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Moniz T, Melro C, Watling C. In many voices: exploring end-of-life care through patient, caregiver and physician narratives. MEDICAL HUMANITIES 2024:medhum-2024-012926. [PMID: 39074979 DOI: 10.1136/medhum-2024-012926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/31/2024]
Abstract
As the focus on end-of-life care intensifies, so too does the need to better understand the experiences of patients, caregivers and physicians. Delivering empathetic care requires a shared understanding of illness and its meaning and impact. The narratives of patients, caregivers and physicians each offer a distinct perspective on clinical experiences, yet comparative research is uncommon. This study compares written narratives about end-of-life illness and care by these groups.We created an archive of 332 first-person written narratives about end of life (patient=65, caregiver=156, physician=111) published between 1 January 2010 and 31 December 2019 through searching public domains (eg, national newspapers), personal blogs, and academic and literary journals in Canada. A comparative narrative analysis was conducted for patterns of content (eg, theme) and strategy (eg, characterisation).All three groups wrote about feeling gratitude. Patients also emphasised coping with change and carrying on. Caregivers further focused on grieving loss, and physicians most often wrote about valuing humanism. Physicians were most likely to ascribe agency to someone (ie, patients) or something (ie, death) other than themselves and to decentre themselves in the story. Patients and physicians most often made the patient the main character of their stories, while caregivers were as likely to centre the story on themselves as on the patient. Physicians were most likely to describe death as a source of tension, while patients and caregivers described the illness experience, often comparing it to battle. Physicians and caregivers tended to write testimonies, while patients wrote quests.Narrative research can illuminate unique aspects of end-of-life care. While death is a shared experience, each group approaches it differently. The disconnects have potential consequences for how end of life is experienced-whether patients' values are honoured, whether caregivers receive support, and whether physicians experience burn-out. We need to foster learning experiences that integrate these unique perspectives into medical education and practice, including leveraging the affordances of studying written narratives towards this end.
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Affiliation(s)
- Tracy Moniz
- Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Carolyn Melro
- Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Chris Watling
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Singh GK, Mudge A, Matthews R, Yates P, Phillips JL, Virdun C. Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM). BMC Palliat Care 2024; 23:177. [PMID: 39026237 PMCID: PMC11256639 DOI: 10.1186/s12904-024-01494-4] [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: 03/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
| | - Alison Mudge
- Greater Brisbane Medical School, The University of Queensland, Herston, QLD, Australia
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Robyn Matthews
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Jane L Phillips
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Claudia Virdun
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
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White NM, Barnett AG, Lee XJ, Farrington A, Carter H, McPhail SM, Cardona M, Hillman K, Callaway L, Willmott L, White BP, Harvey G, Graves N, Brown C. Impact of a prospective feedback loop aimed at reducing non-beneficial treatments in older people admitted to hospital and potentially nearing the end of life. A cluster stepped-wedge randomised controlled trial. Age Ageing 2024; 53:afae115. [PMID: 38851216 PMCID: PMC11162291 DOI: 10.1093/ageing/afae115] [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: 09/28/2023] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVES To investigate if a prospective feedback loop that flags older patients at risk of death can reduce non-beneficial treatment at end of life. DESIGN Prospective stepped-wedge cluster randomised trial with usual care and intervention phases. SETTING Three large tertiary public hospitals in south-east Queensland, Australia. PARTICIPANTS 14 clinical teams were recruited across the three hospitals. Teams were recruited based on a consistent history of admitting patients aged 75+ years, and needed a nominated lead specialist consultant. Under the care of these teams, there were 4,268 patients (median age 84 years) who were potentially near the end of life and flagged at risk of non-beneficial treatment. INTERVENTION The intervention notified clinicians of patients under their care determined as at-risk of non-beneficial treatment. There were two notification flags: a real-time notification and an email sent to clinicians about the at-risk patients at the end of each screening day. The nudge intervention ran for 16-35 weeks across the three hospitals. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients with one or more intensive care unit (ICU) admissions. The secondary outcomes examined times from patients being flagged at-risk. RESULTS There was no improvement in the primary outcome of reduced ICU admissions (mean probability difference [intervention minus usual care] = -0.01, 95% confidence interval -0.08 to 0.01). There were no differences for the times to death, discharge, or medical emergency call. There was a reduction in the probability of re-admission to hospital during the intervention phase (mean probability difference -0.08, 95% confidence interval -0.13 to -0.03). CONCLUSIONS This nudge intervention was not sufficient to reduce the trial's non-beneficial treatment outcomes in older hospital patients. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Xing J Lee
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Hannah Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Digital Health and Informatics Directorate, Metro South Health, Woolloongabba, Brisbane, Australia
| | - Magnolia Cardona
- Bond University Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Population Health, The University of New South Wales, Kensington, New South Wales, Australia
| | - Kenneth Hillman
- Simpson Centre for Health Services Research, South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medial Research, Liverpool, New South Wales, Australia
| | - Leonie Callaway
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben P White
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Duke-NUS Postgraduate Medical School, National University of Singapore, Singapore
| | - Christine Brown
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Elina H, Sofia E, Tricia CS, Jaana-Maija K, Katariina K, Anu SJ. Patients Receiving Palliative Care and Their Experiences of Encounters With Healthcare Professionals. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:497-513. [PMID: 35235482 PMCID: PMC11100268 DOI: 10.1177/00302228221077486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The study aimed to explore experiences of encounters with health care professionals among patients receiving palliative cancer care in specialist palliative care inpatient units. A qualitative explorative study design was conducted in a specialist palliative care inpatient setting. Data collection was implemented using semi-structured individual interviews (20 palliative care cancer patients) and analysed with inductive content analysis. Palliative care patients experienced both meaningful and disrespectful encounters with healthcare professionals. The meaningful encounters encompassed authentic and supportive experiences, while the disrespectful encounters included indifferent and inadequate experiences. Caring for a patient receiving palliative care requires care beyond tending to a patient's physical needs. Patients should be encountered holistically and as equal human beings without highlighting their roles as patients. The healthcare professionals and the organisations should also acknowledge the importance of time and effort spent for encounters and conversations with the patients instead of concentrating resources mainly on physical care.
