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Hancı V, Ergün B, Gül Ş, Uzun Ö, Erdemir İ, Hancı FB. Assessment of readability, reliability, and quality of ChatGPT®, BARD®, Gemini®, Copilot®, Perplexity® responses on palliative care. Medicine (Baltimore) 2024; 103:e39305. [PMID: 39151545 PMCID: PMC11332738 DOI: 10.1097/md.0000000000039305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/19/2024] Open
Abstract
There is no study that comprehensively evaluates data on the readability and quality of "palliative care" information provided by artificial intelligence (AI) chatbots ChatGPT®, Bard®, Gemini®, Copilot®, Perplexity®. Our study is an observational and cross-sectional original research study. In our study, AI chatbots ChatGPT®, Bard®, Gemini®, Copilot®, and Perplexity® were asked to present the answers of the 100 questions most frequently asked by patients about palliative care. Responses from each 5 AI chatbots were analyzed separately. This study did not involve any human participants. Study results revealed significant differences between the readability assessments of responses from all 5 AI chatbots (P < .05). According to the results of our study, when different readability indexes were evaluated holistically, the readability of AI chatbot responses was evaluated as Bard®, Copilot®, Perplexity®, ChatGPT®, Gemini®, from easy to difficult (P < .05). In our study, the median readability indexes of each of the 5 AI chatbots Bard®, Copilot®, Perplexity®, ChatGPT®, Gemini® responses were compared to the "recommended" 6th grade reading level. According to the results of our study answers of all 5 AI chatbots were compared with the 6th grade reading level, statistically significant differences were observed in the all formulas (P < .001). The answers of all 5 artificial intelligence robots were determined to be at an educational level well above the 6th grade level. The modified DISCERN and Journal of American Medical Association scores was found to be the highest in Perplexity® (P < .001). Gemini® responses were found to have the highest Global Quality Scale score (P < .001). It is emphasized that patient education materials should have a readability level of 6th grade level. Of the 5 AI chatbots whose answers about palliative care were evaluated, Bard®, Copilot®, Perplexity®, ChatGPT®, Gemini®, their current answers were found to be well above the recommended levels in terms of readability of text content. Text content quality assessment scores are also low. Both the quality and readability of texts should be brought to appropriate recommended limits.
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Affiliation(s)
- Volkan Hancı
- Clinic of Anesthesiology and Critical Care, Sincan Education and Research Hospital, Ankara, Turkey
| | - Bişar Ergün
- Clinic of Internal Medicine and Critical Care, Dr. Ismail Fehmi Cumalioğlu City Hospital, Tekirdağ, Turkey
| | - Şanser Gül
- Clinic of Neurosurgery, Ankara Ataturk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Özcan Uzun
- Clinic of Internal Medicine and Nephrology, Yalova City Hospital, Yalova, Turkey
| | - İsmail Erdemir
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ferid Baran Hancı
- Artificial Intelligence Engineering Department, Faculty of Engineering, Ostim Technical University, Ankara, Turkey
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Pini S, Bekker HL, Bennett M, Ziegler L. A Structured Intervention to Support Early Palliative Care Conversations for Oncology Patients - A Qualitative Feasibility Study. Clin Oncol (R Coll Radiol) 2022; 34:e515-e522. [PMID: 35659476 DOI: 10.1016/j.clon.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 01/31/2023]
Abstract
AIMS For patients with advanced cancer, early access to palliative care can have numerous psychosocial and disease management benefits. However, it can be difficult for clinicians to initiate these initial conversations about palliative care. The aim of the present study was to beta test an intervention to facilitate timely conversations about palliative care between patients and clinicians. MATERIALS AND METHODS The study reported forms one stage of a complex intervention development study following Medical Research Council guidance for developing complex interventions. Feasibility was explored from patient and clinician perspectives in an oncology outpatient setting. RESULTS Sixteen patients and 18 clinicians participated. Three phases of the intervention were assessed through patient and clinician interviews. The analysis produced three themes in each phase: (i) Preparation (patient preparedness; healthcare professionals' perspectives on palliative care; administration, data and communication); (ii) STEP consultation (defining perspectives on palliative care; how palliative care fits with the current treatment plan; permission to explore future care); (iii) Outcomes (changes in perspective and approaches to coping; opening the door to future conversations; referrals and involvement of palliative services). CONCLUSIONS The STEP intervention generated important early conversations about end-of-life care that may otherwise not have occurred. No patients regretted having the STEP consultation, which resulted in palliative care referrals for some. Others felt better informed about the support services available and better able to have further conversations. Participating clinicians found the structured conversation guide useful, as it acted as a prompt for areas to cover, as well as providing an explicit way to open discussion about difficult topics.
