to rule out a reduction in hospital-free days in the intervention groups. Secondary outcomes included choices in ADs for an overall comfort-oriented approach to care, choices to forgo 4 forms of life support, patients' quality of life, decision conflict, place of death, admissions to hospitals and intensive care units, and costs of inpatient care. RESULTS Among 515 patients randomized, 10 withdrew consent and 13 were later found to be ineligible, leaving 492 (95.5%) in the modified intention-to-treat (mITT) sample (median [interquartile range] age, 63 [56-70] years; 279 [56.7%] men; 122 [24.8%] black; 363 [73.8%] with cancer). Of these, 264 (53.7%) returned legally valid ADs and were debriefed about their assigned intervention. Among these, patients completing comfort ADs were more likely to choose comfort care (54 of 85 [63.5%]) than those returning standard ADs (45 of 91 [49.5%]) or life-extending ADs (33 of 88 [37.5%]) (P = .001). Among 492 patients in the mITT sample, 57 of 168 patients [33.9%] who completed the comfort AD, 47 of 165 patients [28.5%] who completed the standard AD, and 35 of 159 patients [22.0%] who completed the life-extending AD chose comfort care (P = .02), with patients not returning ADs coded as not selecting comfort care. In mITT analyses, median (interquartile range) hospital-free days among 168 patients assigned to comfort ADs and 159 patients assigned to life-extending default ADs were each noninferior to those among 165 patients assigned to standard ADs (standard AD: 486 [306-717] days; comfort AD: 554 [296-833] days; rate ratio, 1.05; 95% CI, 0.90-1.23; P < .001; life-extending AD: 550 [325-783] days; rate ratio, 1.03; 95% CI, 0.88-1.20; P < .001). There were no differences among groups in other secondary outcomes. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, default options in ADs altered the choices seriously ill patients made regarding their future care without changing clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02017548.
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Affiliation(s)
- Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
| | - Dylan S Small
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Statistics Department, the Wharton School, the University of Pennsylvania, Philadelphia
| | - Andrea B Troxel
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Division of Biostatistics, New York University School of Medicine, New York
- Department of Population Health, New York University School of Medicine, New York
| | - Elizabeth Cooney
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
| | - Brian Bayes
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
| | - Marzana Chowdhury
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
| | - Heather E Tomko
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Doctor-Patient Communication, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Palliative and Supportive Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Loewenstein
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Carnegie Mellon University, Department of Social and Decision Sciences, Pittsburgh, Pennsylvania
| | - Kevin G Volpp
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, the University of Pennsylvania, Philadelphia
- The Wharton School, Health Care Management Department, the University of Pennsylvania, Philadelphia
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Program of Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Cindy L Bryce
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Pereira A, Ferreira A, Abrantes AR, Gomes C, Saraiva J, Teixeira L, Heyland DK, Martins J, Pinto S, Fernandes O. Cultural Adaptation and Validation of the Portuguese Version of the CANHELP Lite Bereavement Questionnaire. Healthcare (Basel) 2020; 8:healthcare8010027. [PMID: 32024229 PMCID: PMC7151010 DOI: 10.3390/healthcare8010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Satisfaction with care is an important outcome measure in end-of-life care. Validated instruments are necessary to evaluate and disseminate interventions that improve satisfaction with care at the end of life, contributing to improving the quality of care offered at the end of life to the Portuguese population. The purpose of this study was to perform a cross-cultural adaptation and psychometric analysis of the Portuguese version of the CANHELP Lite Bereavement Questionnaire. METHODS Methodological research with an analytical approach that includes translation, semantic, and cultural adaptation. RESULTS The Portuguese version comprised 24 items. A panel of experts and bereaved family members found it acceptable and that it had face and content validity. A total of 269 caregivers across several care settings in the northern region of Portugal were recruited for further testing. The internal consistency analysis of the adapted instrument resulted in a global alpha value of 0.950. The correlation between the adapted CANHELP questionnaire and a global rating of satisfaction was of 0.886 (p < 0.001). CONCLUSIONS The instrument has good psychometric properties. It was reliable and valid in assessing caregivers' satisfaction with end-of-life care and can be used in both clinical and research settings.
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Affiliation(s)
- Alexandra Pereira
- Abel Salazar Biomedical Institute, Community Care Unit of Lousada, 4620-848 Lousada, Portugal;
- Correspondence: ; Tel.: +351-91-700-76-18
| | - Amélia Ferreira
- Abel Salazar Biomedical Institute, Community Care Unit of Lousada, 4620-848 Lousada, Portugal;
| | | | | | - Joana Saraiva
- Centro Hospitalar Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Laetitia Teixeira
- Abel Salazar Biomedical Institute, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal;
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario ON K7L 3N, Canada;
| | - José Martins
- Medical-Surgical Nursing Department, Nursing School of Coimbra, 3046-841 Coimbra, Portugal;
| | - Sara Pinto
- Escola Superior de Saúde de Santa Maria, Center for Health Technology and Services Research (CINTESIS), NursID, 4049-024 Porto, Portugal;
| | - Olga Fernandes
- Escola Superior de Enfermagem do Porto, Center for Health Technology and Services Research (CINTESIS), NursID, 4200-072 Porto, Portugal;
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21
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Cohen SR, Russell LB, Leis A, Shahidi J, Porterfield P, Kuhl DR, Gadermann AM, Sawatzky R. More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire - Expanded. BMC Palliat Care 2019; 18:92. [PMID: 31672131 PMCID: PMC6823967 DOI: 10.1186/s12904-019-0473-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) - Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL - Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. METHODS Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. RESULTS Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). CONCLUSIONS MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
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Affiliation(s)
- S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montréal, Canada. .,Lady Davis Research Institute of the Jewish General Hospital, Palliative Care Research, room E8.06, 3755 Côte Ste. Catherine Road, Montréal, Québec, H3T 1E2, Canada.