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Affiliation(s)
- Haavisto Elina
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland
- Department of Nursing Science, University of Turku, Finland
- Satakunta Central Hospital, Pori, Finland
| | - Eriksson Sofia
- Finno-Ugrian and Scandinavian Studies, Faculty of Arts, University of Helsinki, Finland
| | | | | | | | - Soikkeli-Jalonen Anu
- Finno-Ugrian and Scandinavian Studies, Faculty of Arts, University of Helsinki, Finland
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Ho VWT, Ling NMW, Anbarasan D, Chan YH, Merchant RA. Proof-of-concept for an automatable mortality prediction scoring in hospitalised older adults. Front Med (Lausanne) 2024; 11:1329107. [PMID: 38846139 PMCID: PMC11153690 DOI: 10.3389/fmed.2024.1329107] [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: 10/28/2023] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction It is challenging to prognosticate hospitalised older adults. Delayed recognition of end-of-life leads to failure in delivering appropriate palliative care and increases healthcare utilisation. Most mortality prediction tools specific for older adults require additional manual input, resulting in poor uptake. By leveraging on electronic health records, we aim to create an automatable mortality prediction tool for hospitalised older adults. Methods We retrospectively reviewed electronic records of general medicine patients ≥75 years at a tertiary hospital between April-September 2021. Demographics, comorbidities, ICD-codes, age-adjusted Charlson Comorbidity Index (CCI), Hospital Frailty Risk Score, mortality and resource utilization were collected. We defined early deaths, late deaths and survivors as patients who died within 30 days, 1 year, and lived beyond 1 year of admission, respectively. Multivariate logistic regression analyses were adjusted for age, gender, race, frailty, and CCI. The final prediction model was created using a stepwise logistic regression. Results Of 1,224 patients, 168 (13.7%) died early and 370 (30.2%) died late. From adjusted multivariate regression, risk of early death was significantly associated with ≥85 years, intermediate or high frail risk, CCI > 6, cardiovascular risk factors, AMI and pneumonia. For late death, risk factors included ≥85 years, intermediate frail risk, CCI >6, delirium, diabetes, AMI and pneumonia. Our mortality prediction tool which scores 1 point each for age, pneumonia and AMI had an AUC of 0.752 for early death and 0.691 for late death. Conclusion Our mortality prediction model is a proof-of-concept demonstrating the potential for automated medical alerts to guide physicians towards personalised care for hospitalised older adults.
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Affiliation(s)
- Vanda W. T. Ho
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie M. W. Ling
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
| | - Denishkrshna Anbarasan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Maia FDOM, Guimarães LC, Misko MD, de Souza TR, Fonseca MRA. Experiences of family members of cancer patients in palliative care: a qualitative systematic review protocol. JBI Evid Synth 2024; 22:713-719. [PMID: 37921629 DOI: 10.11124/jbies-23-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize the experiences of family members of cancer patients in palliative care. INTRODUCTION Increasingly, palliative care is the approach advocated when a life-threatening illness has been diagnosed. Cancer patients and their families, when receiving early identification, correct assessment, and treatment of pain and other problems through palliative care, report feeling supported in their illness experience. The patients and their families also describe immediate and personalized symptom management, holistic support, decision-making guidance, and preparation for the future, including the dying process and stages of grief. A growing number of studies address palliative care patients and, in particular, the central role of family in this approach. This review will synthesize qualitative research on this subject, providing recommendations to health professionals to help them better understand the experiences and needs of family members of cancer patients receiving palliative care. INCLUSION CRITERIA The review will consider studies examining experiences of families of cancer patients in palliative care, in all types of settings and contexts. The studies will focus on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, qualitative descriptive, and mixed methods studies. METHODS The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search strategy will aim to locate both published and unpublished studies, in any language, with no date restrictions. Methodological quality will be evaluated using the standard JBI critical appraisal checklist for qualitative research. The findings will be pooled using the meta-aggregation approach or will be presented in narrative format. The final synthesized findings will be graded according to the ConQual approach. REVIEW REGISTRATION PROSPERO CRD42022333937.