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Affiliation(s)
- S Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - H L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - M Bennett
- Academic Unit of Palliative Care, University of Leeds, Leeds, UK
| | - L Ziegler
- Academic Unit of Palliative Care, University of Leeds, Leeds, UK
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Atena D, Imane B, Maryam R, Naiire S, Fatemeh T. The level of knowledge about palliative care in Iranian patients with cancer. BMC Palliat Care 2022; 21:33. [PMID: 35264125 PMCID: PMC8907034 DOI: 10.1186/s12904-022-00920-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patient awareness plays an important role in integrating palliative care into the patient care process. Lack of awareness can create a negative attitude towards palliative care and affect patients' decisions during the treatment process. The present study was conducted to determine the level of knowledge about palliative care in Iranian patients with cancer. Methods The descriptive study was conducted with a convenience sample of 103 cancer patients admitted to an oncology center in Yazd, Iran, A three-part questionnaire including demographic information, sources of palliative care information and the Palliative Care Knowledge Scale (PaCKS) was used to collect data. All statistical analyses were performed using software SPSS 21. Results The mean age of patients was 36.2 ± 13.5 years. Of the total, 38.8% of patients received information about palliative care through the media and 36.9% from the treatment team. On a scale of 0 to 13, the mean PaCKS score was 6.7 ± 3.7. A ‘good’ level of knowledge was reported by 29.1% of participants; however 84.5% stated that they should leave other doctors at the time of receiving palliative care, 71.8% considered palliative care for patients in the last six months of life, 84.5% considered palliative care for patients with cancer, and 70.9% stated that palliative care encourages people to discontinue treatments aimed at treating their disease. Conclusion Our study found most cancer patients have a moderate to weak level of knowledge and considerable misinformation about palliative care, which highlights the importance of providing palliative care education. The development of training programs in this area could play an effective role in improving patients' knowledge of palliative care.
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Affiliation(s)
- Dadgari Atena
- Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bagheri Imane
- Ph.D Nursing Student, College of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rassouli Maryam
- PhD. RN Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salmani Naiire
- Hematology and Oncology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. .,, Yazd, Iran.
| | - Tahani Fatemeh
- Oncology Nurse, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Bennett MI, Allsop MJ, Allen P, Allmark C, Bewick BM, Black K, Blenkinsopp A, Brown J, Closs SJ, Edwards Z, Flemming K, Fletcher M, Foy R, Godfrey M, Hackett J, Hall G, Hartley S, Howdon D, Hughes N, Hulme C, Jones R, Meads D, Mulvey MR, O’Dwyer J, Pavitt SH, Rainey P, Robinson D, Taylor S, Wray A, Wright-Hughes A, Ziegler L. Pain self-management interventions for community-based patients with advanced cancer: a research programme including the IMPACCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Each year in England and Wales, 150,000 people die from cancer, of whom 110,000 will suffer from cancer pain. Research highlights that cancer pain remains common, severe and undertreated, and may lead to hospital admissions.
Objective
To develop and evaluate pain self-management interventions for community-based patients with advanced cancer.
Design
A programme of mixed-methods intervention development work leading to a pragmatic multicentre randomised controlled trial of a multicomponent intervention for pain management compared with usual care, including an assessment of cost-effectiveness.
Participants
Patients, including those with metastatic solid cancer (histological, cytological or radiological evidence) and/or those receiving anti-cancer therapy with palliative intent, and health professionals involved in the delivery of community-based palliative care.
Setting
For the randomised controlled trial, patients were recruited from oncology outpatient clinics and were randomly allocated to intervention or control and followed up at home.
Interventions
The Supported Self-Management intervention comprised an educational component called Tackling Cancer Pain, and an eHealth component for routine pain assessment and monitoring called PainCheck.
Main outcome measures
The primary outcome was pain severity (measured using the Brief Pain Inventory). The secondary outcomes included pain interference (measured using the Brief Pain Inventory), participants’ pain knowledge and experience, and cost-effectiveness. We estimated costs and health-related quality-of-life outcomes using decision modelling and a separate within-trial economic analysis. We calculated incremental cost-effectiveness ratios per quality-adjusted life-year for the trial period.