| | - Lara B Russell
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Anne Leis
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - David R Kuhl
- Departments of Family Practice and Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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22
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Kohen SA, Nair R. Improving hospital-based communication and decision-making about scope of treatment using a standard documentation tool. BMJ Open Qual 2019; 8:e000396. [PMID: 31321314 PMCID: PMC6597658 DOI: 10.1136/bmjoq-2018-000396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 01/26/2019] [Accepted: 03/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Vancouver Island Health Authority (VIHA) implemented a standard advance care planning (ACP) document called the medical order for scope of treatment (MOST) in February 2016 to improve end of life communication and documentation. This study aims to see if the MOST implementation improves inpatient ACP documentation when compared with the ‘do not resuscitate’ (DNR) order. Improvement is measured by: (1) proportion of inpatients with documented orders for life-sustaining treatment, (2) discordance between patient’s expressed wishes and chart documentation, (3) patient satisfaction and (4) days admitted to an acute care hospital within 90 days of study inclusion. Methods We performed a single-centre quality improvement study tracking the effects of MOST implementation. 329 consecutive patients were enrolled at a 215-bed community hospital located in Comox, British Columbia, Canada. Results The MOST integrated well into the process of care, significantly improving ACP documentation from 33% preimplementation to 100% over 8 months of implementation. MOST completion was associated with a significant decrease in discordance between patients’ wishes and documented goals of care. Patients with a MOST were significantly older and had a higher charlson comorbidity score than those without a MOST. Despite this, there was no difference in the number of days study patients were admitted to hospital within 90 days of study inclusion. Conclusions MOST implementation improves the frequency and quality of inpatient ACP documentation with no effect on acute care utilisation.
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Affiliation(s)
- Samuel Abuaf Kohen
- Internal Medicine and Critical Care, Comox Valley Hospital, Courtenay, British Columbia, Canada
| | - Rajesh Nair
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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23
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Guirimand F, Martel-Samb P, Guy-Coichard C, Picard S, Devalois B, Copel L, Abel A, Ghadi V. Development and validation of a French questionnaire concerning patients' perspectives of the quality of palliative care: the QUALI-PALLI-Patient. BMC Palliat Care 2019; 18:19. [PMID: 30744627 PMCID: PMC6369559 DOI: 10.1186/s12904-019-0403-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Indicators for the quality of palliative care are a priority of caregivers and managers to allow improvement of various care settings and their comparison. The involvement of patients and families is of paramount, although this is rarely achieved in practice. No validated assessment tools are available in French. Simple cultural adaption of existing questionnaires may be insufficient, due to the varying organization of care in different countries. The purpose of this study was to develop and validate a new instrument to measure the quality of palliative care and satisfaction from the patient point of view. Methods Results from a qualitative study were used by a multi-professional workgroup to construct an initial set of 42 items exploring six domains. A cross-sectional survey was conducted in seven hospitals, encompassing three care settings: two palliative care units, one palliative care hospital, and four standard medical units with a mobile palliative care team. All items were assessed for acceptability. We conducted exploratory structural analysis using Principal Component Analysis (PCA), and evaluated external validity by comparison against global rating of satisfaction and the MD Anderson Symptom Inventory (MDASI) questionnaire. Results A total of 214 patients completed the questionnaire. After removing 7 items from the response distribution, PCA identified eight interpretable domains from the 35 final items: availability of caregivers, serenity, quality of information, pain management, caregivers’ listening skills, psychosocial and spiritual aspects, possibility to refuse (care or volunteers), and respect for the patient. Internal consistency was good or acceptable for all subscales (Cronbach’s α 0.5–0.84), except the last one (0.15). Factorial structure was found globally maintained across subgroups defined by age, sex, Palliative Performance Scale (PPS ≥ 60%, 40–50% and ≤ 30%), and care settings. General satisfaction was inversely correlated with the 2 scores of the MDASI questionnaire: symptoms’ severity and impact on life. Each subscale, except “possibility to refuse”, correlated with general satisfaction. Conclusions Quali-Palli-Pat appears to be a valid, reliable, and well-accepted French tool to explore the quality of care and the satisfaction of palliative care patients. It should be confirmed in a wider sample of care settings. Trial registration clinicaltrials.gov NCT02814682, registration date 28.6.2016. Electronic supplementary material The online version of this article (10.1186/s12904-019-0403-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Guirimand
- Pôle recherche SPES "Soins Palliatifs en Société", Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France.
| | - Patricia Martel-Samb
- Unité de Recherche Clinique URC HU PIFO, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | | | - Stéphane Picard
- Unité de Soins Palliatifs, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Bernard Devalois
- Centre de Recherche Interprofessionnel Bientraitance et Fin de Vie, Service de Médecine Palliative, Hôpital de Pontoise, Pontoise, France
| | - Laure Copel
- Unité de Soins Palliatifs, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Anne Abel
- Équipe Mobile de Soins Palliatifs, AP-HP, Hôpital Ambroise Paré, Boulogne, France
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McIlvennan CK, Matlock DD, Thompson JS, Dunlay SM, Blue L, LaRue SJ, Lewis EF, Patel CB, Fairclough DL, Leister EC, Swetz KM, Baldridge V, Walsh MN, Allen LA. Caregivers of Patients Considering a Destination Therapy Left Ventricular Assist Device and a Shared Decision-Making Intervention: The DECIDE-LVAD Trial. JACC-HEART FAILURE 2018; 6:904-913. [PMID: 30316931 DOI: 10.1016/j.jchf.2018.06.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/03/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aims to characterize caregivers of patients considering destination therapy left ventricular assist device (DT-LVAD) and evaluate the effectiveness of a shared decision-making (SDM) intervention. BACKGROUND Caregivers play an integral role in the care of patients with chronic illness. At the extreme, pursuing a DT-LVAD is a major preference-sensitive decision that requires high-level caregiver engagement. Yet, little is known about caregivers of patients considering DT-LVAD, and there is a paucity of research on the involvement of caregivers in medical decision-making. METHODS A 6-center, stepped-wedge trial was conducted. After varying time in usual care (control), sites were transitioned to an SDM intervention consisting of staff education and pamphlet and video decision aids (DAs). The primary outcome was decision quality, measured by knowledge and values-choice concordance. RESULTS From 2015 to 2017, 182 caregivers of patients considering DT-LVAD were enrolled (control group, n = 111; intervention group, n = 71). The median age was 61 years, 86.5% were female, and 75.8% were spouses. Caregiver knowledge (0% to 100%) improved from baseline to post-education in both groups: in the control group it improved from 64.2% to 73.3%; in the intervention group it improved from 62.6% to 76.4% (adjusted difference of difference: 4.8%; p = 0.08). At 1 month, correlation between stated values and caregiver-reported treatment choice was stronger in the intervention group (difference in Kendall's tau: 0.36, 95% confidence interval: 0.04 to 0.71; p = 0.03). Caregivers reported decisional conflict (0 to 100) at baseline (control group: 19.0 ± 2.1; intervention group: 21.4 ± 2.6), which decreased post-education more in the control group (control group: 9.0 ± 1.9, intervention group: 18.8 ± 2.4; p = 0.009). Caregivers in the control group were more likely to "definitely recommend" the educational materials than those in the intervention group (93.5% vs. 74.5%, respectively; p = 0.004). CONCLUSIONS An SDM intervention improved concordance between caregiver values and treatment choice for their loved ones but did not significantly impact knowledge. Caregivers found the DAs less acceptable than more biased educational materials and exposure to DAs led to higher conflict initially. These findings highlight the complexity of SDM involving caregivers of patients with chronic illness. (PCORI-1310-06998 Trial of a Decision Support Intervention for Patients and Caregivers Offered Destination Therapy Heart Assist Device [DECIDE-LVAD]; NCT02344576).
