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Oliver DP, Ersek M, White P, Jorgenson L, Pitzer K, Rolbiecki A, Mayahara M, Washington K, Demiris G. Addressing Statistical Power and Increasing Diversity in Hospice Research: Electronic Medical Record Participant Identification Compared to Nurse Referral Approaches to Recruitment. J Pain Symptom Manage 2024:S0885-3924(24)00920-5. [PMID: 39197694 DOI: 10.1016/j.jpainsymman.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024]
Abstract
CONTEXT Recruitment of targeted samples into hospice clinical trials is often challenging. While electronic medical records (EMR) are commonly used in hospital-based research, it is uncommon in hospice research. The community setting and the variability in hospices and their medical record creates unique challenges. OBJECTIVES This paper compares recruitment in two hospice randomized controlled trials, each of which had a group recruited by using the EMR identification and a group recruited by nurse referral. We sought to answer three questions: 1) What is the impact of using the EMR to identify hospice participants for clinical research? 2) How do the referral count and consent rate (referrals that ultimately result in verbal informed consent to participate in research) differ between hospice agencies using an EMR participant identification approach compared to those using a nurse referral approach? and 3) What are the challenges associated with using the EMR to identify potential research participants? METHOD Recruitment data from two hospice clinical trials was combined into a new database. Data from hospice nurse referral agencies was compared with data from those agencies who participated in EMR-identified referrals. RESULTS The EMR identification process was feasible and efficient, resulting in more referrals and more consented participants than the nurse referral method. Of particular interest is that 8% more black caregivers were recruited using the EMR identification process than the nurse referral. CONCLUSIONS The EMR-identified recruitment process is the recommended method in hospice research.
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Affiliation(s)
- Debra Parker Oliver
- Ira Kodner Professor of Supportive Care Research, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, Goldfarb School of Nursing, 4590 Children's Place, Mailstop 90-29-931, St. Louis, MO. 63110.
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, s
| | - Patrick White
- Stokes Family Endowed Chair and chief, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Lucas Jorgenson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Kyle Pitzer
- Assistant Professor, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Abigail Rolbiecki
- Assistant Professor, Department of Family Medicine, University of Missouri
| | - Masako Mayahara
- Associate Professor, Goldfarb School of Nursing, Barnes Jewish College of Nursing
| | - Karla Washington
- Associate Professor, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - George Demiris
- Penn Integrates Knowledge University Professor, Department of Biobehavioral and Health Science, School of Nursing; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
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Seibel K, Rios CLO, Sparna T, Becker C, Gaertner J, Becker G, Boehlke C. Implementation of a digital distress detection system in palliative care: qualitative data on perspectives of a multiprofessional palliative care team. BMC Palliat Care 2024; 23:203. [PMID: 39113031 PMCID: PMC11304939 DOI: 10.1186/s12904-024-01530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/23/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Digital health technologies such as sensor systems are intended to support healthcare staff in providing adequate patient care. In the Department of Palliative Medicine (University Medical Center Freiburg), we developed and implemented a noninvasive, bed-based sensor system in a pilot study. The aim was to detect distress in patients who were no longer able to express themselves by monitoring heart and respiratory rates, vocalizations, and movement measurements. The sensor system was intended to supplement standard care, which generally cannot guarantee constant monitoring. As there is a lack of data on how healthcare professionals experience such a techno-digital innovation, the aim of this study was to explore how the multiprofessional palliative care team who piloted the sensor system perceived its potential benefits and limitations, and how they experienced the broader context of healthcare technology and research in palliative care. METHODS We conducted a qualitative interview study with 20 members of the palliative care team and analyzed the recorded, verbatim transcribed interviews using qualitative content analysis. RESULTS The sensor system was described as easy to use and as helpful support for patients, care staff, and relatives, especially against the backdrop of demographic change. However, it could not replace human interpretation of stress and subsequent treatment decisions: this remained the expertise of the nursing staff. A potential reduction in personnel was expected to be a risk of a digital monitoring system. The special conditions of research and digital health technologies in an end-of-life context also became clear. Specifically, healthcare staff were open to health technologies if they benefited the patient and were compatible with professional nursing and/or palliative care attitudes. Additionally, a patient-protective attitude and possible interprofessional differences in priorities and the resulting challenges for the team became apparent. CONCLUSIONS A potential digital solution for distress monitoring was considered useful by palliative care practitioners. However, interprofessional differences and compatibility with existing palliative care practices need to be considered before implementing such a system. To increase user acceptability, the perspectives of healthcare professionals should be included in the implementation of technological innovations in palliative care.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
| | - Claudia Lorena Orellana Rios
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
- Current address: Helios Klinikum Bonn/Rhein-Sieg, Bonn, Germany
| | - Titus Sparna
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Carola Becker
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Jan Gaertner
- Current address: Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Palliative Care Center Basel, Basel, Switzerland
| | - Gerhild Becker
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Medicine, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
- Current address: Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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Payne SA, Sumerfield M, Hughes S. Opportunities and Challenges in Patient and Public Involvement and Engagement in Palliative Care Research. J Palliat Med 2024. [PMID: 39102355 DOI: 10.1089/jpm.2024.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Affiliation(s)
- Sheila Alison Payne
- Division of Health Research, Faculty of Health and Medicine, International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Marion Sumerfield
- 4DPICTURE Project Group, International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sean Hughes
- Division of Health Research, Faculty of Health and Medicine, International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
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Salins N, Hughes S, Preston N. Oncologists' palliative care referral behaviour: testing utility of social exchange theory as an explanatory framework. BMC Palliat Care 2024; 23:183. [PMID: 39048941 PMCID: PMC11267831 DOI: 10.1186/s12904-024-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Adults and children with cancer are referred to palliative care infrequently or late. Oncologists often gatekeep these referrals. Social exchange theory is used to explain physician referral behaviour in various clinical settings. Its utility in a cancer palliative care setting is not known. METHODS We used Karl Popper's hypothetico-deductive approach to test the hypothesis. The hypothesis was that social exchange theory is a helpful framework for explaining oncologists' palliative care referral behaviour in a cancer setting. The utility of the theoretical framework was tested against the empiric findings of a systematic review and original research. RESULTS Most components of social exchange theory known to explain physician referral behaviour like beliefs about the provider or service, emotions triggered during the professional engagement, its symbolism and stigma, the complexity of the referral task, efforts needed to achieve it, its cost, benefit, and value were similar in a cancer setting. Empirical findings suggest that oncologists provided strategies and solutions to better palliative care integration instead of comparing their existing engagement with potential alternatives and choosing them. CONCLUSION Social exchange theory was found to be helpful in explaining oncologists' palliative care referral behaviour. To further develop the social exchange theory based on the data used to test it, it is recommended to include feedback and solutions as a component of the theoretical framework alongside a comparison level for alternatives.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Sean Hughes
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, United Kingdom
| | - Nancy Preston
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, United Kingdom
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Zheng R, Wang J, Wang Y, Zhu P, Wang L, Zhang Z, Dong F. "Let them be": Family members' perspectives on the participation of advanced cancer patients in nursing research: A qualitative descriptive study. Int J Nurs Stud 2024; 155:104772. [PMID: 38676991 DOI: 10.1016/j.ijnurstu.2024.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Recruiting advanced cancer patients is crucial for nursing research in cancer care. However, nurse researchers often face various socio-cultural challenges, particularly in mainland China, where cultural taboos around death pose significant obstacles. An unexplored constraint in this context is the pivotal role Chinese family members play in patients' healthcare decision-making. This research gap underscores the need for a deeper understanding of Chinese family members' perspectives on the engagement of advanced cancer patients in nursing research. OBJECTIVE To explore the perceptions and concerns of family members regarding the recruitment and participation of advanced cancer patients in nursing research. DESIGN A qualitative descriptive study was conducted. SETTINGS Three cancer hospitals in mainland China. PARTICIPANTS A purposive sample of 18 family members, consisting of children or spouses of advanced cancer patients, was recruited as participants. METHODS Semi-structured interviews were conducted to collect data between September 2022 and January 2023. The thematic analysis method was used to analyze the data. RESULTS Three themes were identified: The absence of prior participation, Family members' reluctance to facilitate patient involvement, and Strategies to encourage patients' future participation. Family members were hesitant to allow their relatives with advanced cancer to engage in nursing research, primarily due to concerns about distressing patients, the use of potential sensitive language, stigma, and the risks involved in participation. To address these concerns, they emphasized the importance of gaining family approval prior to patient enrolment. They highlighted the need of family involvement on behalf of sick relatives in research, advocating for the inclusion of a wide range of patients rather than targeting specific subgroups. They also reiterated the significance of choosing the right time for participation and avoiding using sensitive terms such as 'cancer', 'dying', and 'death' when engaging with patients. Moreover, they proposed the recruitment of patients by trusted professionals, shortening the duration of research activities and simplifying research procedures. CONCLUSIONS This study provides fresh insights into the perspectives of family members concerning the recruitment and engagement of advanced cancer patients in nursing research. It emphasizes the importance of addressing their concerns and recommendations, aiding nurse researchers in developing culturally sensitive recruitment strategies and fostering the inclusive participation of advanced cancer patients in nursing research within the context of family-centered care and cultural taboos surrounding death.