Results
Work package 1 – We found barriers to and variation in the co-ordination of advanced cancer care by oncology and primary care professionals. We identified that the median time between referral to palliative care services and death for 42,758 patients in the UK was 48 days. We identified key components for self-management and developed and tested our Tackling Cancer Pain resource for acceptability. Work package 2 – Patients with advanced cancer and their health professionals recognised the benefits of an electronic system to monitor pain, but had reservations about how such a system might work in practice. We developed and tested a prototype PainCheck system. Work package 3 – We found that strong opioids were prescribed for 48% of patients in the last year of life at a median of 9 weeks before death. We delivered Medicines Use Reviews to patients, in which many medicines-related problems were identified. Work package 4 – A total of 161 oncology outpatients were randomised in our clinical trial, receiving either supported self-management (n = 80) or usual care (n = 81); their median survival from randomisation was 53 weeks. Primary and sensitivity analyses found no significant treatment differences for the primary outcome or for other secondary outcomes of pain severity or health-related quality of life. The literature-based decision modelling indicated that information and feedback interventions similar to the supported self-management intervention could be cost-effective. This model was not used to extrapolate the outcomes of the trial over a longer time horizon because the statistical analysis of the trial data found no difference between the trial arms in terms of the primary outcome measure (pain severity). The within-trial economic evaluation base-case analysis found that supported self-management reduced costs by £587 and yielded marginally higher quality-adjusted life-years (0.0018) than usual care. However, the difference in quality-adjusted life-years between the two trial arms was negligible and this was not in line with the decision model that had been developed. Our process evaluation found low fidelity of the interventions delivered by clinical professionals.
Limitations
In the randomised controlled trial, the low fidelity of the interventions and the challenge of the study design, which forced the usual-care arm to have earlier access to palliative care services, might explain the lack of observed benefit. Overall, 71% of participants returned outcome data at 6 or 12 weeks and so we used administrative data to estimate costs. Our decision model did not include the negative trial results from our randomised controlled trial and, therefore, may overestimate the likelihood of cost-effectiveness.
Conclusions
Our programme of research has revealed new insights into how patients with advanced cancer manage their pain and the challenges faced by health professionals in identifying those who need more help. Our clinical trial failed to show an added benefit of our interventions to enhance existing community palliative care support, although both the decision model and the economic evaluation of the trial indicated that supported self-management could result in lower health-care costs.
Future work
There is a need for further research to (1) understand and facilitate triggers that prompt earlier integration of palliative care and pain management within oncology services; (2) determine the optimal timing of technologies for self-management; and (3) examine prescriber and patient behaviour to achieve the earlier initiation and use of strong opioid treatment.
Trial registration
Current Controlled Trials ISRCTN18281271.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Bridgette M Bewick
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoe Edwards
- School of Pharmacy, University of Bradford, Bradford, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Division of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Geoff Hall
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Jones
- Yorkshire Centre for Health Informatics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John O’Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Angela Wray
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Masoud B, Imane B, Naiire S. Patient awareness of palliative care: systematic review. BMJ Support Palliat Care 2021; 13:136-142. [PMID: 34635546 DOI: 10.1136/bmjspcare-2021-003072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the barriers to the integration of palliative care within the process of patient care and treatment is the lack of awareness of patients about palliative care. In order to develop efficient resources to improve patient awareness, comprehensive information is required to determine the specific aspects of palliative care where a paucity of evidence on patient awareness exists. This review aims to synthesise evidence from previous studies in order to provide a comprehensive information set about the current state of patient awareness of palliative care. METHODS In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Magiran, Scientific Information Database(SID) and Islamic Science Citation (ISC) were searched to identify articles published between 2000 and 2021 that considered patients' awareness of palliative care. RESULTS Of the 5347 articles found, 22 studies were retained after quality evaluation; three full-text articles were excluded. Nineteen articles are included in this review. More than half of the patients did not have any information about palliative care or hospice care. Some patients accurately defined hospice care and palliative care; other patients had misunderstandings about palliative care. Patients had limited information about pastoral care, social care and bereavement care. Patients' awareness about individuals or centres providing palliative care or hospice care was limited. Video presentation and distribution of information at the community level indicated that this method would be beneficial in increasing the awareness. CONCLUSION The review points to the need for patient education programmes and interventional studies to increase patients' awareness.