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Affiliation(s)
- Colleen K McIlvennan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Veteran Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon M Dunlay
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Laura Blue
- Duke University Medical Center, Durham, North Carolina
| | - Shane J LaRue
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Diane L Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Erin C Leister
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Keith M Swetz
- University of Alabama School of Medicine, Birmingham, Alabama
| | | | - Mary Norine Walsh
- St. Vincent Heart Center, Division of Cardiology, Indianapolis, Indiana
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
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Sawatzky R, Laforest E, Schick-Makaroff K, Stajduhar K, Reimer-Kirkham S, Krawczyk M, Öhlén J, McLeod B, Hilliard N, Tayler C, Robin Cohen S. Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings. J Patient Rep Outcomes 2018; 2:36. [PMID: 30175318 PMCID: PMC6104521 DOI: 10.1186/s41687-018-0065-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation.
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Affiliation(s)
- Richard Sawatzky
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,2Centre for Health Evaluation and Outcome Sciences, Providence Health Care, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z 1Y6 Canada.,13Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden
| | - Esther Laforest
- 3Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC H3A 2M7 Canada
| | - Kara Schick-Makaroff
- 4Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kelli Stajduhar
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Sheryl Reimer-Kirkham
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,7Faculty of Graduate Studies, University of Calgary, MacKimmie Tower, Room 213, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada.,8Faculty of Graduate Studies, University of Victoria, PO Box 3025 STN CSC, Victoria, BC V8W 3P2 Canada
| | - Marian Krawczyk
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - Joakim Öhlén
- 9Center for Person-Centered Care, Institute of Health and Care Sciences, Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden.,14Palliative Centre, Sahlgrenska University Hospital, Box 30110, 400 43 Göteborg, Sweden
| | - Barbara McLeod
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Neil Hilliard
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Carolyn Tayler
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,BC Centre for Palliative Care, 300 - 601 Sixth St., New Westminster, BC V3L 3C1 Canada
| | - S Robin Cohen
- 11Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,12Lady Davis Research Institute of the Jewish General Hospital, 3755 Côte Ste. Catherine Road, Montreal, QC H3T 1E2 Canada
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A Multicenter Trial of a Shared Decision Support Intervention for Patients and Their Caregivers Offered Destination Therapy for Advanced Heart Failure: DECIDE-LVAD: Rationale, Design, and Pilot Data. J Cardiovasc Nurs 2018; 31:E8-E20. [PMID: 27203272 DOI: 10.1097/jcn.0000000000000343] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shared decision making is important to ensure that patients receive therapies aligned with their goals and values. Based upon a detailed needs assessment with diverse stakeholders, pamphlet and video decision aids for destination therapy left ventricular assist devices (DT LVAD) were developed to help patients and their caregivers think through, forecast, and deliberate their options. These decision aids are the foundation of the Multicenter Trial of a Shared Decision Support Intervention for Patients and their Caregivers Offered Destination Therapy for End-Stage Heart Failure (DECIDE-LVAD) study, a multicenter, randomized trial aimed at understanding the effectiveness and implementation of a shared decision support intervention for patients considering DT LVAD. METHODS/DESIGN A stepped-wedge randomized controlled trial was designed, guided by the RE-AIM framework and modeled after an effectiveness-implementation hybrid type II design. Six DT LVAD programs from across the United States will participate. Primary outcomes include knowledge and values-treatment concordance. Patients with advanced heart failure who are being considered for DT LVAD and their caregivers are eligible with a target enrollment of 168 dyads. From August 2014 to January 2015, an acceptability and feasibility pilot study was performed, which clarified opportunities and challenges around decision support for DT LVAD and resulted in significant modifications to the DECIDE-LVAD study. DISCUSSION Study findings will provide a foundation for implementing decision support interventions, including decision aids, with patients who have chronic progressive illness facing end-of-life decisions involving invasive, preference-sensitive therapy options.
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Nurhaeni N. Reliability and validity of the family satisfaction instrument in families of children with pneumonia. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stajduhar K, Sawatzky R, Robin Cohen S, Heyland DK, Allan D, Bidgood D, Norgrove L, Gadermann AM. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. BMC Palliat Care 2017; 16:59. [PMID: 29178901 PMCID: PMC5702136 DOI: 10.1186/s12904-017-0237-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. METHODS A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test - Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. RESULTS Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of "doctor and nurse care", "illness management", "health services" and "communication". The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. CONCLUSION Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.