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Affiliation(s)
- Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Jun Wang
- Center for Human Geography and Urban Development, Guangzhou University, Guangzhou, Guangdong, China
| | - Yanhui Wang
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Zhu
- Department of Nursing, Jiangsu Province Cancer Hospital, Nanjing, China
| | - Li Wang
- Department of VIP Medical Services, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenling Zhang
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Fengqi Dong
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Walshe C, Dunleavy L, Preston N, Payne S, Ellershaw J, Taylor V, Mason S, Nwosu AC, Gadoud A, Board R, Swash B, Coyle S, Dickman A, Partridge A, Halvorsen J, Hulbert-Williams N. Understanding barriers and facilitators to palliative and end-of-life care research: a mixed method study of generalist and specialist health, social care, and research professionals. BMC Palliat Care 2024; 23:159. [PMID: 38918771 PMCID: PMC11202245 DOI: 10.1186/s12904-024-01488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Palliative care provision should be driven by high quality research evidence. However, there are barriers to conducting research. Most research attention focuses on potential patient barriers; staff and organisational issues that affect research involvement are underexplored. The aim of this research is to understand professional and organisational facilitators and barriers to conducting palliative care research. METHODS A mixed methods study, using an open cross-sectional online survey, followed by working groups using nominal group techniques. Participants were professionals interested in palliative care research, working as generalist/specialist palliative care providers, or palliative care research staff across areas of North West England. Recruitment was via local health organisations, personal networks, and social media in 2022. Data were examined using descriptive statistics and content analysis. RESULTS Participants (survey n = 293, working groups n = 20) were mainly from clinical settings (71%) with 45% nurses and 45% working more than 10 years in palliative care. 75% were not active in research but 73% indicated a desire to increase research involvement. Key barriers included lack of organisational research culture and capacity (including prioritisation and available time); research knowledge (including skills/expertise and funding opportunities); research infrastructure (including collaborative opportunities across multiple organisations and governance challenges); and patient and public perceptions of research (including vulnerabilities and burdens). Key facilitators included dedicated research staff, and active research groups, collaborations, and networking opportunities. CONCLUSIONS Professionals working in palliative care are keen to be research active, but lack time, skills, and support to build research capabilities and collaborations. A shift in organisational culture is needed to enhance palliative care research capacity and collaborative opportunities across clinical and research settings.
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Affiliation(s)
- Catherine Walshe
- International Observatory On End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Lesley Dunleavy
- International Observatory On End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory On End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sheila Payne
- International Observatory On End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | | | | | | | - Amy Gadoud
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Ruth Board
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Seamus Coyle
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew Dickman
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Jaime Halvorsen
- NIHR Clinical Research Network North West Coast, Liverpool, UK
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Lormans T, de Graaf E, de Vries S, Leget C, Teunissen S. 'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration. Palliat Care Soc Pract 2024; 18:26323524241260426. [PMID: 38911602 PMCID: PMC11191620 DOI: 10.1177/26323524241260426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it. Objective This study aims to identify what patients need when using the USD-4D in clinical palliative care. Design A generic qualitative design with primary and secondary analyses of semistructured interviews. Methods Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis. Results Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach. Conclusion For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.
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Affiliation(s)
- Tom Lormans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584CG, The Netherlands
| | - Everlien de Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sita de Vries
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Leget
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization Process Theory. J Adv Nurs 2024. [PMID: 38884574 DOI: 10.1111/jan.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/26/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
AIM To evaluate the failed implementation of the Carer Support Needs Assessment Tool Intervention for family caregivers in end-of-life care, within a trial context using Normalization Process Theory (NPT). DESIGN An evaluation study was conducted to learn lessons from our trial, which was not successful due to the low number of participants. The evaluation study utilized various data sources, including published data from interviews and questionnaires, and unpublished data derived from emails and conversation notes. METHODS Data were retrospectively collected. Thematic analysis was conducted guided by the NPT framework. This framework emphasizes that successful implementation of an intervention relies on its 'normalization', consisting of four constructs: coherence, cognitive participation, collective action and reflexive monitoring. RESULTS Coherence (sense making): Nurses felt the intervention could contribute to their competence in assessing family caregivers' needs, but some were unsure how it differed from usual practice. Cognitive participation (relational work): Nurse champions played a crucial role in building a community of practice. However, sustaining this community was challenging due to staff turnover and shortages. Collective action (work done to enable the intervention): Nurses felt the Carer Support Needs Assessment Tool training enabled them to improve their support of family caregivers. However, contextual factors complicated implementation, such as being used to a patient rather than a family-focused approach and a high workload. Reflexive monitoring (appraisal of the intervention): Positive experiences of the nurses with the intervention motivated them to implement it. However, the research context made nurses hesitant to recruit family caregivers because of the potential burden of participation. CONCLUSION Although the intervention demonstrated potential to assist nurses in providing tailored support to family caregivers, its integration into daily practice was not optimal. Contextual factors, such as a patient-focused approach to care and the research context, hampered normalization of the intervention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Assessing and considering contextual factors that may influence implementation of a complex care intervention is needed. The NPT provided a valuable framework for evaluating the implementation process in our study. IMPACT What problem did the study address? This evaluation study analysed the factors that promoted or hindered the implementation of a nursing intervention to support family caregivers in end-of-life care. What were the main findings? Both the intervention and the intervention training have potential and value for nurses in providing tailored support to family caregivers. However, the implementation faced challenges due to organizational factors and the research context, including recruitment. Where and on whom will the research have an impact? This insight is valuable for all stakeholders involved in implementing complex nursing interventions, including researchers, nurses and funders. REPORTING METHOD This study has adhered to the relevant EQUATOR guidelines: Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involved. TRIAL REGISTRATION The trial was prospectively registered on the Dutch Trial Register (NL7702).
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Salins N, Rao K, Damani A, Hughes S, Preston N. Paediatric oncologists' perspectives on Strategic solutions to develop Integrated Cancer Palliative Care: feedback intervention theory as an explanatory Framework. BMC Palliat Care 2024; 23:130. [PMID: 38778373 PMCID: PMC11112766 DOI: 10.1186/s12904-024-01462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Globally, children with cancer often experience delays in palliative care referral or are infrequently referred. Therefore, we conducted a qualitative study to gain insight from paediatric oncologists into what enables or deters palliative care referral. Strategic solutions to develop integrated palliative care was a critical study theme. In this paper, we have explained and interpreted these strategic solutions through the lens of feedback intervention theory. METHODOLOGY The study findings were interpreted using Kumar's six-step approach that enabled systematic evaluation of a theory's appropriateness and alignment with the researcher's paradigm, methodology, and study findings. It also explained how theory informed analysis and elucidated challenges or the development of new models. The feedback intervention theory appraises the discrepancy between actual and desired goals and provides feedback to improve it. RESULTS Strategic solutions generated from the study findings were coherent with the aspects elucidated in theory, like coping mechanisms, levels of feedback hierarchy, and factors determining the effect of the feedback intervention on performance. Paediatric oncologists suggested integrating palliative care providers in the team innocuously, improving communication between teams, relabelling palliative care as symptom control, and working with a skilled and accessible palliative care team. The paper proposes an infinite loop model developed from the study, which has the potential to foster integrated palliative care through excellent collaboration and continuous feedback. CONCLUSION Applying feedback intervention theory can bridge the gap between actual and desired practice for integrated cancer palliative care in paediatric oncology.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krithika Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sean Hughes
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, United Kingdom
| | - Nancy Preston
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, United Kingdom
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Kukla H. Balancing burden and benefit: Reflecting on interviews with individuals nearing the end of their lives. Palliat Support Care 2024; 22:419-420. [PMID: 37817322 DOI: 10.1017/s1478951523001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Helena Kukla
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
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Betker L, Seifart C, von Blanckenburg P. Questionnaires About the End of Life for Cancer Patients - Is the Response Burden Acceptable? J Pain Symptom Manage 2024; 67:233-240. [PMID: 38016508 DOI: 10.1016/j.jpainsymman.2023.11.025] [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: 07/25/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
CONTEXT Research about the end of life with the help of patient-reported outcomes in vulnerable populations such as cancer patients is needed but is potentially burdensome and can therefore raise concerns. OBJECTIVES To assess the response burden due to questionnaires about the end of life in cancer patients and to explore associations with individual variables. METHODS In a cross-sectional design response burden was assessed using a six-item instrument after completion of a survey that concerned the end of life. Associations with age, gender, type of care (curative/palliative), years since diagnosis, distress, depression, anxiety, death anxiety, readiness for end-of-life conversations, and readiness for advance care planning were explored via correlational analyses and multiple regressions. Burden due to the topic of end-of-life and completing questionnaires in general was compared. RESULTS A total of 269 cancer patients (mean age 61.4 (SD =12.3); 59.5% male; 58.4% in palliative care) completed the survey in a German hospital. The majority did not report response burden; 29.7% reported at least some burden due to study participation. The multiple regression (F [10,26] = 9.97, p < 0.001) indicated that stable predictors of response burden were higher death anxiety (ß = 0.4), lower readiness to talk about one's end of life (ß = -0.34) and higher age (ß = 0.23). No additional subjective burden due to the topic of end-of-life was reported. CONCLUSION The reported response burden seems acceptable since it was generally low. However, a subgroup did report some burden. Minimising burden and enhancing participants' benefits without compromising the research quality should further influence study designs in this field.