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Affiliation(s)
- Flávia de Oliveira Motta Maia
- School of Nursing, State University of Campinas (UNICAMP), Campinas, São Paulo, SP, Brazil
- The Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, São Paulo, SP, Brazil
| | | | - Maira Deguer Misko
- School of Nursing, State University of Campinas (UNICAMP), Campinas, São Paulo, SP, Brazil
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Virdun C, Button E, Phillips JL, Yates P, Luckett T. Perspectives of inpatients with palliative care needs, their families, clinicians and key stakeholders on measuring quality of hospital care via patient experience measures: A qualitative study. Palliat Med 2023; 37:1498-1508. [PMID: 37920917 PMCID: PMC10657505 DOI: 10.1177/02692163231209845] [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] [Indexed: 11/04/2023]
Abstract
BACKGROUND Globally there are high numbers of patients with palliative care needs receiving care in hospitals. Patient reported experience measures (PREMs) provide useful data to guide improvement work. How to implement PREMs within palliative care populations is unclear. AIM To explore the perspectives of inpatients with palliative care needs, their family members, and the clinical team regarding the use of a generic PREM as compared with a PREM designed for people with palliative care needs and related implementation factors. DESIGN A qualitative study was undertaken using semi-structured interviews and focus groups and integrated thematic analysis. SETTING/PARTICIPANTS Inpatients with palliative care needs, their family members, and clinical team members were recruited from three wards in an Australian metropolitan hospital. RESULTS Twenty-seven interviews and three focus groups were conducted. Six themes emerged: (1) PREMs for people with palliative care needs ought to be tailored to the needs of this population; (2) PREMs should appraise whether the needs of families have been met in addition to those of patients; (3) PREMs for inpatients with palliative care needs ought to be easy to use, brief and incorporate space for free text alongside each question; (4) Implementation of PREMs for people with palliative care needs ought to consider who administers these, when and how often; (5) PREM data need to be specific enough to inform process change and/or care provision; (6) Patients and families require meaningful feedback to encourage PREM completion. CONCLUSIONS This study provides practical guidance for PREM selection and implementation to inform improvements to care for inpatients with palliative care needs.
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Affiliation(s)
- Claudia Virdun
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Elise Button
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Services, Herston, QLD, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Patsy Yates
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
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Saarinen J, Mishina K, Soikkeli-Jalonen A, Haavisto E. Family members' participation in palliative inpatient care: An integrative review. Scand J Caring Sci 2023; 37:897-908. [PMID: 34958141 DOI: 10.1111/scs.13062] [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: 08/25/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
AIM To analyse how family members participate in hospital inpatient palliative care, and how their participation could be supported. METHODS This review followed a methodology outlined in the literature for integrative reviews. A literature search supplemented by a manual search was conducted on four electronic databases during 2020 to 2021: PubMed, CINAHL, PsycINFO, and Cochrane Library. A critical appraisal of the included studies was performed, and data were analysed using inductive content analysis. RESULTS The literature search resulted in 4990 articles, of which 14 articles were included in this review. Four main categories were identified concerning the participation of family members in hospital inpatient palliative care: participation in the physical care, provision of emotional support, promoting good patient care, and support provided by healthcare professionals for family members' participation. Family members' participation can be supported in different ways, including active communication and adequate information. CONCLUSION Family members' participation in hospital inpatient palliative care has been an important part of palliative care in hospital settings. Family members should be offered the opportunity to participate in patient care, and their presence in the hospital should be accommodated. Research on the topic is still scarce, and future research is needed from different perspectives, including intervention research.
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Affiliation(s)
- Johanna Saarinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Kaisa Mishina
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | | | - Elina Haavisto
- Deparment of Health Sciences, Tampere University, Tampere, Finland
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Li X, Che SL, Zhu M, Ng WI. What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China. Palliat Support Care 2023:1-9. [PMID: 38031427 DOI: 10.1017/s1478951523001657] [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: 12/01/2023]
Abstract
OBJECTIVES This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. METHODS A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. RESULTS A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI. SIGNIFICANCE OF RESULTS This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
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Affiliation(s)
- Xiang Li
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
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Saarinen J, Mishina K, Soikkeli-Jalonen A, Konradsen H, Haavisto E. Participation in inpatient care from the perspective of family members of palliative care patients. Int J Palliat Nurs 2023; 29:446-454. [PMID: 37757806 DOI: 10.12968/ijpn.2023.29.9.446] [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: 09/29/2023]
Abstract
BACKGROUND The participation of family members in inpatient palliative care has been shown to be meaningful; it contributes to the wellbeing of the patient. Even so, little is known about the perspectives of family members regarding their participation in this type of care. AIM The aim of this study was to describe participation in inpatient care from the perspective of family members of palliative care patients. METHOD This study involved semi-structured individual interviews with family members (n=19) of patients receiving inpatient palliative care, as well as inductive thematic analysis. FINDINGS Four main themes describing the family members' perspectives of their participation in inpatient palliative care were identified: family members attending to everyday activities, importance of participation to family members, family members providing emotional support to patients and the role of family members in discussions and decision-making processes concerning patient care. CONCLUSION Family members participate in inpatient palliative care in different ways. Participation was experienced as important to patients and family members, and some family members felt that participation may have supported their coping process.