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Affiliation(s)
- Bahrami Masoud
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bagheri Imane
- College of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Salmani Naiire
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Pini S, Hackett J, Taylor S, Bekker HL, Kite S, Bennett MI, Ziegler L. Patient and professional experiences of palliative care referral discussions from cancer services: A qualitative interview study. Eur J Cancer Care (Engl) 2020; 30:e13340. [PMID: 33051957 DOI: 10.1111/ecc.13340] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/20/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this paper was to identify current barriers, facilitators and experiences of raising and discussing palliative care with people with advanced cancer. METHODS Semi-structured interviews were conducted with patients with advanced cancer and healthcare professionals (HCPs). Patients were included who had and had not been referred to palliative care. Transcripts were analysed using framework analysis. RESULTS Twenty-four patients and eight HCPs participated. Two overarching themes and five sub-themes emerged: Theme one-referral process: timing and triggers, responsibility. Theme two-engagement: perception of treatment, prognosis and palliative care, psychological and emotional preparedness for discussion, and understanding how palliative care could benefit present and future care. CONCLUSION There is a need to identify suitable patients earlier in their cancer trajectory, address misconceptions about palliative care, treatment and prognosis, and better prepare patients and HCPs to have meaningful conversations about palliative care. Patients and HCPs need to establish and communicate the relevance of palliative care to the patient's current and future care, and be clear about the referral process.
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Affiliation(s)
- Simon Pini
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Martin House Research Centre, Social Policy Research Unit, University of York, York, UK
| | - Sally Taylor
- The Christie NHS Foundation Trust, Manchester, UK
| | - Hilary L Bekker
- Leeds Unit for Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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The quality of care of the dying in hospital-next-of-kin perspectives. Support Care Cancer 2020; 28:4527-4537. [PMID: 32388617 PMCID: PMC7378108 DOI: 10.1007/s00520-020-05465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/13/2020] [Indexed: 11/07/2022]
Abstract
Purpose Providing high-quality care for the dying is essential in palliative care. Quality of care can be checked, compared, and improved by assessing responses from bereaved next-of-kin. The objectives of this study are to examine quality of care in the last 2 days of life of hospitalized patients considering specific aspects of their place of care. Methods The “Care of the Dying Evaluation” (CODE™) questionnaire, validated in German in 2018 (CODE-GER), examines quality of care for the patient and support of next-of-kin, allocating values between 0 (low quality) and 4 (high quality). The total score (0–104) is divided into subscales which indicate support/time given by doctors/nurses, spiritual/emotional support, information/decision-making, environment, information about the dying process, symptoms, and support at the actual time of death/afterwards. Next-of-kin of patients with an expected death in specialized palliative care units and other wards in two university hospitals between April 2016 and March 2017 were included. Results Most of the 237 analyzed CODE-GER questionnaires were completed by the patient’s spouse (42.6%) or children (40.5%) and 64.1% were female. Patients stayed in hospital for an average of 13.7 days (3–276; SD 21.1). Half of the patients died in a specialized palliative care unit (50.6%). The CODE-GER total score was 85.7 (SD 14.17; 25–104). Subscales were rated significantly better for palliative care units than for other wards. Unsatisfying outcomes were reported in both groups in the subscales for information/decision-making and information about the dying process. Conclusion The overall quality of care for the dying was rated to be good. Improvements of information about the dying process and decision-making are needed. Trial registration DRKS00013916 Electronic supplementary material The online version of this article (10.1007/s00520-020-05465-2) contains supplementary material, which is available to authorized users.