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Affiliation(s)
- Liv Betker
- Department of Clinical Psychology and Psychotherapy (L.B., P.B.), Philipps-University Marburg, Marburg, Germany.
| | - Carola Seifart
- Department of Medicine, Research Group Medical Ethics (C.S.), Philipps-University Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy (L.B., P.B.), Philipps-University Marburg, Marburg, Germany
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Wakefield D, Ta Y, Dewhurst F, Hussain J, Chamberlain C, Etkind S. Qualified and motivated, but limited by specialty-specific barriers: a national survey of UK Palliative Medicine consultants research experience. BMJ Support Palliat Care 2024; 14:76-86. [PMID: 37611937 DOI: 10.1136/spcare-2023-004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Providing high-quality safe palliative care requires high-quality clinically driven research. Little is known about how to optimise clinical research capacity in this field.To understand interest and capacity to conduct clinical research in palliative medicine and identify key facilitators and barriers, by surveying palliative medicine consultants and academic trainees. METHODS National online survey exploring experience in conducting research, including facilitators and barriers. Sent to all current UK palliative medicine consultants, and previous/current academic trainees. Descriptive statistics are reported with framework analysis of free text responses. RESULTS 195 surveys were submitted including 15 respondents with Integrated Academic Training (IAT) experience. 78% (n=140/180) of consultants were interested in conducting research. Despite this enthusiasm, 83% had no allocated time within their job plan. 88% of those who undertook IAT would recommend IAT, but 60% reported difficulty transitioning from academic trainee to research active consultant.Barriers to research included; insufficient research culture and integration, with small teams working in a mixture of National Health Service (NHS) and non-NHS settings, leading to isolated, silo working. Even those who had undertaken IAT, felt a 'cliff edge' in opportunities after completing IAT. Filling service gaps was routinely prioritised over research activity. CONCLUSION Palliative medicine consultants, including those who have completed academic training want to conduct research but overwhelming barriers limit activity. A palliative care-specific strategy that permeates different palliative care settings, promotes interspecialty collaboration and improves the current infrastructure for palliative care research to maximise gains from IAT and embed a research culture are suggested.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Felicity Dewhurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle upon Tyne, UK
| | - Jamilla Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Charlotte Chamberlain
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Evans BA, Khanom A, Edwards A, Edwards B, Farr A, Foster T, Fothergill R, Gripper P, Gunson I, Porter A, Rees N, Scott J, Snooks H, Watkins A. Experiences and views of people who frequently call emergency ambulance services: A qualitative study of UK service users. Health Expect 2024; 27:e13856. [PMID: 37578195 PMCID: PMC10726061 DOI: 10.1111/hex.13856] [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: 05/23/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. METHODS We used a two-stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third-sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results. RESULTS People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers. CONCLUSION People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services. PATIENT OR PUBLIC CONTRIBUTION People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee.
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Affiliation(s)
- Bridie A. Evans
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Ashra Khanom
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Adrian Edwards
- School of Medicine, PRIME Centre Wales, Division of Population MedicineCardiff UniversityCardiffUK
| | - Bethan Edwards
- Public Contributor, c/o Swansea University Medical SchoolSwanseaUK
| | - Angela Farr
- Swansea Centre for Health EconomicsSwansea UniversitySwanseaUK
| | | | | | - Penny Gripper
- Public Contributor, c/o Swansea University Medical SchoolSwanseaUK
| | - Imogen Gunson
- West Midlands Ambulance Service University NHS Foundation TrustWest MidlandsUK
| | - Alison Porter
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Nigel Rees
- Welsh Ambulance Services NHS TrustCwmbranUK
| | | | - Helen Snooks
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
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Oelschlägel L, Moen A, Dihle A, Christensen VL, Heggdal K, Österlind J, Steindal SA. Implementation of remote home care: assessment guided by the RE-AIM framework. BMC Health Serv Res 2024; 24:145. [PMID: 38287394 PMCID: PMC10825998 DOI: 10.1186/s12913-024-10625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Welfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care. METHODS A secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted. RESULTS Five themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions in recruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients' daily lives, it was perceived as a static service unable to keep pace with disease progression. CONCLUSIONS A person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway.
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Moen
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Marie Cederschiöld University, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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Kendal S, Louch G, Walker L, Shafiq S, Halligan D, Brierley-Jones L, Baker J. Implementing and evaluating patient-focused safety technology on adult acute mental health wards. J Psychiatr Ment Health Nurs 2024. [PMID: 38279658 DOI: 10.1111/jpm.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. WHAT ARE THE IMPLICATIONS FOR PRACTICE This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. ABSTRACT INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. AIM Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. METHOD Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. RESULTS Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. DISCUSSION Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. IMPLICATIONS FOR PRACTICE The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.
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Affiliation(s)
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford, UK
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van Hylckama Vlieg MAM, Pot IE, Visser HPJ, Jong MAC, van der Vorst MJDL, van Mastrigt BJ, Kiers JNA, van den Homberg PPPH, Thijs-Visser MF, Oomen-de Hoop E, van der Heide A, van der Kuy PHM, van der Rijt CCD, Geijteman ECT. Appropriate medication use in Dutch terminal care: study protocol of a multicentre stepped-wedge cluster randomized controlled trial (the AMUSE study). BMC Palliat Care 2024; 23:6. [PMID: 38172930 PMCID: PMC10762916 DOI: 10.1186/s12904-023-01334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Polypharmacy is common among patients with a limited life expectancy, even shortly before death. This is partly inevitable, because these patients often have multiple symptoms which need to be alleviated. However, the use of potentially inappropriate medications (PIMs) in these patients is also common. Although patients and relatives are often willing to deprescribe medication, physicians are sometimes reluctant due to the lack of evidence on appropriate medication management for patients in the last phase of life. The aim of the AMUSE study is to investigate whether the use of CDSS-OPTIMED, a software program that gives weekly personalized medication recommendations to attending physicians of patients with a limited life expectancy, improves patients' quality of life. METHODS A multicentre stepped-wedge cluster randomized controlled trial will be conducted among patients with a life expectancy of three months or less. The stepped-wedge cluster design, where the clusters are the different study sites, involves sequential crossover of clusters from control to intervention until all clusters are exposed. In total, seven sites (4 hospitals, 2 general practices and 1 hospice from the Netherlands) will participate in this study. During the control period, patients will receive 'care as usual'. During the intervention period, CDSS-OPTIMED will be activated. CDSS-OPTIMED is a validated software program that analyses the use of medication based on a specific set of clinical rules for patients with a limited life expectancy. The software program will provide the attending physicians with weekly personalized medication recommendations. The primary outcome of this study is patients' quality of life two weeks after baseline assessment as measured by the EORTC QLQ-C15-PAL questionnaire, quality of life question. DISCUSSION This will be the first study investigating the effect of weekly personalized medication recommendations to attending physicians on the quality of life of patients with a limited life expectancy. We hypothesize that the CDSS-OPTIMED intervention could lead to improved quality of life in patients with a life expectancy of three months or less. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT05351281, Registration Date: April 11, 2022).
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Affiliation(s)
| | - I E Pot
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H P J Visser
- Department of Internal Medicine, Noordwest Ziekenhuis, Alkmaar, The Netherlands
| | - M A C Jong
- Department of Internal Medicine, Noordwest Ziekenhuis, Alkmaar, The Netherlands
| | - M J D L van der Vorst
- Department of Internal Medicine, Center for Supportive and Palliative Care, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - J N A Kiers
- Family Medicine Network, Nijmegen, The Netherlands
| | | | - M F Thijs-Visser
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | - E Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P H M van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E C T Geijteman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Vlckova K, Gonella S, Bavelaar L, Mitchell G, Sussman T. Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence. Int J Nurs Pract 2023:e13224. [PMID: 38113927 DOI: 10.1111/ijn.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
AIM This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations. BACKGROUND Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex. DESIGN A systematic review was conducted. DATA SOURCES Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis. RESULTS Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data. CONCLUSION The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.
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Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care, Prague, The Czech Republic
- Third Faculty of Medicine, Prague, The Czech Republic
| | - Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Torino, Torino, Italy
| | - Laura Bavelaar
- Leiden University Medical Center, Leiden, The Netherlands
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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Potthoff S, Hempeler C, Gather J, Gieselmann A, Vollmann J, Scholten M. Research ethics in practice: An analysis of ethical issues encountered in qualitative health research with mental health service users and relatives. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:517-527. [PMID: 37639076 PMCID: PMC10725844 DOI: 10.1007/s11019-023-10169-5] [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] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethics" and the identification and handling of ethical issues by researchers during the research process as "ethics in practice." While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors.
