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Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. PATIENT EDUCATION AND COUNSELING 2023; 114:107811. [PMID: 37244131 PMCID: PMC10526983 DOI: 10.1016/j.pec.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. METHODS We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US. RESULTS Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses. CONCLUSION The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present. PRACTICE IMPLICATIONS Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, United States.
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, United States
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, United States; Department of Population Health Sciences, Duke University School of Medicine, United States
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Caring for people who take care: What is already done? Palliat Support Care 2021; 20:720-730. [DOI: 10.1017/s147895152100119x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The growing prevalence and impact of cancer on the family system calls for a palliative care approach with the family as the unit of care. This study aimed at providing an overview of the intervention programs that have been developed to offer support to the family caregivers of oncologic patients receiving palliative care.
Method
Sixteen articles were included in the final review, encompassing (i) studies focused on intervention programs with family caregivers of cancer patients in palliative care, (ii) studies including a pre- and post-test evaluation of the intervention program, (iii) and studies whose cancer patients were at least 18 years old.
Results
A great heterogeneity was verified with respect to care settings, number of sessions, outcome measures, or timing of assessment within the reviewed programs. These findings mirrored the complexity of the palliative care approach, which is difficult to standardize. Nonetheless, some interventions with different features accomplished good and sometimes similar results. The studies’ main outcomes were clustered in five categories: psychological symptomatology, general quality of life, caregiving role, family relational variables, and bereavement/grief. Moreover, 44% of the main outcomes were psychological symptomatology of family caregivers, with an emphasis toward anxiety and depression. Also shown was a growing emergence of technology use among these interventions.
Significance of results
Results revealed a scarcity of family-oriented programs and lack of certified mental health professionals as interventionists. Future studies and interventions should focus on the positive outcomes of the caregiving experience and must acknowledge the cultural differences when trying to replicate programs. Considering that there is no precise formula for dealing with terminal illness and grief, we submit that family-centered and systemic lenses are excellent approaches for support during this adjustment process. In conclusion, the present study advocates for increased investment in the field, underscoring the importance of family caregivers’ mental health.
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McInerney F, Doherty K, Bindoff A, Robinson A, Vickers J. How is palliative care understood in the context of dementia? Results from a massive open online course. Palliat Med 2018; 32:594-602. [PMID: 29235386 PMCID: PMC5851129 DOI: 10.1177/0269216317743433] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A palliative approach to the care of people with dementia has been advocated, albeit from an emergent evidence base. The person-centred philosophy of palliative care resonates with the often lengthy trajectory and heavy symptom burden of this terminal condition. AIM To explore participants' understanding of the concept of palliative care in the context of dementia. The participant population took an online course in dementia. DESIGN The participant population took a massive open online course on 'Understanding Dementia' and posted answers to the question: 'palliative care means …' We extracted these postings and analysed them via the dual methods of topic modelling analysis and thematic analysis. SETTING/PARTICIPANTS A total of 1330 participants from three recent iterations of the Understanding Dementia Massive Open Online Course consented to their posts being used. Participants included those caring formally or informally for someone living with dementia as well as those with a general interest in dementia Results: Participants were found to have a general awareness of palliative care, but saw it primarily as terminal care, focused around the event of death and specialist in nature. Comfort was equated with pain management only. Respondents rarely overtly linked palliative care to dementia. CONCLUSIONS A general lack of palliative care literacy, particularly with respect to dementia, was demonstrated by participants. Implications for dementia care consumers seeking palliative care and support include recognition of the likely lack of awareness of the relevance of palliative care to dementia. Future research could access online participants more directly about their understandings/experiences of the relationship between palliative care and dementia.
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Affiliation(s)
- Fran McInerney
- Faculty of Health, Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Kathleen Doherty
- Faculty of Health, Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Aidan Bindoff
- Faculty of Health, Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Andrew Robinson
- Faculty of Health, Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - James Vickers
- Faculty of Health, Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, TAS, Australia
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Kissane DW, Zaider TI, Li Y, Hichenberg S, Schuler T, Lederberg M, Lavelle L, Loeb R, Del Gaudio F. Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement. J Clin Oncol 2016; 34:1921-7. [PMID: 27069071 DOI: 10.1200/jco.2015.63.0582] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. PATIENTS AND METHODS Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. RESULTS On the CGI, a significant treatment effect (Wald χ(2) = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ(2) = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ(2) = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. CONCLUSION Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder.
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Affiliation(s)
- David W Kissane
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Talia I Zaider
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Yuelin Li
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Shira Hichenberg
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Tammy Schuler
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Marguerite Lederberg
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Lisa Lavelle
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Rebecca Loeb
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
| | - Francesca Del Gaudio
- David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia
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Menyhért M, Csikós Á, Radványi I, Busa C. The importance of psychosocial care. Orv Hetil 2014; 155:1485-92. [DOI: 10.1556/oh.2015.30163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Psychosocial support is very important for cancer patients, because it affects the quality of life of the patients and the course of the disease. It helps the family to deal with difficult situations and prepare for future challenges. Aim: The aim of this study was to analyse the psychosocial care in the Pécs-Baranyai Hospice Foundation and answer the following questions: what are the characteristics of psychosocial care and how many people receive this support. Method: It was a retrospective study. Results: During the 8 years examined, 36% of the patients (273 persons) asked or proposed by anyone psychosocial support for the family. However, meeting between the patient and expert evolved only in 49% of the 273 patients and, thus, only 18% of the patients received psychosocial support. Conclusions: In the Pécs-Baranya Hospice Foundation less patients received psychosocial support, than those who would need it. Psychosocial care is not yet an integral part of hospice care in practice. Orv. Hetil., 2014, 155(37), 1485–1492.
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Affiliation(s)
- Mónika Menyhért
- Pécsi Tudományegyetem, Klinikai Központ Palliatív Mobil Team Pécs Rákóczi út 2. 7623
| | - Ágnes Csikós
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Családorvostani Intézet, Hospice-Palliatív Tanszék Pécs
| | - Ildikó Radványi
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Családorvostani Intézet, Hospice-Palliatív Tanszék Pécs
| | - Csilla Busa
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Családorvostani Intézet, Hospice-Palliatív Tanszék Pécs
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