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Villarreal-Garza C, Platas A, Miaja M, Mesa-Chavez F, Garcia-Garcia M, Fonseca A, Pineda C, de la Rosa-Pacheco S, Galvez-Hernandez CL, Bargallo-Rocha E, Castro J, Rodriguez-Gomez D, Cruz-Ramos M, Mohar A. Patients’ satisfaction with a supportive care program for young breast cancer patients in Mexico: Joven & Fuerte supports patients’ needs and eases their illness process. Support Care Cancer 2020; 28:4943-4951. [DOI: 10.1007/s00520-020-05334-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
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Hackett J, Bekker H, Bennett MI, Carder P, Gallagher J, Henry C, Kite S, Taylor S, Velikova G, Ziegler L. Developing a complex intervention to support timely engagement with palliative care for patients with advanced cancer in primary and secondary care in the UK: a study protocol. BMJ Open 2018; 8:e022835. [PMID: 29764891 PMCID: PMC5961581 DOI: 10.1136/bmjopen-2018-022835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care. We will work closely with patients and health professionals to develop a patient decision aid and health professional training module designed to facilitate a timely and informed conversation about palliative care. METHODS AND ANALYSIS This study is being conducted over 24 months from November 2017 to October 2019 and follows the UK Medical Research Council framework for developing complex interventions and the International Patient Decision Aids Guideline. The Ottawa Decision Support Framework underpins the study. The Supporting Timely Engagement with Palliative care (STEP) intervention will be developed though an iterative process informed by interviews and focus groups with patients with advanced cancer, oncologists, general practitioners and palliative care doctors. An expert panel will also review each iteration. The expert panel will consist of a patient representative with experience of palliative care, health professionals who are involved in advanced cancer care decision-making, a medical education expert and the National Council for Palliative Care director of transformation. The feasibility and acceptability of the decision aid and doctor training will be tested in oncology and general practice settings. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Office for Research Ethics Committees Northern Ireland (ORECNI), approval reference 17/NI/0249. Dissemination and knowledge transfer will be conducted via publications, national bodies and networks, and patient and family groups.
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Affiliation(s)
- Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hilary Bekker
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- NHS Bradford and Districts CCGs, Bradford, UK
| | - Jean Gallagher
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Suzanne Kite
- Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Galina Velikova
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Kloeppel EM, Hanaya H, Seilacher E, Schroth S, Liebl P, Keinki C, Koester MJ, Huebner J. Utility of a Referral Letter to Improve Comprehensibility of Cancer Patients in Palliative Care: a Single-Center Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:487-492. [PMID: 27325274 DOI: 10.1007/s13187-016-1062-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In spite of a referral letter as an important document for communicating between physicians, whether it could also be useful as a source of information for patients has not yet established. We included cancer patients in palliative care setting, all of whom completed a standardized questionnaire regarding their opinion concerning the utility of a referral letter as a source of information and its requirements to achieve a better understanding. Completed questionnaires were received from 50 cancer patients. Ninety-four percent of participants agreed that a referral letter could be of great importance for procuring medical information to them. There was only minor divergence among the participants respecting age, gender, or education. Particular requirements were diagnosis, treatment plan, prognosis, list of drugs, and contact data of involved physicians. Additional important topics were laboratory values, alternatives to current therapy, side effects and supportive therapy, and advices regarding lifestyle and naturopathy. The majority of patients also concluded to accept technical terms in doctor's letters if a glossary supported their comprehension. The majority of patients prefer a concise description of medical information in a referral letter. This form of a letter would boost patients' involvement and help them transfer medical information to other therapists or relatives.
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Affiliation(s)
- Eva-Marie Kloeppel
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Hani Hanaya
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Eckart Seilacher
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Sarah Schroth
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Patrick Liebl
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Christian Keinki
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Marie Jolin Koester
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jutta Huebner
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Fletcher C, Flight I, Chapman J, Fennell K, Wilson C. The information needs of adult cancer survivors across the cancer continuum: A scoping review. PATIENT EDUCATION AND COUNSELING 2017; 100:383-410. [PMID: 27765377 DOI: 10.1016/j.pec.2016.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/29/2016] [Accepted: 10/08/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To provide an updated synthesis of the literature that investigates the self-reported information needs of people diagnosed with cancer across the cancer continuum. METHODS We conducted a scoping review of the literature published from August 2003 to June 2015 and expanded an existing typology summarizing the information needs of people diagnosed with cancer. RESULTS The majority of the included studies (n=104) focused on questions relevant to the diagnosis/active treatment phase of the cancer continuum (52.9%) and thus the most frequently identified information needs related to this phase (33.4%). Information needs varied across the continuum and the results highlight the importance of recognising this fact. CONCLUSION People diagnosed with cancer experience discrete information needs at different points from diagnosis to survival. Much of the research conducted in this area has focused on their information needs during the diagnosis and treatment of cancer, and literature relating to information needs following completion of treatment is sparse. PRACTICE IMPLICATIONS Further research is needed to discern the specific nature of the treatment concerns and identify the information needs that survivors experience during recurrence of cancer, metastasis or changes in diagnosis, and the end of life phase of the cancer continuum.