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Affiliation(s)
- Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - S. Robin Cohen
- Oncology and Medicine, McGill University, Lady Davis Research Institute, Jewish General Hospital, 845 Sherbrooke Street West, Montreal, QC H3A 0G4 Canada
| | - Daren K. Heyland
- Critical Care Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Diane Allan
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SASK S7N 2Z4 Canada
| | - Darcee Bidgood
- Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Leah Norgrove
- Palliative Care, Saanich Peninsula Hospital, Island Health, 2166 Mt. Newton X Road, Saanichton, BC V8M 2B2 Canada
| | - Anne M. Gadermann
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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Heyland DK, Dodek P, You JJ, Sinuff T, Hiebert T, Tayler C, Jiang X, Simon J, Downar J. Validation of quality indicators for end-of-life communication: results of a multicentre survey. CMAJ 2017; 189:E980-E989. [PMID: 28760834 DOI: 10.1503/cmaj.160515] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making. METHODS We administered a questionnaire to patients and their family members in 12 hospitals and asked them about advance care planning and goals-of-care discussions. Responses were used to calculate a quality indicator score. To validate this score, we determined its correlation with the concordance between the patients' expressed wishes and the medical order for life-sustaining treatments recorded in the hospital chart. We compared the correlation with concordance for the advance care planning component score with that for the goal-of-care discussion scores. RESULTS We enrolled 297 patients and 209 family members. At all sites, both overall quality indicators and individual domain scores were low and there was wide variability around the point estimates. The highest-ranking institution had an overall quality indicator score (95% confidence interval) of 40% (36%-44%) and the lowest had a score of 18% (11%-25%). There was a strong correlation between the overall quality indicator score and the concordance measure (r = 0.72, p = 0.008); the estimated correlation between the advance care planning score and the concordance measure (r = 0.35) was weaker than that between the goal-of-care discussion scores and the concordance measure (r = 0.53). INTERPRETATION Quality of end-of-life communication and decision-making appears low overall, with considerable variability across hospitals. The proposed quality indicator measure shows feasibility and partial validity. Study registration: ClinicalTrials.gov, no. NCT01362855.
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Affiliation(s)
- Daren K Heyland
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont.
| | - Peter Dodek
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - John J You
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - Tasnim Sinuff
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - Tim Hiebert
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - Carolyn Tayler
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - Xuran Jiang
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - Jessica Simon
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
| | - James Downar
- Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine, and Health Research Methods, Evidence and Impact (You), McMaster University, Hamilton, Ont.; Department of Critical Care Medicine, Sunnybrook Hospital and Sunnybrook Research Institute; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto (Sinuff), Toronto, Ont.; Winnipeg Regional Health Authority Palliative Care Program (Hiebert), Winnipeg, Man.; Fraser Health Authority (Tayler), Surrey, BC; Division of Palliative Medicine (Simon), Department of Oncology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Alta.; Divisions of Critical Care and Palliative Care, Department of Medicine (Downar), University of Toronto, Toronto, Ont
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Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4621592. [PMID: 28706945 PMCID: PMC5494554 DOI: 10.1155/2017/4621592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. METHODS AND RESULTS Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. PHASE 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. PHASE 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. CONCLUSION This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.
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Angelino E, Gragnano A, Miglioretti M. Measuring family satisfaction with inpatient rehabilitation care. Int J Health Care Qual Assur 2017; 29:33-47. [PMID: 26771060 DOI: 10.1108/ijhcqa-03-2015-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the psychometric characteristics of the Questionnaire of Family members' Satisfaction about the Rehabilitation (QFSR), a new questionnaire assessing the satisfaction of patients' families with the in-hospital rehabilitation service, i.e., the organizational procedure, medical treatment, relationship with nurses/other health workers, and outcome. DESIGN/METHODOLOGY/APPROACH The QFSR (13 items) was administered to 1,226 (F=60.4 percent; mean age=57.4, SD 15 years) family members of patients admitted to two units for inpatient rehabilitation, i.e., cardiovascular and neuromotor. FINDINGS Confirmatory factor analysis (CFA) confirmed the theoretical four-factor structure of the questionnaire in a subsample of 308 respondents randomly selected from the sample (SB χ² (61)=57.4, p=0.61; RMSEA=0.0; 90 percent CI [0.0, 0.031], CFI=1.00). The remaining 708 respondents (393 relatives of cardiovascular unit inpatients and 315 relatives of neuromotor unit inpatients) were used to test measurement invariance between the groups of family members with patients in the two units. The configurial, scalar, and strict factorial invariance provided a good fit to the data. ORIGINALITY/VALUE The QFSR, specifically developed to measure the satisfaction of family members of patients undergoing rehabilitation, appears to be a promising brief questionnaire that can provide important indications for continuous improvement in the delivery of healthcare.
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Affiliation(s)
- Elisabetta Angelino
- Department of Psychology, Major Hospital Center, Salvatore Maugeri Foundation IRCCS, Turin, Italy
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Cohen SR, Sawatzky R, Russell LB, Shahidi J, Heyland DK, Gadermann AM. Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire-Revised. Palliat Med 2017; 31:120-129. [PMID: 27412257 DOI: 10.1177/0269216316659603] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The McGill Quality of Life Questionnaire has been widely used with people with life-threatening illnesses without modification since its publication in 1996. With use, areas for improvement have emerged; therefore, various minor modifications were tested over time. AIM To revise the McGill Quality of Life Questionnaire (McGill Quality of Life Questionnaire-Revised) while maintaining or improving its psychometric properties and length, keeping it as close as possible to the McGill Quality of Life Questionnaire to enable reasonable comparison with existing McGill Quality of Life Questionnaire literature. DESIGN Data sets from eight studies were used (four studies originally used to develop the McGill Quality of Life Questionnaire, two to develop new McGill Quality of Life Questionnaire versions, and two with unrelated purposes). The McGill Quality of Life Questionnaire-Revised was developed using analyses of measurement invariance, confirmatory factor analysis, and calculation of correlations with the McGill Quality of Life Questionnaire's global quality of life item. SETTING/PARTICIPANTS Data were from 1702 people with life-threatening illnesses recruited from acute and palliative care units, palliative home care services, and oncology and HIV/AIDS outpatient clinics. RESULTS The McGill Quality of Life Questionnaire-Revised consists of 14 items (plus the global quality of life item). A new Physical subscale was created combining physical symptoms and physical well-being and a new item on physical functioning. The Existential subscale was reduced to four items. The revised Support subscale, renamed Social, focuses more on relationships. The Psychological subscale remains unchanged. Confirmatory factor analysis results provide support for the measurement structure of the McGill Quality of Life Questionnaire-Revised. The overall scale has good internal consistency reliability ( α = 0.94). CONCLUSION The McGill Quality of Life Questionnaire-Revised improves on and can replace the McGill Quality of Life Questionnaire since it contains improved wording, a somewhat expanded repertoire of concepts with fewer items, and a single subscale for the physical domain, while retaining good psychometric properties.