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Affiliation(s)
- Johanna Saarinen
- Student, Department of Nursing Science, University of Turku, Turku, Finland
| | - Kaisa Mishina
- Senior researcher, Department of Nursing Science; Department of Child Psychiatry; INVEST Research Flagship Centre University of Turku, Turku, Finland
| | - Anu Soikkeli-Jalonen
- Doctoral researcher, Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
| | - Hanne Konradsen
- Professor, Herlev and Gentofte University Hospital, Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Elina Haavisto
- Professor, Department of Nursing Science, University of Turku, Turku, Finland, Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland Satakunta Central Hospital, Pori, Finland
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11
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [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: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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12
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Gattinger H, Ott S, Maurer C, Marty-Teuber B, Hantikainen V, Fringer A. Effect of an educational intervention on nurses' competence in activities of daily living support in end-of-life care using a pretest-posttest repeated measures design. BMC Palliat Care 2023; 22:119. [PMID: 37605181 PMCID: PMC10464419 DOI: 10.1186/s12904-023-01232-2] [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: 09/24/2022] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Most patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients' movement and protects nurses' musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the "Advanced Kinaesthetics in Palliative care (AdKinPal) program" on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units. METHODS A pretest-posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention - the AdKinPal program - is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants' demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints. RESULTS Fifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses' perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence. CONCLUSIONS The AdKinPal program can raise nurses' Kinaesthetics competence. Thereby, patients' autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses' self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff's musculoskeletal health can be promoted by enhancing their Kinaesthetics competence. TRIAL REGISTRATION DRKS00015908. Registration Date 23.11.2018.
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Affiliation(s)
- Heidrun Gattinger
- Institut of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland.
| | - Stefan Ott
- School of Management, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland
| | - Carola Maurer
- Institut of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland
| | | | - Virpi Hantikainen
- Department of Nursing Science, University of Turku, Turku, Turun yliopisto, 20014, Finland
| | - André Fringer
- ZHAW School of Health Sciences, Institute of Nursing, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland
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13
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Michel C, Seipp H, Kuss K, Hach M, Kussin A, Riera-Knorrenschild J, Bösner S. Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC Palliat Care 2023; 22:100. [PMID: 37480117 PMCID: PMC10360287 DOI: 10.1186/s12904-023-01227-z] [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: 01/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.
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Affiliation(s)
- Cathrin Michel
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Andrea Kussin
- Department of Anaesthesia and Intensive Care Therapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
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14
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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15
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Reid JC, Dennis B, Hoad N, Clarke F, Hanmiah R, Vegas DB, Boyle A, Toledo F, Rudkowski JC, Soth M, Heels-Ansdell D, Cheung A, Willison K, Neville TH, Cheung J, Woods A, Cook D. Enhancing end of life care on general internal medical wards: the 3 Wishes Project. BMC Palliat Care 2023; 22:11. [PMID: 36788522 PMCID: PMC9925934 DOI: 10.1186/s12904-023-01133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital. METHODS From January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively. RESULTS From March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1st, 3rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1st, 3rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program. CONCLUSIONS The formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.
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Affiliation(s)
- Julie C. Reid
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Brittany Dennis
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Neala Hoad
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - France Clarke
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Rajendar Hanmiah
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Daniel Brandt Vegas
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Boyle
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Feli Toledo
- grid.416721.70000 0001 0742 7355Department of Spiritual Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jill C. Rudkowski
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Mark Soth
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Diane Heels-Ansdell
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Andrew Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Kathleen Willison
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada ,grid.25073.330000 0004 1936 8227School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Thanh H. Neville
- grid.19006.3e0000 0000 9632 6718Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Jason Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Woods
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Deborah Cook
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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Soikkeli‐Jalonen A, Mishina K, Virtanen H, Charalambous A, Haavisto E. Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units—A qualitative descriptive study. Nurs Open 2022; 10:3018-3027. [PMID: 36539588 PMCID: PMC10077415 DOI: 10.1002/nop2.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
AIM This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients. DESIGN A qualitative descriptive design. METHOD The data were collected with focus group interviews and analysed with inductive content analysis. RESULTS Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.
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Affiliation(s)
- Anu Soikkeli‐Jalonen
- Department of Health Sciences, Faculty of Social Sciences Tampere University Tampere Finland
| | - Kaisa Mishina
- Department of Nursing Science University of Turku Turku Finland
- Department of Child Psychiatry University of Turku Turku Finland
- INVEST Research Flagship Centre University of Turku Turku Finland
| | - Heli Virtanen
- Department of Nursing Science University of Turku Turku Finland
| | - Andreas Charalambous
- Department of Nursing Science University of Turku Turku Finland
- Cyprus University of Technology Limassol Cyprus
| | - Elina Haavisto
- Department of Health Sciences, Faculty of Social Sciences Tampere University Tampere Finland
- Satakunta Central Hospital Pori Finland
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17
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Zulueta Egea M, Prieto-Ursúa M, Bermejo Toro L, Palmar-Santos AM. Dimensions of good palliative nursing care: Expert panel consensus and perceptions of palliative professionals. J Clin Nurs 2022. [PMID: 36380458 DOI: 10.1111/jocn.16583] [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: 06/23/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. BACKGROUND The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are. DESIGN Mixed-method, Delphi approach and exploratory qualitative study. METHODS Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. RESULTS The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. CONCLUSIONS The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family. RELEVANCE TO CLINICAL PRACTICE Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses. PATIENT OR PUBLIC CONTRIBUTION Two primary caregivers participated in the panel of experts and the semi-structured interview.