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Affiliation(s)
- Sarah Potthoff
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany.
| | - Christin Hempeler
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Astrid Gieselmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
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Dunleavy L, Preston N, Walshe C. Health care professional recruitment of patients and family carers to palliative care randomised controlled trials: A qualitative multiple case study. Palliat Med 2023; 37:1540-1553. [PMID: 37753865 PMCID: PMC10657513 DOI: 10.1177/02692163231197917] [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] [Indexed: 09/28/2023]
Abstract
BACKGROUND Trial participant recruitment is an interactional process between health care professionals, patients and carers. Little is known about how clinicians carry out this role in palliative care trials and the reasons why they do or do not recruit participants. AIMS To explore how clinicians recruit to palliative care trials, why they choose to implement particular recruitment strategies, and the factors that influence their choices. DESIGN A qualitative multiple case study of three UK palliative care trials. Data collection included interviews and study documentation. Analysis involved developing and refining theoretical propositions, guided by the '6Ps' of the 'Social Marketing Mix Framework' as an a priori framework (identifying participants, product, price, place, promotion and working with partners). Framework Analysis guided within and then cross-case analysis. SETTINGS/PARTICIPANTS Study investigators and research staff (n = 3, 9, 7) from trial coordinating centres and recruitment sites (hospice and hospital). RESULTS Cross-case analysis suggests the 'Social Marketing Mix Framework' is useful for understanding recruitment processes but wider contextual issues need to be incorporated. These include the 'emotional labour' of diagnosing dying and communicating palliative and end-of-life care to potential participants and how the recruitment process is influenced by the power relationships and hierarchies that exist among professional groups. These factors can lead to and support paternalistic practices. CONCLUSIONS Those planning trials need to ensure that trial recruiters, depending on their experience and trial characteristics, have access to training and support to address the 'emotional labour' of recruitment. The type of training required requires further research.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
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Parker D, Reymond L, Cooper K, Tieman J, Ivynian S. An evaluation of an online education programme to improve nurses' ability to support carers to use subcutaneous medicines. Int J Palliat Nurs 2023; 29:538-546. [PMID: 38039121 DOI: 10.12968/ijpn.2023.29.11.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Most Australians say they wish to die at home, but many are admitted to inpatient facilities for symptom management. Caring@home resources can be used to support informal carers to manage breakthrough symptoms safely using subcutaneous medicines. Nurses require education about how to teach informal carers to use these resources. AIM To evaluate the effectiveness and relevance of an online education programme for registered nurses (RNs) about using the caring@home resources. METHODS Nurses must complete an online survey prior to the commencement of the online education programme and again upon completion to assess their change in skills, knowledge, confidence and attitudes of the RNs. T-tests were conducted to compare average pre- and post-education scores. FINDINGS The knowledge, skills and confidence of RNs to teach carers improved significantly following the completion of an education programme. There was a significant change in attitude, meaning that the perceived benefit of teaching informal carers to give subcutaneous medicines improved. All reported they would use the resources in their clinical practice. CONCLUSION The online education programme is an effective and cost-efficient strategy to educate nurses to support informal carers to help manage breakthrough symptoms using subcutaneous medicines.
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Affiliation(s)
- Deborah Parker
- Professor of Nursing Aged Care (Dementia); Co-Director of the Ageing Research Collaborative, University of Technology Sydney
| | - Liz Reymond
- Director of Queensland Voluntary Assisted Dying Support and Pharmacy Service; Co-director of the Statewide Office of Advance Care Planning and of the Queensland-wide PallConsult service; Brisbane South Palliative Care Collaborative; Griffith University School of Medicine, Gold Coast Campus
| | - Karen Cooper
- Project Manager; Brisbane South Palliative Care Collaborative
| | - Jennifer Tieman
- Matthew Flinders Fellow; Director of the Research Centre in Palliative Care, Death and Dying (RePaDD), Director of CareSearch Research Centre for Palliative Care, Death and Dying, Flinders University
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Verma S, Hingwala J, Low JTS, Patel AA, Verma M, Bremner S, Haddadin Y, Shinall MC, Komenda P, Ufere NN. Palliative clinical trials in advanced chronic liver disease: Challenges and opportunities. J Hepatol 2023; 79:1236-1253. [PMID: 37419393 DOI: 10.1016/j.jhep.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
Patients with advanced chronic liver disease have a complex symptom burden and many are not candidates for curative therapy. Despite this, provision of palliative interventions remains woefully inadequate, with an insufficient evidence base being a contributory factor. Designing and conducting palliative interventional trials in advanced chronic liver disease remains challenging for a multitude of reasons. In this manuscript we review past and ongoing palliative interventional trials. We identify barriers and facilitators and offer guidance on addressing these challenges. We hope that this will reduce the inequity in palliative care provision in advanced chronic liver disease.
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Affiliation(s)
- Sumita Verma
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
| | - Jay Hingwala
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arpan A Patel
- Division of Digestive Diseases, University of California, Los Angeles, USA; Department of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Stephen Bremner
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Yazan Haddadin
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Paul Komenda
- University of Manitoba, Winnipeg, Manitoba, Canada
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Gibson Watt T, Gillanders D, Spiller JA, Finucane AM. Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. Palliat Med 2023; 37:1100-1128. [PMID: 37489074 PMCID: PMC10503261 DOI: 10.1177/02692163231183101] [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] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.
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Affiliation(s)
- Tilly Gibson Watt
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - David Gillanders
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Juliet A Spiller
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
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23
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Skedsmo K, Nes AAG, Stenseth HV, Hofsø K, Larsen MH, Hilderson D, Smis D, Hagelin CL, Olaussen C, Solberg MT, Bingen HM, Ølnes MA, Steindal SA. Simulation-based learning in palliative care in postgraduate nursing education: a scoping review. BMC Palliat Care 2023; 22:30. [PMID: 36991463 DOI: 10.1186/s12904-023-01149-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education. METHODS The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework. RESULTS This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice. CONCLUSIONS The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.
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Affiliation(s)
- Karoline Skedsmo
- Lovisenberg Diaconal University College, Lovisenberggt. 15B, 0456, Oslo, Norway.
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway.
| | | | | | - Kristin Hofsø
- Lovisenberg Diaconal University College, Lovisenberggt. 15B, 0456, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Carina Lundh Hagelin
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Olaussen
- Lovisenberg Diaconal University College, Lovisenberggt. 15B, 0456, Oslo, Norway
| | | | | | - Mia Alexandra Ølnes
- Lovisenberg Diaconal University College, Lovisenberggt. 15B, 0456, Oslo, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt. 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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24
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Müller A, Paul A, Best J, Kunkel S, Voltz R, Strupp J. "My everyday life has returned to normal"- Experiences of patients and relatives with a palliative day care clinic: a qualitative evaluation study. BMC Palliat Care 2023; 22:26. [PMID: 36927777 PMCID: PMC10020068 DOI: 10.1186/s12904-023-01140-5] [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: 07/04/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Palliative day care clinics (PDCCs) complement inpatient and home palliative care and provide access to a range of multi-professional services. However, they are not part of standard care in Germany. Yet, international studies show that PDCCs have a positive impact on e.g. quality of life. To evaluate one of the first PDCCs in Germany (Aschaffenburg-Alzenau (PDCC-AA)) by describing the experiences, satisfaction, challenges, wishes of patients and relatives and possible alternatives to treatment in the PDCC. METHODS Qualitative study using semi-structured telephone interviews. Data was analyzed using qualitative structuring content analysis according to Kuckartz with deductive a priori categories and inductive subcategories. RESULTS A total of 31 patients and 38 relatives completed telephone interviews. The majority of patients were diagnosed with a cancer or tumor disease. The following four main themes emerged: (1) alternatives to treatment at the PDCC, (2) symptom relief, (3) sense of security, (4) "everyday life framing" (normality of everyday life). Participants valued the medical treatment (especially for pain), psychosocial support given and having direct access to a range of services (e.g., wound care and pleural drainage), while relatives valued being provided respite services. A sense of security, availability of therapies, and devoted time that healthcare providers spent to explain e.g., treatment options were mentioned most positively, as well as confidence in dealing with the illness. As to whether there was an alternative to treatment in the PDCC, some saw further inpatient stays, the emergency room or care by general practitioners as options (although not preferred). Patients expressed concern that they were not treated and informed according to their needs in other care settings. CONCLUSIONS PDCCs may close a gap between inpatient and home palliative care. Participants mentioned that hospital stays can be delayed or even prevented.
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Affiliation(s)
- Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Alfred Paul
- Clinical Center Aschaffenburg-Alzenau, Alzenau, Germany
| | - Johannes Best
- Clinical Center Aschaffenburg-Alzenau, Alzenau, Germany
| | | | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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25
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Kistemaker KRJ, de Graeff A, Crul M, de Klerk G, van de Ven PM, van der Meulen MP, van Zuylen L, Steegers MAH. Magnesium hydroxide versus macrogol/electrolytes in the prevention of opioid-induced constipation in incurable cancer patients: study protocol for an open-label, randomized controlled trial (the OMAMA study). BMC Palliat Care 2023; 22:22. [PMID: 36915062 PMCID: PMC10012532 DOI: 10.1186/s12904-023-01143-2] [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: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Opioid-induced constipation (OIC) is a common symptom in cancer patients treated with opioids with a prevalence of up to 59%. International guidelines recommend standard laxatives such as macrogol/electrolytes and magnesium hydroxide to prevent OIC, although evidence from randomized controlled trials is largely lacking. The aim of our study is to compare magnesium hydroxide with macrogol /electrolytes in the prevention of OIC in patients with incurable cancer and to compare side-effects, tolerability and cost-effectiveness. METHODS Our study is an open-label, randomized, multicenter study to examine if magnesium hydroxide is non-inferior to macrogol/electrolytes in the prevention of OIC. In total, 330 patients with incurable cancer, starting with opioids for pain management, will be randomized to treatment with either macrogol/electrolytes or magnesium hydroxide. The primary outcome measure is the proportion of patients with a score of < 30 on the Bowel Function Index (BFI), measured on day 14. The Rome IV criteria for constipation, side effects of and satisfaction with laxatives, pain scores, quality of life (using the EQ-5D-5L), daily use of laxatives and escape medication, and cost-effectiveness will also be assessed. DISCUSSION In this study we aim to examine if magnesium hydroxide is non-inferior to macrogol/electrolytes in the prevention of OIC. The outcome of our study will contribute to prevention of OIC and scientific evidence of guidelines on (opioid-induced) constipation. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov: NCT05216328 and in the Dutch trial register: NTR80508. EudraCT number 2022-000408-36.