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Affiliation(s)
- S Robin Cohen
- 1 Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,2 Lady Davis Research Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Richard Sawatzky
- 3 School of Nursing, Trinity Western University, Langley, BC, Canada.,4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Lara B Russell
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,5 School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Daren K Heyland
- 7 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.,8 Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Anne M Gadermann
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,9 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Development of a measure (ICECAP-Close Person Measure) through qualitative methods to capture the benefits of end-of-life care to those close to the dying for use in economic evaluation. Palliat Med 2017; 31:53-62. [PMID: 27260168 DOI: 10.1177/0269216316650616] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-of-life care affects both the patient and those close to them. Typically, those close to the patient are not considered within economic evaluation, which may lead to the omission of important benefits resulting from end-of-life care. AIM To develop an outcome measure suitable for use in economic evaluation that captures the benefits of end-of-life care to those close to the dying. DESIGN To develop the descriptive system for the outcome measure, in-depth qualitative interviews were conducted with the participants and constant comparative analysis methods were used to develop a descriptive system for the measure. PARTICIPANTS Twenty-seven individuals bereaved within the last 2 years or with a close-person currently receiving end-of-life care were purposively recruited into the study. Participants were recruited through newsletters, adverts, snowball sampling and a local hospice. RESULTS Twenty-seven individuals were recruited. A measure of capability with six attributes, each with five levels, was developed based on themes arising from the analysis. Attributes comprise the following: good communication with services, privacy and space to be with the loved one, emotional support, practical support, being able to prepare and cope and being free from emotional distress related to the condition of the decedent. CONCLUSION This measure is designed to capture the benefits of end-of-life care to close-persons for use in economic evaluation. Further research should value the measure and develop methods for incorporating outcomes for close-persons into economic evaluation.
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Affiliation(s)
- Alastair Canaway
- 1 Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hareth Al-Janabi
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
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Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9025643. [PMID: 28044138 PMCID: PMC5156795 DOI: 10.1155/2016/9025643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022]
Abstract
Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.
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Carlozzi NE, Downing NR, McCormack MK, Schilling SG, Perlmutter JS, Hahn EA, Lai JS, Frank S, Quaid KA, Paulsen JS, Cella D, Goodnight SM, Miner JA, Nance MA. New measures to capture end of life concerns in Huntington disease: Meaning and Purpose and Concern with Death and Dying from HDQLIFE (a patient-reported outcomes measurement system). Qual Life Res 2016; 25:2403-2415. [PMID: 27393121 DOI: 10.1007/s11136-016-1354-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Huntington disease (HD) is an incurable terminal disease. Thus, end of life (EOL) concerns are common in these individuals. A quantitative measure of EOL concerns in HD would enable a better understanding of how these concerns impact health-related quality of life. Therefore, we developed new measures of EOL for use in HD. METHODS An EOL item pool of 45 items was field tested in 507 individuals with prodromal or manifest HD. Exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted to establish unidimensional item pools. Item response theory (IRT) and differential item functioning analyses were applied to the identified unidimensional item pools to select the final items. RESULTS EFA and CFA supported two separate unidimensional sets of items: Concern with Death and Dying (16 items), and Meaning and Purpose (14 items). IRT and DIF supported the retention of 12 Concern with Death and Dying items and 4 Meaning and Purpose items. IRT data supported the development of both a computer adaptive test (CAT) and a 6-item, static short form for Concern with Death and Dying. CONCLUSION The HDQLIFE Concern with Death and Dying CAT and corresponding 6-item short form, and the 4-item calibrated HDQLIFE Meaning and Purpose scale demonstrate excellent psychometric properties. These new measures have the potential to provide clinically meaningful information about end-of-life preferences and concerns to clinicians and researchers working with individuals with HD. In addition, these measures may also be relevant and useful for other terminal conditions.
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Affiliation(s)
- N E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - N R Downing
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - M K McCormack
- Department of Pathology, Rowan University, Piscataway, NJ, USA
| | - S G Schilling
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - J S Perlmutter
- Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA
- Program in Occupational Therapy and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - E A Hahn
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - J S Lai
- Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Northwestern University, Evanston, IL, USA
- Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Frank
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K A Quaid
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - J S Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
- Department of Psychology, The University of Iowa, Iowa City, IA, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Northwestern University, Evanston, IL, USA
- Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S M Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - J A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - M A Nance
- Hennepin County Medical Center, Minneapolis, MN, USA
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Howard M, Bonham AJ, Heyland DK, Sudore R, Fassbender K, Robinson CA, McKenzie M, Elston D, You JJ. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study. BMJ Open 2016; 6:e010375. [PMID: 27338877 PMCID: PMC4932285 DOI: 10.1136/bmjopen-2015-010375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. SETTING A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. PARTICIPANTS A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. OUTCOMES We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). RESULTS 196 patients (38-96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25). CONCLUSIONS The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.
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Affiliation(s)
- Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron J Bonham
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Public Health, Queen's University, Kingston, Ontario, Canada
| | - Rebecca Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | | | - Carole A Robinson
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael McKenzie
- Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John J You
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Gabler NB, Cooney E, Small DS, Troxel AB, Arnold RM, White DB, Angus DC, Loewenstein G, Volpp KG, Bryce CL, Halpern SD. Default options in advance directives: study protocol for a randomised clinical trial. BMJ Open 2016; 6:e010628. [PMID: 27266769 PMCID: PMC4908890 DOI: 10.1136/bmjopen-2015-010628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Although most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise. Advance directives (ADs) were created to provide opportunities to set limits on aggressive care near life's end. This study tests the hypothesis that redesigning ADs such that comfort-oriented care is provided as the default, rather than requiring patients to actively choose it, will promote better patient-centred outcomes. METHODS AND ANALYSIS This multicentre trial randomises seriously ill adults to receive 1 of 3 different ADs: (1) a traditional AD that requires patients to actively choose their goals of care or preferences for specific interventions (eg, feeding tube insertion) or otherwise have their care guided by their surrogates and the prevailing societal default toward aggressive care; (2) an AD that defaults to life-extending care and receipt of life-sustaining interventions, enabling patients to opt out from such care; or (3) an AD that defaults to comfort care, enabling patients to opt into life-extending care. We seek to enrol 270 patients who return complete, legally valid ADs so as to generate sufficient power to detect differences in the primary outcome of hospital-free days (days alive and not in an acute care facility). Secondary outcomes include hospital and intensive care unit admissions, costs of care, hospice usage, decision conflict and satisfaction, quality of life, concordance of preferences with care received and bereavement outcomes for surrogates of patients who die. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Boards at all trial centres, and is guided by a data safety and monitoring board and an ethics advisory board. Study results will be disseminated using methods that describe the results in ways that key stakeholders can best understand and implement. TRIAL REGISTRATION NUMBER NCT02017548; Pre-results.