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Affiliation(s)
- Mar Zulueta Egea
- University Centre for Health Sciences, San Juan de Dios Foundation, San Rafael, Nebrija University Madrid, Spain
| | - María Prieto-Ursúa
- Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University, Madrid, Spain
| | - Laura Bermejo Toro
- Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University, Madrid, Spain
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18
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Giannitrapani KF, Yefimova M, McCaa MD, Goebel JR, Kutney-Lee A, Gray C, Shreve ST, Lorenz KA. Using Family Narrative Reports to Identify Practices for Improving End-of-Life Care Quality. J Pain Symptom Manage 2022; 64:349-358. [PMID: 35803554 DOI: 10.1016/j.jpainsymman.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT Patient experiences should be considered by healthcare systems when implementing care practices to improve quality of end-of-life care. Families and caregivers of recent in-patient decedents may be best positioned to recommend practices for quality improvement. OBJECTIVES To identify actionable practices that bereaved families highlight as contributing to high quality end-of-life care. METHODS We conducted qualitative content analysis of narrative responses to the Bereaved Family Surveys Veterans Health Administration inpatient decedents. Out of 5964 completed surveys in 2017, 4604 (77%) contained at least one word in response to the open-ended questions. For feasibility, 1500/4604 responses were randomly selected for analysis. An additional 300 randomly selected responses were analyzed to confirm saturation. RESULTS Over 23% percent (355/1500) of the initially analyzed narrative responses contained actionable practices. By synthesizing narrative responses to the BFS in a national healthcare system, we identified 98 actionable practices reported by the bereaved families that have potential for implementation in QI efforts. Specifically, we identified 67 end-of-life practices and 31 practices in patient-centered care domains of physical environment, food, staffing, coordination, technology and transportation. The 67 cluster into domains including respectful care and communication, emotional and spiritual support, death benefits, symptom management. Sorting these practices by target levels for organizational change illuminated opportunities for implementation. CONCLUSION Narrative responses from bereaved family members can yield approaches for systematic quality improvement. These approaches can serve as a menu in diverse contexts looking for approaches to improve patient quality of death in in-patient settings.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, Stanford, CA, USA.
| | - Maria Yefimova
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Office of Research (M.Y.), Patient Care Services, Stanford Healthcare, Stanford, CA, USA
| | - Matthew D McCaa
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Joy R Goebel
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; School of Nursing California State University Long Beach (J.R.G.), Long Beach CA, USA
| | - Ann Kutney-Lee
- Veteran Experience Center (A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing (A.K.L.), Philadelphia, PA, USA
| | - Caroline Gray
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Scott T Shreve
- Hospice and Palliative Care Program (S.T.S.), US Department of Veteran Affairs, Hospice and Palliative Care Unit, Lebanon VA Medical Center, Lebanon, PA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, Stanford, CA, USA
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19
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Anu SJ, Kaisa M, Heli V, Andreas C, Elina H. Family members’ experiences of psychosocial support in palliative care inpatient units: A descriptive qualitative study. Eur J Oncol Nurs 2022; 61:102201. [DOI: 10.1016/j.ejon.2022.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/08/2022] [Accepted: 09/18/2022] [Indexed: 11/26/2022]
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20
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Important End-of-Life Topics among Latino Patients and Caregivers Coping with Advanced Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158967. [PMID: 35897338 PMCID: PMC9330392 DOI: 10.3390/ijerph19158967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
There is a known end-of-life related disparity among Latino individuals, and there is a need to develop culturally sensitive interventions to help patients and caregivers cope with advanced cancer. Latino patients and caregivers coping with advanced cancer were asked to list important end-of-life topics to culturally inform a psychosocial intervention adaptation process. A qualitative study was conducted, and semi-structured interviews were performed, audio-recorded, and transcribed. Recordings and transcriptions were reviewed and analyzed using thematic content coding. The semi-structured interview described and demonstrated intervention components and elicited feedback about each. Free listing method was used to assess important topics among Latino advanced cancer patients (n = 14; stage III and IV) and caregivers. Patients and caregivers were given a list of 15 topics and asked which topics they deemed important to integrate into the intervention. Overall, more than half of the participants considered it important to include 13 of the 15 topics related to daily activities (eight subcategories), psychosocial support (three subcategories), discussing diagnosis and support (three subcategories), and financial difficulties (one subcategory). Patient-caregivers reported importance in most end-of-life topics. Future research and intervention development should include topics related to psychosocial support, daily activities, discussing diagnosis and support, and financial difficulties.
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21
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Chua KZY, Quah ELY, Lim YX, Goh CK, Lim J, Wan DWJ, Ong SM, Chong CS, Yeo KZG, Goh LSH, See RM, Lee ASI, Ong YT, Chiam M, Ong EK, Zhou JX, Lim C, Ong SYK, Krishna L. A systematic scoping review on patients' perceptions of dignity. Palliat Care 2022; 21:118. [PMID: 35787278 PMCID: PMC9251939 DOI: 10.1186/s12904-022-01004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01004-4.