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Affiliation(s)
- K R J Kistemaker
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Oncology, De Boelelaan 1117, Amsterdam, The Netherlands. .,Amsterdam UMC Location Vrije Universiteit Amsterdam, Anesthesiology, De Boelelaan 1117, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - A de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Academic Hospice Demeter, De Bilt, The Netherlands
| | - M Crul
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Clinical Pharmacology and Pharmacy, De Boelelaan 1117, Amsterdam, The Netherlands
| | - G de Klerk
- Spaarne Gasthuis Location Hoofddorp, Medical Oncology, Spaarnepoort 1, Hoofddorp, The Netherlands
| | - P M van de Ven
- Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P van der Meulen
- Department of Epidemiology and Health Economics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L van Zuylen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Oncology, De Boelelaan 1117, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M A H Steegers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Anesthesiology, De Boelelaan 1117, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
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Adams A, Miller-Lewis L, Tieman J. Learning Designers as Expert Evaluators of Usability: Understanding Their Potential Contribution to Improving the Universality of Interface Design for Health Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4608. [PMID: 36901617 PMCID: PMC10001568 DOI: 10.3390/ijerph20054608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
User-based evaluation by end users is an essential step in designing useful interfaces. Inspection methods can offer an alternate approach when end-user recruitment is problematic. A Learning Designers' usability scholarship could offer usability evaluation expertise adjunct to multidisciplinary teams in academic settings. The feasibility of Learning Designers as 'expert evaluators' is assessed within this study. Two groups, healthcare professionals and Learning Designers, applied a hybrid evaluation method to generate usability feedback from a palliative care toolkit prototype. Expert data were compared to end-user errors detected from usability testing. Interface errors were categorised, meta-aggregated and severity calculated. The analysis found that reviewers detected N = 333 errors, with N = 167 uniquely occurring within the interface. Learning Designers identified errors at greater frequencies (60.66% total interface errors, mean (M) = 28.86 per expert) than other evaluator groups (healthcare professionals 23.12%, M = 19.25 and end users 16.22%, M = 9.0). Patterns in severity and error types were also observed between reviewer groups. The findings suggest that Learning Designers are skilled in detecting interface errors, which benefits developers assessing usability when access to end users is limited. Whilst not offering rich narrative feedback generated by user-based evaluations, Learning Designers complement healthcare professionals' content-specific knowledge as a 'composite expert reviewer' with the ability to generate meaningful feedback to shape digital health interfaces.
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Affiliation(s)
- Amanda Adams
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
| | - Lauren Miller-Lewis
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Wayville, Adelaide, SA 5034, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
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27
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Razak O A, Yang SY, Cho MS, Min BS, Han YD. Palliative surgery as a bridge to systemic treatment for malignant bowel obstruction due to peritoneal metastases: A retrospective, case-control study. Asian J Surg 2023; 46:160-165. [PMID: 35260331 DOI: 10.1016/j.asjsur.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High-quality data on palliative surgery in patients with malignant bowel obstruction (MBO) caused by peritoneal metastases (PM) are lacking. We aimed to determine the utility of palliative surgery for such patients. METHODS We retrospectively analyzed patients considered for surgery for MBO, caused by PM, in our department from January 2019 to October 2020. None of them could tolerate a diet, despite conservative treatment. We investigated the clinical characteristics and perioperative outcomes and calculated overall survival (OS). Kaplan-Meier survival analysis was performed, with the log-rank test to evaluate differences in OS rates. Multivariate Cox regression was performed to determine prognostic factors. RESULTS Sixty (67%) patients underwent surgery, whereas, 30 (33%) received the best supportive care (BSC) treatment. A better (p = 0.002) median OS was observed in patients undergoing surgery (3.9 months) than in those receiving BSC (2.6 months). Severe complications were observed in 12 (20%) patients, including 30-day mortality (7 patients). Forty-eight (80%) patients in the surgery group could tolerate a diet and the hospital stay (mean ± standard deviation) was 20.0 ± 23.1 days. Re-obstruction was observed in five (8.3%) patients after 78.6 ± 63.3 days. Patients in the postoperative chemotherapy group exhibited a better (p < 0.001) median OS (12.3 months) than did those in the no-postoperative chemotherapy group (3.5 months). Only postoperative chemotherapy (hazard ratio 0.264, 95% confidence interval 0.143-0.487, p < 0.001) was identified as an independent prognostic factor. CONCLUSIONS Compared with BSC, surgery is associated with a better OS in patients with MBO due to PM. Surgery should be considered as a bridge to systemic treatment for such patients.
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Affiliation(s)
| | - Seung Yoon Yang
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Jakobsen G, Sjue K, Paulsen Ø, Kaasa S, Hjermstad MJ, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Support Care Cancer 2023; 31:60. [PMID: 36534165 PMCID: PMC9763131 DOI: 10.1007/s00520-022-07537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. METHODS A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). RESULTS Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). CONCLUSION Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807922.
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Affiliation(s)
- Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), and Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- Institute of Clinical Medicine, European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, University of Oslo, Oslo, Norway, and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway, and European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Salins N, Hughes S, Preston N. Presuppositions, cost–benefit, collaboration, and competency impacts palliative care referral in paediatric oncology: a qualitative study. Palliat Care 2022; 21:215. [DOI: 10.1186/s12904-022-01105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
Although a significant proportion of children with cancer need palliative care, few are referred or referred late, with oncologists and haematologists gatekeeping the referral process. We aimed to explore the facilitators and barriers to palliative care referral.
Methods
Twenty-two paediatric oncologists and haematologists were purposively recruited and interviewed. Data were analysed using reflexive thematic analysis. Findings were interpreted using the critical realist paradigm.
Results
Four themes were generated. 1) Oncologists expressed concern about the competency of palliative care teams. Palliative care often symbolised therapeutic failure and abandonment, which hindered referral. Trustworthy palliative care providers had clinical competence, benevolence, and knowledge of oncology and paediatrics. 2) Making a palliative care referral was associated with stigma, navigating illness-related factors, negative family attitudes and limited resources, impeding palliative care referral. 3) There were benefits to palliative care referral, including symptom management and psychosocial support for patients. However, some could see interactions with the palliative care team as interference hindering future referrals. 4) Suggested strategies for developing an integrated palliative care model include evident collaboration between oncology and palliative care, early referral, rebranding palliative care as symptom control and an accessible, knowledgeable, and proactive palliative care team.
Conclusion
Presuppositions about palliative care, the task of making a referral, and its cost-benefits influenced referral behaviour. Early association with an efficient rebranded palliative care team might enhance integration.
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van Esch HJ, Stoppelenburg A, van Zuylen L, van der Rijt CC, van der Heide A. When a dying patient is asked to participate in a double-blind, placebo-controlled clinical trial on symptom control: The decision-making process and experiences of relatives. Palliat Med 2022; 36:1552-1558. [PMID: 36503315 PMCID: PMC9749009 DOI: 10.1177/02692163221127557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Placebo-controlled trials can provide evidence to inform end-of-life care, but it is contested whether asking dying patients to participate in such trials is morally justifiable. To investigate the experiences of these patients is even more complex. Therefore, proxy assessments by relatives can be a good alternative. AIM To explore the experience of participating in a placebo-controlled trial at the end of life from the perspective of bereaved relatives. DESIGN Mixed-method study, including questionnaires and interviews. SETTING/PARTICIPANTS The SILENCE study was a randomized, double-blind, placebo-controlled trial on the efficacy of scopolamine butylbromide to prevent death rattle. The study was performed in six inpatient hospice facilities. Patients were asked to participate at admission in the hospice. Three months after the death of the patient, bereaved relatives were invited to fill in a questionnaire and to participate in an interview. One hundred four questionnaires were completed and 17 relatives were interviewed. RESULTS Fourteen percent of the relatives participating in the questionnaire study considered the participation of their loved one in research a bit burdensome and 10% considered it a bit stressful. Seventeen percent thought that it was a bit burdensome for the patient. Eighty-three percent considered participation in this type of research (very) valuable. The in-depth interviews showed that patients and relatives jointly decided about participation in this double-blind placebo-controlled medication trial. Relatives generally respected and felt proud about patients' decision to participate. CONCLUSION The large majority of bereaved relatives experienced the participation of their dying love one in this RCT as acceptable and valuable.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Laurens Cadenza, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Centrum Amsterdam, Amsterdam, The Netherlands
| | - Carin Cd van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kremeike K, Bausewein C, Freytag A, Junghanss C, Marx G, Schnakenberg R, Schneider N, Schulz H, Wedding U, Voltz R. [DNVF Memorandum: Health Services Research in the Last Year of Life]. DAS GESUNDHEITSWESEN 2022. [PMID: 36220106 DOI: 10.1055/a-1889-4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This memorandum outlines current issues concerning health services research on seriously ill and dying people in the last year of their lives as well as support available for their relatives. Patients in the last phase of life can belong to different disease groups, they may have special characteristics (e. g., people with cognitive and complex impairments, economic disadvantage or migration background) and be in certain phases of life (e. g., parents of minor children, (old) age). The need for a designated memorandum on health services research in the last year of life results from the special situation of those affected and from the special features of health services in this phase of life. With reference to these special features, this memorandum describes methodological and ethical specifics as well as current issues in health services research and how these can be adequately addressed using quantitative, qualitative and mixed methods. It has been developed by the palliative medicine section of the German Network for Health Services Research (DNVF) according to the guidelines for DNVF memoranda.