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Affiliation(s)
- Chloe Fletcher
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia.
| | - Janine Chapman
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia
| | - Kate Fennell
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia
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Goldberg J, Hinchey J, Feder S, Schulman-Green D. Developing and Evaluating a Self-Management Intervention for Women With Breast Cancer. West J Nurs Res 2016; 38:1243-63. [PMID: 27230751 DOI: 10.1177/0193945916650675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reports of self-management interventions usually focus on efficacy and do not detail processes of intervention development and evaluation. We describe the development and evaluation of Managing Cancer Care: A Personal Guide, a patient-oriented cancer self-management intervention consisting of seven modules on the topics of self-management, care options, transitions, communication, symptom management, and self-efficacy. We developed and evaluated the intervention in stages by partnering with women with breast cancer. Stages were as follows: individual interviews ( n = 25), intervention design, focus group ( n = 6), pilot testing with metastatic patients ( n = 23), and population testing with non-metastatic patients ( n = 105). We used interpretive description and content analysis for qualitative analyses and used descriptive statistics to analyze module ratings and frequency of use. We report results of each stage and discuss the challenges of creating a self-management intervention that has broad appeal without taking a one-size-fits-all approach and implementing a self-management intervention in a real-world versus research setting.
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Moghaddam N, Coxon H, Nabarro S, Hardy B, Cox K. Unmet care needs in people living with advanced cancer: a systematic review. Support Care Cancer 2016; 24:3609-22. [PMID: 27137214 DOI: 10.1007/s00520-016-3221-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/17/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The support needs of cancer patients vary according to the phase of their cancer journey. Recent developments in healthcare are such that the advanced cancer phase is increasingly experienced as a chronic illness phase, with consequent changes in patient support needs. Understanding these needs, and identifying areas of unmet need, can enable us to develop services that are more adequate to the task of supporting this population. METHODS We conducted a systematic search of four electronic databases to identify studies examining the unmet needs of people living with advanced cancer. Relevant data were extracted and synthesised; meta-analyses were conducted to obtain pooled estimates for prevalence of needs. RESULTS We identified 23 studies (4 qualitative) for inclusion. Unmet needs were identified across a broad range of domains, with greatest prevalence in informational (30-55 %), psychological (18-42 %), physical (17-48 %), and functional (17-37 %) domains. There was considerable heterogeneity amongst studies in terms of methods of assessment, coding and reporting of needs, respondent characteristics, and appraised study quality. CONCLUSIONS Heterogeneity made it difficult to compare across studies and inflated confidence intervals for pooled estimates of prevalence-we need standardised and comprehensive approaches to assessment and reporting of unmet needs to further our understanding. Nonetheless, the review identified prominent needs across a range of (interacting) experiential domains. Moreover, by focussing on unmet needs for support, we were able to extrapolate potential implications for service development.
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Affiliation(s)
- Nima Moghaddam
- College of Social Sciences, University of Lincoln, Brayford Pool, Lincoln, UK.
| | | | | | - Beth Hardy
- Department of Health Sciences, University of York, York, UK
| | - Karen Cox
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Abstract
Euthymic bipolar patients are often impacted by residual symptoms (RSs) that increase the risk of relapse or low functioning. We aimed to identify the perceptions of RSs, barriers to management, and service needs in euthymic bipolar patients. A qualitative methodology (focus group) was used. The interviews were investigated using a semistructured guide, tape-recorded, transcribed verbatim, and analyzed thematically. Twenty-three bipolar patients expressed concern about several RSs, such as emotional dysregulation, circadian rhythm disruption, cognitive impairment, low self-esteem, and physical symptoms. They reported concern about the impact of RSs on their functioning and about the need for more systematic assessment of RSs during interepisode visits. Selection bias may have occurred because the recruitment was limited to France and there may be cultural differences in the perceptions of RSs. Bipolar patients experienced bipolar disorder as a chronic disorder because they frequently continued to suffer from RSs associated with a functional impact.
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Van De Belt TH, Hendriks AFW, Aarts JWM, Kremer JAM, Faber MJ, Nelen WLDM. Evaluation of patients’ questions to identify gaps in information provision to infertile patients. HUM FERTIL 2014; 17:133-40. [DOI: 10.3109/14647273.2014.912762] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Satisfaction with information and its association with illness perception and quality of life in Indonesian breast cancer patients. Support Care Cancer 2013; 21:2999-3007. [DOI: 10.1007/s00520-013-1877-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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