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Affiliation(s)
- Nicole B Gabler
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Cooney
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dylan S Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Arnold
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Derek C Angus
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - George Loewenstein
- Center for Behavioral Decision Research, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Kevin G Volpp
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cindy L Bryce
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scott D Halpern
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Noome M, Dijkstra BM, van Leeuwen E, Vloet LCM. The Perspectives of Intensive Care Unit Nurses About the Current and Ideal Nursing End-of-Life Care. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A systematic review of instruments assessing dimensions of distress among caregivers of adult and pediatric cancer patients. Palliat Support Care 2016; 15:110-124. [DOI: 10.1017/s1478951516000079] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractObjective:Caregivers of cancer patients face intense demands throughout the course of the disease, survivorship, and bereavement. Caregiver burden, needs, satisfaction, quality of life, and other significant areas of caregiving are not monitored regularly in the clinic setting, resulting in a need to address the availability and clinical effectiveness of cancer caregiver distress tools. This review aimed to determine the availability of cancer caregiver instruments, the variation of instruments between different domains of distress, and that between adult and pediatric cancer patient populations.Method:A literature search was conducted using various databases from 1937 to 2013. Original articles on instruments were extracted separately if not included in the original literature search. The instruments were divided into different areas of caregiver distress and into adult versus pediatric populations. Psychometric data were also evaluated.Results:A total of 5,541 articles were reviewed, and 135 articles (2.4%) were accepted based on our inclusion criteria. Some 59 instruments were identified, which fell into the following categories: burden (n = 26, 44%); satisfaction with healthcare delivery (n = 5, 8.5%); needs (n = 14, 23.7%); quality of life (n = 9, 15.3%); and other issues (n = 5, 8.5%). The median number of items was 29 (4–125): 20/59 instruments (33.9%) had ≤20 items; 13 (22%) had ≤20 items and were psychometrically sound, with 12 of these 13 (92.3%) being self-report questionnaires. There were 44 instruments (74.6%) that measured caregiver distress for adult cancer patients and 15 (25.4%) for caregivers of pediatric patients.Significance of results:There is a significant number of cancer caregiver instruments that are self-reported, concise, and psychometrically sound, which makes them attractive for further research into their clinical use, outcomes, and effectiveness.
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Bowyer AV, Finlay I, Baillie J, Byrne A, McCarthy J, Sampson C, Snow V, Nelson A. Gaining an accurate reflection of the reality of palliative care through the use of free-text feedback in questionnaires: the AFTER study. BMJ Support Palliat Care 2016; 9:e17. [PMID: 26888770 PMCID: PMC6579493 DOI: 10.1136/bmjspcare-2015-000920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/28/2015] [Accepted: 01/05/2016] [Indexed: 11/22/2022]
Abstract
Background In healthcare, many service evaluation questionnaires use free-text boxes without formal mechanisms for analysis. Patients and carers spend time documenting concerns that are often ignored or managed locally in an ad hoc manner. Currently, palliative care experiences of patients and carers in Wales are measured using a service evaluation questionnaire, comprising both closed and open-ended questions. Previous research, exploring free-text responses from this questionnaire, suggests that questionnaire refinement should accommodate service users’ expressed priorities and concerns, and highlights the need to incorporate free-text data analysis strategies during study design. Methods Results from a previous analysis of 596 free-text responses provided the basis for an expert consensus day, where the current service evaluation questionnaire was refined. The refined version was tested during cognitive interviews with patients (n=10) and carers (n=7) receiving palliative care from 1 of 2 UK hospices. Data were analysed thematically. Results Interviews highlighted minor areas for change within the questionnaire and provided broader insight into patients’ experiences of palliative care services. Patients and carers place an emphasis on simplifying language, decreasing the numeric response range and reducing written instructions; relying instead on visual cues, including formatting and layout. Findings highlighted the importance patients attached to providing meaningful free-text contributions. Conclusions Questionnaire refinement should use the patient perspective to effectively facilitate respondent understanding, pertinence and usability. The importance of employing data analysis strategies during questionnaire design may reduce research waste, thus enabling a better interrogation of service provision.
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Affiliation(s)
| | - Ilora Finlay
- Department of Palliative Medicine, Velindre Cancer Centre, Cardiff, UK
| | - Jessica Baillie
- School of Healthcare Sciences Cardiff University, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Jacqui McCarthy
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Catherine Sampson
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Veronica Snow
- Powys Health Board and South West Wales Cancer Network, Bro Ddyfi Community Hospital, Machynlleth, Powys, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
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Sandsdalen T, Rystedt I, Grøndahl VA, Hov R, Høye S, Wilde-Larsson B. Patients' perceptions of palliative care: adaptation of the Quality from the Patient's Perspective instrument for use in palliative care, and description of patients' perceptions of care received. BMC Palliat Care 2015; 14:54. [PMID: 26525048 PMCID: PMC4630886 DOI: 10.1186/s12904-015-0049-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Instruments specific to palliative care tend to measure care quality from relative perspectives or have insufficient theoretical foundation. The instrument Quality from the Patient's Perspective (QPP) is based on a model for care quality derived from patients' perceptions of care, although it has not been psychometrically evaluated for use in palliative care. The aim of this study was to adapt the QPP for use in palliative care contexts, and to describe patients' perceptions of the care quality in terms of the subjective importance of the care aspects and the perceptions of the care received. METHOD A cross-sectional study was conducted between November 2013 and December 2014 which included 191 patients (73% response rate) in late palliative phase at hospice inpatient units, hospice day-care units, wards in nursing homes that specialized in palliative care and homecare districts, all in Norway. An explorative factor analysis using principal component analysis, including data from 184 patients, was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's alpha and paired t-tests were used to describe patients' perceptions of their care. RESULTS The QPP instrument was adapted for palliative care in four steps: (1) selecting items from the QPP, (2) modifying items and (3) constructing new items to the palliative care setting, and (4) a pilot evaluation. QPP instrument specific to palliative care (QPP-PC) consists of 51 items and 12 factors with an eigenvalue ≥1.0, and showed a stable factor solution that explained 68.25% of the total variance. The reliability coefficients were acceptable for most factors (0.79-0.96). Patients scored most aspects of care related to both subjective importance and actual care received as high. Areas for improvement were symptom relief, participation, continuity, and planning and cooperation. CONCLUSION The QPP-PC is based on a theoretical model of quality of care, and has its roots in patients' perspectives. The instrument was developed and psychometrically evaluated in a sample of Norwegian patients with various diagnoses receiving palliative care in different care contexts. The evaluation of the QPP-PC shows promising results, although it needs to be further validated and tested in other contexts and countries.