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Affiliation(s)
- Kerstin Kremeike
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Junghanss
- Hämatologie, Onkologie und Palliativmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Gabriella Marx
- Institut und Poliklinik Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Holger Schulz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study. BMJ Open 2022. [PMCID: PMC9362824 DOI: 10.1136/bmjopen-2021-057229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families. Methods and analysis The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights. Ethics and dissemination The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying. Trial registration number NCT04271085.
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Winger JG, Kelleher SA, Fisher HM, Somers TJ, Samsa GP. Designing Psychosocial Intervention Pilot Studies: A Tutorial for Palliative Care Investigators. J Pain Symptom Manage 2022; 63:e749-e755. [PMID: 35235856 PMCID: PMC9133099 DOI: 10.1016/j.jpainsymman.2022.02.338] [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: 10/22/2021] [Revised: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 11/22/2022]
Abstract
This is a tutorial on designing a persuasive pilot study of a psychosocial intervention (e.g., behavioral symptom management) in the palliative care setting. This tutorial is most relevant for early stages of intervention research that aims to progress toward a randomized controlled trial with a high degree of internal validity. Broadly, a pilot study aims to address multiple elements of feasibility and acceptability so that investigators are well positioned for the next study in their program of research. To assist investigators in writing compelling grant applications we designed this tutorial as an annotated checklist of goals that a pilot study within the palliative care domain should seek to accomplish. These goals include the following: 1) begin with the end in mind, 2) use a formal conceptual model, 3) use measures with strong psychometric properties, 4) justify the timing of study sessions and assessments, 5) test recruitment methods, 6) estimate retention, 7) assess interventionist fidelity, 8) assess acceptability of the intervention, 9) assess feasibility, and 10) identify barriers to the next study. We elaborate on these goals by describing an ongoing pilot study testing the feasibility and acceptability of a psychosocial pain management intervention for patients with advanced cancer. Pilot studies are crucial for building a successful program of research, but they are also limited in terms of their sample size and overall objectives. A persuasive pilot study is one that is limited yet useful rather than limited and trivial.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA.
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Gregory P Samsa
- Duke Cancer Institute, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
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Macaden L, Broadfoot K, Carolan C, Muirhead K, Neylon S, Keen J. Last Aid Training Online: Participants’ and Facilitators’ Perceptions from a Mixed-Methods Study in Rural Scotland. Healthcare (Basel) 2022; 10:healthcare10050918. [PMID: 35628055 PMCID: PMC9141240 DOI: 10.3390/healthcare10050918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
(1) Background: Palliative and end-of-life care services are increasingly gaining centre stage in health and social care contexts in the UK and globally. Death and dying need are relational processes. Building personal and community capacity along with resilience is vital to support families and communities to normalise death and dying. Last Aid Training (LAT) is one such innovative educational initiative which teaches the general public about the fundamentals of palliative care and promotes public discussion about death and dying. The Highland Hospice [HH] in Scotland has pioneered delivery of LAT in face-to-face settings since March 2019 and online since March 2020 to accommodate pandemic restrictions. (2) Methods: This study used a mixed-methods approach, combining an online survey with LAT participants followed by individual semi-structured qualitative interviews with both LAT participants and facilitators. The primary aim of this study was to investigate the impacts of LAT for participants at the individual, family, and community levels, as well as explore participant and facilitator experiences and perspectives of LAT in an online environment. (3) Results: Overall, this evaluation demonstrates that provision of foundational death literacy education in social contexts enhances the personal knowledge, skills, and confidence of individual community members and supports the notion that this personal growth could lead to strengthened community action. (4) Conclusions: Findings from this study concluded that there is potential to include LAT as the foundational core training to promote death literacy in communities with further exploration to integrate/align LAT with other national/global end-of-life care frameworks.
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Affiliation(s)
- Leah Macaden
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
| | - Kirsten Broadfoot
- Sterena Consultancy, Cromarty IV11 8XA, UK; or
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Clare Carolan
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
- Correspondence:
| | - Kevin Muirhead
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
| | - Siobhan Neylon
- Highland Hospice, Inverness IV19 1AF, UK; (S.N.); (J.K.)
| | - Jeremy Keen
- Highland Hospice, Inverness IV19 1AF, UK; (S.N.); (J.K.)
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DeCamp M, Alasmar A, Fischer S, Kutner JS. Meeting ethical challenges with authenticity when engaging patients and families in end-of-life and palliative care research: a qualitative study. BMC Palliat Care 2022; 21:74. [PMID: 35578262 PMCID: PMC9108140 DOI: 10.1186/s12904-022-00964-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivering high quality, patient- and family-centered care depends upon high quality end-of-life and palliative care (EOLPC) research. Engaging patients and families as advisors, partners, or co-investigators throughout the research lifecycle is widely regarded as critical to ensuring high quality research. Engagement is not only an ethical obligation, it also raises ethical challenges of its own. We conducted a qualitative study to understand ethical challenges and potential solutions when engaging patients and families in EOLPC research. METHODS We recruited and interviewed 20 clinical investigators and 22 patients or family caregivers through the Palliative Care Research Cooperative Group (PCRC). Interview transcripts were analyzed using constructivist grounded theory methodology. Analysis sought to identify ethical challenges and potential solutions, as well as to synthesize findings into practical recommendations tailored to engaging patients and families in EOLPC research. RESULTS Our study identified 8 ethical challenges considered unique to the EOLPC research context and 11 potential solutions to these challenges. The most frequently described ethical challenges included the need to minimize burdens of engagement for patients and caregivers, challenges of dealing with death and illness, and paternalism or "gatekeeping" (i.e., withholding the opportunity to participate from patients or caregivers). Investigators and patients or family caregivers conceptualized ethics challenges differently; several issues appeared to fall outside a traditional research ethics paradigm and more into the ethics of relationships. We synthesized these findings into 4 practical recommendations hypothesized to support authentic engagement. CONCLUSIONS Engaging patients and families in EOLPC research can raise unique ethical challenges. These challenges can be overcome to empower participation, minimize the unique burdens of EOLPC, and promote diversity. Whereas traditional research ethics tend to emphasize protecting research participants who may be vulnerable, an ethics approach based on authentic engagement that explores what it means for investigators and patients or family caregivers to be in a relationship may be needed. Future research is needed to explore this approach and test these recommendations in practice.
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Affiliation(s)
- Matthew DeCamp
- Center for Bioethics and Humanities and Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 13080 E. 19th Ave, Mail Stop B137, Aurora, CO, 80045, USA.
| | - Ahmed Alasmar
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Stacy Fischer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
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Nagla A, Le B, White C, V Kiburg K, Philip J. Attitudes of Palliative Care Practitioners Towards Enrolling Patients in Clinical Trials. J Palliat Care 2022; 37:447-455. [PMID: 35546098 DOI: 10.1177/08258597211063057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Recruitment of participants for clinical trials remains a key consideration for investigators. This is particularly relevant in palliative care, where practitioners are sometimes reluctant to refer patients for consideration of enrolment. Reasons for this reluctance range from concerns about excessive burden to patients, through to debate about the appropriateness of undertaking trials in the palliative care setting. Aim: The aim of this study was (1) to explore palliative care practitioners' attitudes and views of clinical trials, (2) to compare these findings with those of a similar survey undertaken more than a decade earlier, and (3) to explore predictors associated with key concepts of interest associated with clinical trials. Design: The palliative care clinician's attitudes to clinical research survey undertaken in 2007 formed the basis of a repeat survey conducted in 2019. Setting/Participants: Australian and New Zealand palliative care practitioners were surveyed. Results: Surveys were completed by 135 palliative care practitioners. Comparing results of the current study and those findings of more than a decade earlier revealed that attitudes have either not substantially changed or indeed in some areas have become less accepting of clinical trials. This is despite the dramatic increase in the volume of research carried out within palliative care over the last decade. Conclusion: Our survey suggests that the reasons for engagement in research are complex and likely to differ according to local conditions. Careful attention to understanding of the local environment and particularly the attitudes of local practitioners is likely to be essential to be successful in this endeavour.