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Affiliation(s)
- Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Simone Meiqi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Kennan Zhi Guang Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Laura Shih Hui Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Ray Meng See
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore. .,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore. .,Academic Palliative Care Unit, United Kingdom Cancer Research Centre, University of Liverpool, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK. .,Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore. .,The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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22
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Attivissimo LA, Friedman MI, Williams M, Rimar A, Nouryan C, Patel V, Kozikowski A, Zhang M, Pekmezaris R. Goals of care conversation education program: An intervention to help health care professionals break bad news to patients with advanced illness. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:407-417. [PMID: 33627035 DOI: 10.1080/02701960.2021.1893171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of the study was to measure the effectiveness of communication skills intervention results for healthcare professionals. A multi-site pretest-posttest survey assessing the efficacy of a Goals of Care conversation education program. The program aimed to educate healthcare professionals concerning having Goals of Care conversations with patients and families. This research was implemented in a large healthcare organization in the Northeastern United States. This study found significant differences between pretests and posttests across professions, palliative care specialty, degree types, and years of experience in the participant's self-reported ability and comfort levels in having conversations about Goals of Care with patients and families. Providing education on Goals of Care was effective in improving the knowledge and comfort of health care professionals with conducting advanced illness conversations.
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Affiliation(s)
| | - M Isabel Friedman
- Department of Clinical Transformation, Northwell, Lake Success, New York, USA
| | - Myia Williams
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Alexander Rimar
- Department of Medicine, Long Island Jewish Medical Center, Queens, New York, USA
| | - Christian Nouryan
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Vidhi Patel
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Andrzej Kozikowski
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Meng Zhang
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York, USA
- Department of Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Boddaert MS, Douma J, Dijxhoorn AFQ, Héman RACL, van der Rijt CCD, Teunissen SSCM, Huijgens PC, Vissers KCP. Development of a national quality framework for palliative care in a mixed generalist and specialist care model: A whole-sector approach and a modified Delphi technique. PLoS One 2022; 17:e0265726. [PMID: 35320315 PMCID: PMC8942240 DOI: 10.1371/journal.pone.0265726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
In a predominantly biomedical healthcare model focused on cure, providing optimal, person-centred palliative care is challenging. The general public, patients, and healthcare professionals are often unaware of palliative care’s benefits. Poor interdisciplinary teamwork and limited communication combined with a lack of early identification of patients with palliative care needs contribute to sub-optimal palliative care provision. We aimed to develop a national quality framework to improve availability and access to high-quality palliative care in a mixed generalist-specialist palliative care model. We hypothesised that a whole-sector approach and a modified Delphi technique would be suitable to reach this aim. Analogous to the international AGREE guideline criteria and employing a whole-sector approach, an expert panel comprising mandated representatives for patients and their families, various healthcare associations, and health insurers answered the main question: ‘What are the elements defining high-quality palliative care in the Netherlands?’. For constructing the quality framework, a bottleneck analysis of palliative care provision and a literature review were conducted. Six core documents were used in a modified Delphi technique to build the framework with the expert panel, while stakeholder organisations were involved and informed in round-table discussions. In the entire process, preparing and building relationships took one year and surveying, convening, discussing content, consulting peers, and obtaining final consent from all stakeholders took 18 months. A quality framework, including a glossary of terms, endorsed by organisations representing patients and their families, general practitioners, elderly care physicians, medical specialists, nurses, social workers, psychologists, spiritual caregivers, and health insurers was developed and annexed with a summary for patients and families. We successfully developed a national consensus-based patient-centred quality framework for high-quality palliative care in a mixed generalist-specialist palliative care model. A whole-sector approach and a modified Delphi technique are feasible structures to achieve this aim. The process we reported may guide other countries in their initiatives to enhance palliative care.
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Affiliation(s)
- Manon S. Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Joep Douma
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
| | - Anne-Floor Q. Dijxhoorn
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Carin C. D. van der Rijt
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
- Department of Medical Oncology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | | | - Peter C. Huijgens
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Kris C. P. Vissers
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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24
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Granat L, Andersson S, Hadziabdic E, Brännström M, Sandgren A. Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings. Palliat Care 2022; 21:48. [PMID: 35410328 PMCID: PMC8995693 DOI: 10.1186/s12904-022-00940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context. Methods This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method. Results Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant. Conclusions The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.
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Affiliation(s)
- Lisa Granat
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden.
| | - Sofia Andersson
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
| | - Emina Hadziabdic
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
| | | | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
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25
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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26
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Mori M, Morita T, Bruera E, Hui D. Prognostication of the last days of life: Review article. Cancer Res Treat 2022; 54:631-643. [PMID: 35381165 PMCID: PMC9296934 DOI: 10.4143/crt.2021.1573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/26/2022] [Indexed: 12/01/2022] Open
Abstract
Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.
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27
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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28
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Akyirem S, Salifu Y, Bayuo J, Duodu PA, Bossman IF, Abboah-Offei M. An integrative review of the use of the concept of reassurance in clinical practice. Nurs Open 2022; 9:1515-1535. [PMID: 35274826 PMCID: PMC8994970 DOI: 10.1002/nop2.1102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Aim To synthesize evidence on the concept of reassurance in nursing practice. Design Integrative review. Review Method PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962). Results Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.