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Affiliation(s)
- Tuva Sandsdalen
- Department of Health Studies, Faculty of Public Health, Hedmark University College, Postbox 400, 2418, Elverum, Norway. .,Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
| | - Ingrid Rystedt
- Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
| | | | - Reidun Hov
- Department of Health Studies, Faculty of Public Health, Hedmark University College, Postbox 400, 2418, Elverum, Norway.
| | - Sevald Høye
- Department of Health Studies, Faculty of Public Health, Hedmark University College, Postbox 400, 2418, Elverum, Norway.
| | - Bodil Wilde-Larsson
- Department of Health Studies, Faculty of Public Health, Hedmark University College, Postbox 400, 2418, Elverum, Norway. .,Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
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Abdul-Razzak A, Sherifali D, You J, Simon J, Brazil K. 'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective. Health Expect 2015; 19:883-96. [PMID: 26176292 PMCID: PMC5152726 DOI: 10.1111/hex.12384] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background Despite the recognized importance of end‐of‐life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking. Objective We sought to understand patient perspectives on physician behaviours during EOL communication. Design In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi‐structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data. Setting and Participants Seriously ill inpatients at three tertiary care hospitals in Canada. Results We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness. Conclusions Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.
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Affiliation(s)
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - John You
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Baernholdt M, Campbell CL, Hinton ID, Yan G, Lewis E. Quality of hospice care: comparison between rural and urban residents. J Nurs Care Qual 2015; 30:247-53. [PMID: 25546093 PMCID: PMC4582410 DOI: 10.1097/ncq.0000000000000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Discrepancies between needed and received hospice care exist, especially in rural areas. Hospice care quality ratings for 743 rural and urban patients and their families were compared. Rural participants reported higher overall satisfaction and with pain/symptom management. Regardless of geographic location, satisfaction was higher when patients were informed and emotionally supported. Patients and family ratings did not differ. Findings support prior reports using retrospective rather than our study's point-of-care surveys.
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Affiliation(s)
- Marianne Baernholdt
- School of Nursing, Virginia Commonwealth University, Richmond (Dr Baernholdt); School of Nursing (Drs Campbell and Hinton) and Department of Public Health Sciences (Dr Yan), University of Virginia, Charlottesville; and Department of Nursing, James Madison University, Harrisonburg, Virginia (Dr Lewis)
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Boquiren VM, Hack TF, Beaver K, Williamson S. What do measures of patient satisfaction with the doctor tell us? PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00264-5. [PMID: 26111500 DOI: 10.1016/j.pec.2015.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To gain an understanding of how patient satisfaction (PS) with the doctor (PSD) is conceptualized through an empirical review of how it is currently being measured. The content of PS questionnaire items was examined to (a) determine the primary domains underlying PSD, and (b) summarize the specific doctor-related characteristics and behaviors, and patient-related perceptions, composing each domain. METHODS A scoping review of empirical articles that assessed PSD published from 2000 to November 2013. MEDLINE and PsycINFO databases were searched. RESULTS The literature search yielded 1726 articles, 316 of which fulfilled study inclusion criteria. PSD was realized in one of four health contexts, with questions being embedded in a larger questionnaire that assessed PS with either: (1) overall healthcare, (2) a specific medical encounter, or (3) the healthcare team. In the fourth context, PSD was the questionnaire's sole focus. Five broad domains underlying PSD were revealed: (1) Communication Attributes; (2) Relational Conduct; (3) Technical Skill/Knowledge; (4) Personal Qualities; and (5) Availability/Accessibility. CONCLUSIONS Careful consideration of measurement goals and purposes is necessary when selecting a PSD measure. PRACTICE IMPLICATIONS The five emergent domains underlying PSD point to potential key areas of physician training and foci for quality assessment.
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Affiliation(s)
- Virginia M Boquiren
- Behavioural Sciences & Health Research Division, University Health Network, Toronto, Ontario, Canada; College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Thomas F Hack
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; School of Health, University of Central Lancashire, Preston, UK.
| | - Kinta Beaver
- School of Health, University of Central Lancashire, Preston, UK.
| | - Susan Williamson
- School of Health, University of Central Lancashire, Preston, UK.
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Sinuff T, Dodek P, You JJ, Barwich D, Tayler C, Downar J, Hartwick M, Frank C, Stelfox HT, Heyland DK. Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. J Pain Symptom Manage 2015; 49:1070-80. [PMID: 25623923 DOI: 10.1016/j.jpainsymman.2014.12.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/27/2014] [Accepted: 12/20/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT The goal of end-of-life (EOL) communication and decision making is to create a shared understanding about a person's values and treatment preferences that will lead to a plan of care that is consistent with these values and preferences. Improvements in communication and decision making at the EOL have been identified as a high priority from a patient and family point of view. OBJECTIVES The purpose of this study was to develop quality indicators related to EOL communication and decision making. METHODS We convened a multidisciplinary panel of experts to develop definitions, a conceptual framework of EOL communication and decision making, and quality indicators using a modified Delphi method. We generated a list of potential items based on literature review and input from panel members. Panel members rated the items using a seven-point Likert scale (1 = very little importance to 7 = extremely important) over four rounds of review until consensus was achieved. RESULTS About 24 of the 28 panel members participated in all four rounds of the Delphi process. The final list of quality indicators comprised 34 items, divided into the four categories of our conceptual framework: Advance care planning (eight items), Goals of care discussions (13 items), Documentation (five items), and Organization/System aspects (eight items). Eleven items were rated "extremely important" (median score). All items had a median score of five (moderately important) or greater. CONCLUSION We have developed definitions, a conceptual framework, and quality indicators that researchers and health care decision makers can use to evaluate and improve the quality of EOL communication and decision making.