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Affiliation(s)
- Ahmed Nagla
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Clare White
- Northern Ireland Hospice, Belfast, Northern Ireland and Belfast Health and Social Care Trust
| | | | - Jennifer Philip
- Peter MacCallum Cancer Centre, Melbourne, Australia.,St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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van Esch HJ, Prins SD, van de Vathorst S, van der Rijt CCD, van der Heide A, van Zuylen L. Reflections on Including Patients in a Randomized Placebo-Controlled Multicentre Trial in the Dying Phase - the SILENCE Study. J Pain Symptom Manage 2022; 63:e545-e552. [PMID: 34954069 DOI: 10.1016/j.jpainsymman.2021.12.018] [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: 10/11/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
A need exists for studies investigating symptom relief at the end of life. Randomised controlled trials (RCTs) are the gold standard for demonstrating efficacy of medication, but they are difficult to perform at the end of life due to barriers such as the vulnerability of patients, and gatekeeping by healthcare professionals. We analyzed and reflected on recruitment, participation, and strategies used in an RCT at the end of life. The SILENCE study, performed in six inpatient hospice facilities, was a placebo-controlled trial to study the effect of ScopolamIne butyLbromidE giveN prophylactiCally for dEath rattle in dying patients. We addressed patients' vulnerability by using an advance consent procedure, and potential gatekeeping by extensive training of health care professionals and the appointment of hospice doctors as daily responsible researchers. In almost three years, 1097 patients were admitted of whom 626 were eligible at first assessment. Of these, 119 (19%) dropped out because of physical deterioration before they could be informed about the study (44) or sign informed consent (75). Twenty-five (4%) patients were not asked to participate. In 24 cases (4%), relatives advised against the patient participating. Overall, 229 patients (37%) gave informed consent to participate. The vulnerability of patients was the most important barrier in this medication study at the end of life. Gatekeeping by HCPs and relatives occurred in a small number of patients. The robust design and applied strategies to facilitate patient recruitment in this study resulted in a successful study with sufficient participants.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Laurens Cadenza, Oosterhagen 239, 3078 CL Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Sanne D Prins
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Suzanne van de Vathorst
- Department of Medical ethics,philosophy and history, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC, Amsterdam University Medical Centers, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands
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Hanrahan V, Biesty L, Lawrie L, Duncan E, Gillies K. Theory-guided interviews identified behavioral barriers and enablers to healthcare professionals recruiting participants to maternity trials. J Clin Epidemiol 2022; 145:81-91. [PMID: 35081447 DOI: 10.1016/j.jclinepi.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 01/18/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To conduct a behavioral investigation, using the Theoretical Domains Framework (TDF), to identify barriers and enablers to maternity healthcare professionals (HCP) inviting all eligible women to participate in a maternity care trial. STUDY DESIGN AND SETTING We invited HCP recruiters from maternity care trials in high priority research areas including, diabetes, preeclampsia and breastfeeding, from across Ireland and the UK, to take part in a semi-structured interview. Data collection was informed by the TDF, followed by inductive thematic analysis and deductive mapping to the TDF. RESULTS Twenty-two recruiters including midwives, nurses, allied health professionals and doctors were interviewed online or by telephone phone. Thematic analysis generated four global themes; Availability and accessibility of resources, Navigating the recruitment pathway, Prioritising clinical responsibilities over research responsibilities and The influence of colleagues and peers. Themes were mapped to the TDF, identifying 13 domains relevant to the behaviour. CONCLUSION This paper identifies the factors enabling or inhibiting maternity HCP recruiters to invite all eligible women to participate in a maternity care trial. The findings provide guidance for researchers designing trials for this population and the essential first step in developing a recruiter-focused behaviour change intervention to support recruitment to trials in maternity care.
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Affiliation(s)
- Vivienne Hanrahan
- School of Nursing and Midwifery, National University of Ireland, Galway, Áras Moyola, Upper Newcastle, Galway, Ireland; Health Research Board - Trial Methodology Research Network, Áras Moyola, NUI Galway, University Road, Galway, Ireland.
| | - Linda Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Áras Moyola, Upper Newcastle, Galway, Ireland
| | - Louisa Lawrie
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [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: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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Nysæter TM, Olsson C, Sandsdalen T, Wilde-Larsson B, Hov R, Larsson M. Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study. Palliat Care 2022; 21:49. [PMID: 35410199 PMCID: PMC9004171 DOI: 10.1186/s12904-022-00939-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The wish to be cared for and to die at home is common among people with end-stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase. METHODS A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n = 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously. RESULTS The findings are presented as a conceptual model of patients' preferences for care to enable home death. The core category "Hope and trust to get the care I need to die at home" showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories "being in the present", "be safe and in charge" and "be seen and acknowledged" describe the patients' preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: "reliable, compassionate and competent healthcare personnel" and "timely, predictive, continuous and adaptive organisation". CONCLUSION An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person-centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person-centred care model and the use of advanced home care plans with continued re-evaluation for patients' preferences of home care were proposed measures to enable home death.
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Affiliation(s)
- Toril Merete Nysæter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway. .,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.,Department of Bachelor Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway
| | - Bodil Wilde-Larsson
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Elverum, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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Yazdani N, Chartrand J, Stacey D. Exploring Parental Decision Making for a Child With a Life-Limiting Condition: An Interpretive Description Study. J Hosp Palliat Nurs 2022; 24:140-146. [PMID: 35026800 DOI: 10.1097/njh.0000000000000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore parents' and health care professionals' perception of parents' experiences in making decisions between acute and palliative therapies along the trajectory of their child's life-limiting condition. An interpretive description qualitative study was conducted. Semistructured interviews were completed with 6 parents and 6 health care professionals. Qualitative thematic analysis was used to identify, analyze, and report 4 themes: (1) "Going by your heart and gut": the process of making a unique decision; (2) "Not black and white": experiencing decisional conflict when making difficult decisions; (3) "Widening the circle of care": various sources of decision-making support; and (4) "Always a worry": concerns regarding parents' decision quality and outcomes. Parents described experiencing decisional conflict when making health care decisions for their child with a life-limiting condition. Decision support provided by health care professionals in an interprofessional manner was preferred and supplemented by a parent-based support network. Reassurance regarding their good parenting from health care professionals was described as supportive throughout the decision-making experience.
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Brickey J, Flannery M, Cuthel A, Cho J, Grudzen CR. Barriers to recruitment into emergency department-initiated palliative care: a sub-study of a multi-site, randomized controlled trial. BMC Palliat Care 2022; 21:22. [PMID: 35168622 PMCID: PMC8845365 DOI: 10.1186/s12904-021-00899-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. This descriptive analysis explores the barriers to enrolling seriously ill patients scheduled for discharge from the ED into palliative care research. METHODS This descriptive sub-study aims to assess the reasons why patients with advanced illness scheduled for discharge home from 11 EDs across the United States decline to participate in Emergency Medicine Palliative Care Access (EMPallA), a Phase IV randomized controlled trial (RCT) comparing two modes of palliative care delivery. Our aim was to understand why patients decline to enroll to improve future recruitment rates and expand care for patients discharged home from the ED. Research coordinators documented reasons that patients declined to enroll in the larger EMPallA trial; reasons for refusing participation were independently analyzed by two researchers to identify overarching themes. RESULTS Enrollment rate across all sites was 45%; of the 504 eligible patients who declined participation, 47% (n = 237) declined for reasons related to illness severity. 28% of refusals (n = 143) were related to the mode of palliative care delivery, while 24% (n = 123) were due to misconceptions or stigma related to palliative care. Less commonly, patients refused due to general research barriers (16.5%), family/caregiver barriers (11.7%), and physician-related barriers (< 1%). CONCLUSIONS Patients with advanced illnesses presenting to the ED often refuse to participate in palliative care research due to the severity of their illness, the mode of care delivery, and misconceptions about palliative care. In contrast with other studies, our study found minimal physician gatekeeping, which may be the result of both changing attitudes toward palliative care and the nature of the ED setting. Robust training programs are crucial to overcome these misconceptions and to educate patients and providers about the role of palliative care. Future palliative care programs and study designs should recognize the burden this vulnerable population endures and consider alternative modes of care delivery in an effort to increase participation and enrollment. CLINICAL TRIALS REGISTRATION NCT03325985 , October 30, 2017.
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Affiliation(s)
- Julia Brickey
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
| | - Allison Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA.