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Affiliation(s)
- Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Yakubu Salifu
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Mary Abboah-Offei
- School of Health and Life Sciences, University of the West of Scotland, Scotland, UK
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29
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Supporting families of patients with dementia at end-of-life in hospital. Collegian 2022. [DOI: 10.1016/j.colegn.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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A good death from the perspective of healthcare providers from the internal medicine department in Shanghai: A qualitative study. Int J Nurs Sci 2021; 9:236-242. [PMID: 35509698 PMCID: PMC9052265 DOI: 10.1016/j.ijnss.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
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Virdun C, Luckett T, Davidson PM, Lorenz K, Phillips J. Generating key practice points that enable optimal palliative care in acute hospitals: Results from the OPAL project's mid-point meta-inference. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Rumbold B, Aoun SM. Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered? Healthcare (Basel) 2021; 9:healthcare9101286. [PMID: 34682966 PMCID: PMC8536088 DOI: 10.3390/healthcare9101286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 02/06/2023] Open
Abstract
This article presents evidence found in a search of national and international literature for patient preferences concerning settings in which to receive palliative care and the appropriateness of different models of palliative care. The purpose was to inform end-of-life care policy and service development of the Western Australian Department of Health through a rapid review of the literature. It was found that consumer experience of palliative care is investigated poorly, and consumer contribution to service and policy design is limited and selective. Most patients experience a mix of settings during their illness, and evidence found by the review has more to do with qualities and values that will contribute to good end-of-life care in any location. Models of care do not make systematic use of the consumer data that are available to them, although an increasingly common theme is the need for integration of the various sources of care supporting dying people. It is equally clear that most integration models limit their attention to end-of-life care provided by health services. Transitions between settings merit further attention. We argue that models of care should take account of consumer experience not by incorporating generalised evidence but by co-creating services with local communities using a public health approach.
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Affiliation(s)
- Bruce Rumbold
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Samar M. Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
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Hjorth NE, Schaufel MA, Sigurdardottir KR, Haugen DRF. Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study. BMJ Open Respir Res 2021; 7:7/1/e000485. [PMID: 32107203 PMCID: PMC7047484 DOI: 10.1136/bmjresp-2019-000485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS Advance care planning (ACP) is communication about wishes and preferences for end-of-life care. ACP is not routinely used in any Norwegian hospitals. We performed a pilot study (2014-2017) introducing ACP on a thoracic medicine ward in Norway. The aims of this study were to explore which topics patients discussed during ACP conversations and to assess how patients, relatives and clinicians experienced the acceptability and feasibility of performing ACP. METHODS Conversations were led by a study nurse or physician using a semistructured guide, encouraging patients to talk freely. Each conversation was summarised in a report in the patient's medical record. At the end of the pilot period, clinicians discussed their experiences in focus group interviews. Reports and transcribed interviews were analysed using systematic text condensation. RESULTS Fifty-one patients participated in ACP conversations (41-86 years; 9 COPD, 41 lung cancer, 1 lung fibrosis; 11 women); 18 were accompanied by a relative. Four themes emerged: (1) disturbing symptoms, (2) existential topics, (3) care planning and (4) important relationships. All participants appreciated the conversations. Clinicians (1 physician and 7 nurses) participated in two focus group interviews. Reports from ACP conversations revealed patient values previously unknown to clinicians; important information was passed on to primary care. Fearing they would deprive patients of hope, clinicians acted as gatekeepers for recruitment. Although they reported barriers during recruitment, many clinicians saw ACP as pertinent and called for time and skills to integrate it into their daily clinical practice. CONCLUSIONS Patients, relatives and clinicians showed a positive attitude towards ACP. Focusing on present and future symptom control may be an acceptable way to introduce ACP. Important aspects for implementing ACP in this patient group are management support, education, training, feasible routines and allocated time to perform the conversations.
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Affiliation(s)
- Nina Elisabeth Hjorth
- Department of Anaesthesia and Surgical Services, Specialist Palliative Care Team, Haukeland University Hospital, Bergen, Norway .,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Margrethe Aase Schaufel
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Dagny R Faksvåg Haugen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Haugen DF, Hufthammer KO, Gerlach C, Sigurdardottir K, Hansen MIT, Ting G, Tripodoro VA, Goldraij G, Yanneo EG, Leppert W, Wolszczak K, Zambon L, Passarini JN, Saad IAB, Weber M, Ellershaw J, Mayland CR. Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives' Survey within Seven Countries. Oncologist 2021; 26:e1273-e1284. [PMID: 34060705 PMCID: PMC8265351 DOI: 10.1002/onco.13837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. MATERIALS AND METHODS A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6-8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. RESULTS Of 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3-17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. CONCLUSION This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). IMPLICATIONS FOR PRACTICE Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement.
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Affiliation(s)
- Dagny Faksvåg Haugen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | | | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Katrin Sigurdardottir
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Marit Irene Tuen Hansen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Grace Ting
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool
| | - Vilma Adriana Tripodoro
- Pallium Latinoamérica, Buenos Aires, Argentina.,Instituto de Investigaciones Médicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba, Argentina
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland.,Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Lair Zambon
- Department of Internal Medicine, Campinas State University, Campinas, Brazil
| | | | | | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - John Ellershaw
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool
| | - Catriona Rachel Mayland
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool.,Department of Oncology and Metabolism, University of Sheffield, Sheffield
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Murphree DH, Wilson PM, Asai SW, Quest DJ, Lin Y, Mukherjee P, Chhugani N, Strand JJ, Demuth G, Mead D, Wright B, Harrison A, Soleimani J, Herasevich V, Pickering BW, Storlie CB. Improving the delivery of palliative care through predictive modeling and healthcare informatics. J Am Med Inform Assoc 2021; 28:1065-1073. [PMID: 33611523 DOI: 10.1093/jamia/ocaa211] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/28/2020] [Accepted: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Access to palliative care (PC) is important for many patients with uncontrolled symptom burden from serious or complex illness. However, many patients who could benefit from PC do not receive it early enough or at all. We sought to address this problem by building a predictive model into a comprehensive clinical framework with the aims to (i) identify in-hospital patients likely to benefit from a PC consult, and (ii) intervene on such patients by contacting their care team. MATERIALS AND METHODS Electronic health record data for 68 349 inpatient encounters in 2017 at a large hospital were used to train a model to predict the need for PC consult. This model was published as a web service, connected to institutional data pipelines, and consumed by a downstream display application monitored by the PC team. For those patients that the PC team deems appropriate, a team member then contacts the patient's corresponding care team. RESULTS Training performance AUC based on a 20% holdout validation set was 0.90. The most influential variables were previous palliative care, hospital unit, Albumin, Troponin, and metastatic cancer. The model has been successfully integrated into the clinical workflow making real-time predictions on hundreds of patients per day. The model had an "in-production" AUC of 0.91. A clinical trial is currently underway to assess the effect on clinical outcomes. CONCLUSIONS A machine learning model can effectively predict the need for an inpatient PC consult and has been successfully integrated into practice to refer new patients to PC.