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Affiliation(s)
- Tasnim Sinuff
- Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John J You
- Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Doris Barwich
- BC Center for Palliative Care, Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn Tayler
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - James Downar
- Divisions of Critical Care and Palliative Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Hartwick
- Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Frank
- Division of Geriatric Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, and Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
| | - Daren K Heyland
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Lendon JP, Ahluwalia SC, Walling AM, Lorenz KA, Oluwatola OA, Anhang Price R, Quigley D, Teno JM. Measuring Experience With End-of-Life Care: A Systematic Literature Review. J Pain Symptom Manage 2015; 49:904-15.e1-3. [PMID: 25543110 PMCID: PMC5063029 DOI: 10.1016/j.jpainsymman.2014.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/27/2014] [Accepted: 10/22/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. OBJECTIVES To evaluate the instruments currently in use to inform next steps for research and policy in this area. METHODS We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. RESULTS We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. CONCLUSION This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.
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Affiliation(s)
| | | | - Anne M Walling
- VA Greater Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Karl A Lorenz
- VA Greater Los Angeles, Los Angeles, California, USA
| | | | | | | | - Joan M Teno
- Brown University, Providence, Rhode Island, USA
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Factors affecting family satisfaction with inpatient end-of-life care. PLoS One 2014; 9:e110860. [PMID: 25401710 PMCID: PMC4234251 DOI: 10.1371/journal.pone.0110860] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022] Open
Abstract
Background Little data exists addressing satisfaction with end-of-life care among hospitalized patients, as they and their family members are systematically excluded from routine satisfaction surveys. It is imperative that we closely examine patient and institution factors associated with quality end-of-life care and determine high-priority target areas for quality improvement. Methods Between September 1, 2010 and January 1, 2012 the Canadian Health care Evaluation Project (CANHELP) Bereavement Questionnaire was mailed to the next-of-kin of recently deceased inpatients to seek factors associated with satisfaction with end-of-life care. The primary outcome was the global rating of satisfaction. Secondary outcomes included rates of actual versus preferred location of death, associations between demographic factors and global satisfaction, and identification of targets for quality improvement. Results Response rate was 33% among 275 valid addresses. Overall, 67.4% of respondents were very or completely satisfied with the overall quality of care their relative received. However, 71.4% of respondents who thought their relative did not die in their preferred location favoured an out-of-hospital location of death. A common location of death was the intensive care unit (45.7%); however, this was not the preferred location of death for 47.6% of such patients. Multivariate Poisson regression analysis showed respondents who believed their relative died in their preferred location were 1.7 times more likely to be satisfied with the end-of-life care that was provided (p = 0.001). Items identified as high-priority targets for improvement included: relationships with, and characteristics of health care professionals; illness management; communication; and end-of-life decision-making. Interpretation Nearly three-quarters of recently deceased inpatients would have preferred an out-of-hospital death. Intensive care units were a common, but not preferred, location of in-hospital deaths. Family satisfaction with end-of-life care was strongly associated with their relative dying in their preferred location. Improved communication regarding end-of-life care preferences should be a high-priority quality improvement target.
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You JJ, Dodek P, Lamontagne F, Downar J, Sinuff T, Jiang X, Day AG, Heyland DK. What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families. CMAJ 2014; 186:E679-87. [PMID: 25367427 DOI: 10.1503/cmaj.140673] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. METHODS We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. RESULTS Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%-31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients' preferences and prescribed goals of care, and greater patient satisfaction. INTERPRETATION We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
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Affiliation(s)
- John J You
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
| | - Peter Dodek
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - Francois Lamontagne
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - James Downar
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - Tasnim Sinuff
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - Xuran Jiang
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - Andrew G Day
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
| | - Daren K Heyland
- Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont
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Abdul-Razzak A, You J, Sherifali D, Simon J, Brazil K. 'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication. BMJ Open 2014; 4:e005653. [PMID: 25296653 PMCID: PMC4194750 DOI: 10.1136/bmjopen-2014-005653] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To understand patients' preferences for physician behaviours during end-of-life communication. METHODS We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer). RESULTS A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information. CONCLUSIONS Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.
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Affiliation(s)
- Amane Abdul-Razzak
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - John You
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Halpern SD, Loewenstein G, Volpp KG, Cooney E, Vranas K, Quill CM, McKenzie MS, Harhay MO, Gabler NB, Silva T, Arnold R, Angus DC, Bryce C. Default options in advance directives influence how patients set goals for end-of-life care. Health Aff (Millwood) 2013; 32:408-17. [PMID: 23381535 DOI: 10.1377/hlthaff.2012.0895] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although decisions regarding end-of-life care are personal and important, they may be influenced by the ways in which options are presented. To test this hypothesis, we randomly assigned 132 seriously ill patients to complete one of three types of advance directives. Two types had end-of-life care options already checked-a default choice-but one of these favored comfort-oriented care, and the other, life-extending care. The third type was a standard advance directive with no options checked. We found that most patients preferred comfort-oriented care, but the defaults influenced those choices. For example, 77 percent of patients in the comfort-oriented group retained that choice, while 43 percent of those in the life-extending group rejected the default choice and selected comfort-oriented care instead. Among the standard advance directive group, 61 percent of patients selected comfort-oriented care. Our findings suggest that patients may not hold deep-seated preferences regarding end-of-life care. The findings provide motivation for future research examining whether using default options in advance directives may improve important outcomes, including patients' receipt of wanted and unwanted services, resource use, survival, and quality of life.
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Affiliation(s)
- Scott D Halpern
- Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, Philadelphia, PA, USA.
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