| | - Jeanne Cho
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
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LeBaron V, Alam R, Bennett R, Blackhall L, Gordon K, Hayes J, Homdee N, Jones R, Lichti K, Martinez Y, Mohammadi S, Ogunjirin E, Patel N, Lach J. Deploying the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system to support patients and family caregivers in managing pain: A feasibility and acceptability study. (Preprint). JMIR Cancer 2022; 8:e36879. [PMID: 35943791 PMCID: PMC9399893 DOI: 10.2196/36879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/03/2023] Open
Abstract
Background Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective This study aimed to test the feasibility and acceptability of a smart health sensing system—Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)—that was designed to support the monitoring and management of cancer pain in the home setting. Methods Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners’ perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our “BESI-C Performance Scoring Instrument,” the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID) RR2-10.2196/16178
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ridwan Alam
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Rachel Bennett
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kate Gordon
- Virginia Commonwealth University Health, Richmond, VA, United States
| | - James Hayes
- Trident Systems, Inc, Fairfax, VA, United States
| | - Nutta Homdee
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Randy Jones
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Kathleen Lichti
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Yudel Martinez
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Sahar Mohammadi
- Penn Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Nyota Patel
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, United States
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van Esch HJ, van Zuylen L, van der Rijt CCD. Prophylactic Scopolamine Butylbromide and Death Rattle in Patients at the End of Life-Reply. JAMA 2022; 327:285-286. [PMID: 35040890 DOI: 10.1001/jama.2021.21863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Harriette J van Esch
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings SA, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for HIV cure-related research at the end-of-life: a qualitative interview and focus group study in the United States. BMC Med Ethics 2022; 23:2. [PMID: 35012544 PMCID: PMC8748179 DOI: 10.1186/s12910-022-00741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND One of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it. METHODS We conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable. RESULTS All four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants' comfort and needs at the EOL. CONCLUSION Because of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research's impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Sara Gianella
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, 220 Dickson Street, Suite B, San Diego, CA USA
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Christopher Christensen
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Stephen A. Rawlings
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Susan Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, 3333 14th Street, Riverside, CA USA
| | - Davey Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
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Palliative and end-of-life care in primary care during the COVID-19 pandemic and beyond. Br J Gen Pract 2021; 72:6-7. [PMID: 34972792 PMCID: PMC8714522 DOI: 10.3399/bjgp22x718025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Suzuki K, Ikari T, Matsunuma R, Matsuda Y, Matsumoto Y, Miwa S, Mori M, Yamaguchi T, Watanabe H, Tanaka K. The Possibility of Conducting a Clinical Trial on Palliative Care: A Survey of Whether a Clinical Study on Cancer Dyspnea Is Acceptable to Cancer Patients and Their Relatives. J Pain Symptom Manage 2021; 62:1262-1272. [PMID: 34058319 DOI: 10.1016/j.jpainsymman.2021.05.012] [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: 03/16/2021] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Conducting randomized controlled trials on palliative care is difficult owing to barriers like fragility of the patients' health status and health care providers' concerns for patients. However, quality randomized controlled trials are required for care improvement. OBJECTIVES To investigate the willingness of cancer patients and their relatives to participate in a clinical study on cancer dyspnea and identify feasible clinical study designs for this condition. METHODS A nationwide, cross-sectional, web-based survey was conducted with 206 cancer patients and 206 relatives of cancer patients. Their willingness to participate in clinical studies on cancer dyspnea and factors influencing this willingness were assessed in two scenarios: outpatients receiving anticancer treatment and terminally ill inpatients. RESULTS About 23% patients and 23% relatives were willing to participate in clinical trials while 40% and 32%, respectively, were unwilling. Factors related to patient participation were quick and easy trials (outpatient 57%, terminally ill 53%) and oral medication with minimal potential side effects (outpatient 48%). Factors related to unwillingness to participate were placebo-controlled trials (outpatient 51%, terminally ill 50%), disagreements about participation between patients and families (outpatient 49%, terminally ill 49%), and continuous injections (outpatient 61%, terminally ill 47%). Compared to patients, relatives responded more reluctantly, especially for patients in terminal care. Conversely, patients were less reluctant in the terminal setting than the outpatient setting. CONCLUSION Some patients and relatives were reluctant to participate in clinical trials on cancer dyspnea. Thus, trials need to be minimally invasive, quick, and fully explained to and understood by patients and families.
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Affiliation(s)
- Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital (K.S., K.T.), Tokyo, Japan.
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine (T.I.), Sendai, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine (R.M.), Kobe, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center (Y.M.), Sakai, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East (Y.M.), Kashiwa, Japan
| | - Satoru Miwa
- Seirei Hospice, Seirei Mikatahara General Hospital (S.M.), Hamamatsu, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital (M.M.), Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital (T.Y.), Kobe, Japan
| | | | - Keiko Tanaka
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital (K.S., K.T.), Tokyo, Japan
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Bosisio F, Sterie AC, Rubli Truchard E, Jox RJ. Implementing advance care planning in early dementia care: results and insights from a pilot interventional trial. BMC Geriatr 2021; 21:573. [PMID: 34666711 PMCID: PMC8524211 DOI: 10.1186/s12877-021-02529-8] [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: 04/01/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is particularly appropriate for persons with early dementia (PWED) since it promotes conversations about dementia-specific illness scenarios, addresses inconsistencies between advance directives and patients' observed behavior, emphasizes prospective and relational autonomy, and may be generally consistent with older persons' decision-making needs. However, despite evidence of its benefits, ACP is yet to become widely used among PWED. In this paper, we present a dementia-specific tool developed in Western Switzerland, discuss results of a pilot trial designed to promote ACP among PWED and their relatives, and discuss the feasibility and acceptability of the intervention and the study protocol in prevision of a large scale trial. METHODS This one-arm pre-post pilot trial consisted of four visits, with visits 2 and 3 being the ACP intervention. Quantitative outcome measures during visit 1 and 4 assessed the aptitude of the intervention to support PWED autonomy and relatives' knowledge of PWED's preferences. Feasibility was explored according to how the recruitment procedure unfurled and based on the necessary revisions to the study protocol and healthcare providers' reason for excluding a PWED from the study. Acceptability was assessed according to pre-post evaluations, difficulties regarding the intervention or trial participation, and pre-post qualitative interviews regarding participants' reasons to participate to the study, satisfaction with the tool and difficulties perceived. RESULTS The ACP intervention itself was well received by PWED and their relatives that expressed satisfaction with the procedure, especially regarding the opportunity to discuss a sensitive topic with the help of a facilitator. Five main challenges in terms of feasibility were 1) to locate eligible patients, 2) to tailor recruitment procedures to recruitment locations, 3) to adapt inclusion criteria to clinical routines, 4) to engage PWED and their relatives in ACP, and 5) to design a trial that does not burden PWED. Despite these challenges, the intervention increased the number of advance directives, the concordance between PWED's preferences and relatives' decision on their behalf, and relatives' perceived control over healthcare decisions. CONCLUSION Misconceptions about dementia and ACP, in the patient, relatives, and healthcare providers, combined with structural and institutional challenges, have the power to impede research and implementation of ACP in dementia care. For this reason, we conclude that a large scale trial to test a dementia-specific tool of ACP is currently not feasible in Western Switzerland and should be endorsed in a systemic approach of ACP. TRIAL REGISTRATION This trial was registered in the database clinicaltrial.gov with the number NCT03615027 .
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Affiliation(s)
- Francesca Bosisio
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland. .,Service of Palliative and Supportive Care, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland. .,Chair of Geriatric Palliative Care, Lausanne University Hospital and Lausanne University, Hôpital Nestlé, Lausanne, Switzerland.
| | - Anca-Cristina Sterie
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Service of Palliative and Supportive Care, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Chair of Geriatric Palliative Care, Lausanne University Hospital and Lausanne University, Hôpital Nestlé, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Chair of Geriatric Palliative Care, Lausanne University Hospital and Lausanne University, Hôpital Nestlé, Lausanne, Switzerland
| | - Ralf J Jox
- Service of Palliative and Supportive Care, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Chair of Geriatric Palliative Care, Lausanne University Hospital and Lausanne University, Hôpital Nestlé, Lausanne, Switzerland.,Institute of Humanities in Medicine, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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Aspden T, Armstrong M, Serfaty M. Views of healthcare professionals on recruiting to a psychosocial randomised controlled trial: a qualitative study. BMC Health Serv Res 2021; 21:837. [PMID: 34407826 PMCID: PMC8371878 DOI: 10.1186/s12913-021-06817-2] [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: 11/21/2020] [Accepted: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Randomised controlled trials, and in particular those of psychosocial interventions, often fail to recruit to target, resulting in underpowered trials with poor generalisability of findings. The objectives of this study were to explore the views of healthcare professionals on recruiting to psychosocial research studies, and to explore their views on factors that may hinder or facilitate recruitment. METHODS We conducted 14 semi-structured interviews, with healthcare professionals who had been involved in recruitment into a randomised controlled trial of a talking therapy for depression in patients with advanced cancer. Interviews were transcribed and analysed using thematic analysis. RESULTS Five primary themes were identified, comprised of 11 subthemes. Attitudes towards research were largely positive. Health care professionals identified lack of time and narrow screening criteria as barriers to recruitment, and also noted the tendency to withhold participants from research for reasons other than eligibility (e.g., gatekeeping). The engagement of the study team with the clinical recruitment site, and the frequent presence of a researcher in clinics, were noted as facilitating recruitment. CONCLUSIONS Healthcare professionals involved in recruiting to trials of psychosocial interventions hold generally positive views of psychosocial research. However, they report that constraints including space and time limit their ability to recruit, and express anxieties about approaching patients for trial recruitment in the palliative phase of their illness. The findings from this study can inform how best to design trials, and in particular trials of psychosocial interventions, and train health care professionals for the study, to maximise recruitment.
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Affiliation(s)
- Trefor Aspden
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Megan Armstrong
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Marc Serfaty
- Division of Psychiatry, University College London, London, W1T 7NF, UK.
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Weaver MS, Wiener L, Moon MM, Gordon B, Kelly KP, Hinds PS. Family Caregiver Partnerships in Palliative Care Research Design and Implementation. Pediatrics 2021; 148:peds.2020-049403. [PMID: 34103377 PMCID: PMC8276591 DOI: 10.1542/peds.2020-049403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Meaghann S. Weaver
- Division of Palliative Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, Nebraska,National Center for Ethics in Healthcare, Washington, District of Columbia
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michelle M. Moon
- Parent, Division of Hospice and Palliative Medicine, Department of Internal Medicine, School of Medicine, University of Nevada, Reno, Nevada
| | - Bruce Gordon
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Katherine Patterson Kelly
- Department of Nursing Science, Professional Practice and Quality, Children's National Hospital and Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Hospital and Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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