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Affiliation(s)
- Dennis H Murphree
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Shusaku W Asai
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Quest
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yaxiong Lin
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nirmal Chhugani
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob J Strand
- Division of Palliative Care, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriel Demuth
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David Mead
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Wright
- Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Harrison
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitaly Herasevich
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Mitchell I, Lacey J, Anstey M, Corbett C, Douglas C, Drummond C, Hensley M, Mills A, Scott C, Slee JA, Weil J, Scholz B, Burke B, D'Este C. Understanding end-of-life care in Australian hospitals. AUST HEALTH REV 2021; 45:540-547. [PMID: 34074379 DOI: 10.1071/ah20223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
Objective To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results Most patients (n =1430, 84%) were aged ≥60 years, with a low percentage (n =208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n =1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4-48h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n =621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n =1047) experienced active intervention in their final 48h. Conclusions Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic? The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high -quality end -of -life care. What does this paper add? The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners? Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care.
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Affiliation(s)
- Imogen Mitchell
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Jeanette Lacey
- John Hunter Hospital, Medicine and Interventional Services, Newcastle, NSW, Australia
| | | | | | - Carol Douglas
- Palliative and Supportive Care, Royal Brisbane and Women's Hospital, Qld, Australia
| | | | - Michel Hensley
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; and University of Newcastle, NSW, Australia
| | - Amber Mills
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Vic., Australia
| | - Caroline Scott
- Centre of Palliative Care, St Vincent's Hospital, Melbourne, Vic., Australia
| | | | - Jennifer Weil
- University of Melbourne, Department of Medicine, Vic., Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Brandon Burke
- Christchurch Hospital, Christchurch, New Zealand; and University of Otago Christchurch School of Medicine, New Zealand
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, ACT, Australia
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Jiao K, Chow AY, Wang J, Chan II. Factors facilitating positive outcomes in community-based end-of-life care: A cross-sectional qualitative study of patients and family caregivers. Palliat Med 2021; 35:1181-1190. [PMID: 33947292 DOI: 10.1177/02692163211007376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delivery of community-based end-of-life care for patients and family members has been recognized as an important public health care approach. Despite differences in different healthcare settings and the significance of a person-centered approach, little research has investigated facilitators of community-based end-of-life care from the perspective of service recipients. In particular, there has been limited exploration of strategies to ensure positive outcomes at an operational level. AIM To explore factors facilitating positive end-of-life care provision in community-based settings and how these are achieved in practice, from the perspectives of patients and family caregivers. DESIGN A qualitative cross-sectional descriptive study was undertaken through semi-structured interviews with patients and family caregivers subjected to thematic analysis. SETTING/PARTICIPANTS Ten patients and 16 family caregivers were recruited from an end-of-life community care program provided by four non-governmental organizations in Hong Kong. RESULTS Seven core themes were identified: positive emotions about the relationship, positive appraisals of the relationship, care through inquiring about recipients' circumstances, instrumentality of care (i.e. information, coaching on care, practical help, psychological support, multiple activities), comprehensiveness of care (i.e. diversity, post-death care, family-level wellbeing), structure of care (i.e. timely follow-up, well-developed system), and qualities of workers. CONCLUSIONS Improvement in service quality might be achieved through alternating the perceptions or emotional reactions of care recipients toward care providers and increased use of sensitive inquiry. Comprehensive care and positive outcomes might be facilitated by addressing the dualities of care by providing diverse choices in pre-death and post-death care.
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Affiliation(s)
- Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Ym Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.,Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Iris Ik Chan
- Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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Jordan TR, Wotring AJ, McAfee CA, Polavarapu M, Cegelka D, Wagner-Greene VR, Hamdan Z. The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief? DEATH STUDIES 2021; 46:84-90. [PMID: 34027825 DOI: 10.1080/07481187.2021.1929571] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Worldwide, more than 3 million people have died from COVID-19. Each decedent represents a person who was loved, will be missed, and whose death elicited grief. COVID-19 has changed the way we die and grieve. Many people have died without family members and friends present and many of the bereft have grieved and mourned alone. Individuals and communities have experienced multiple losses within a short time while suffering from concomitant stress, anxiety, and depression. More deaths and more grief will continue in the foreseeable future. Preventive education is needed to prepare for and manage the likely increase in complicated grief.
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Affiliation(s)
- Timothy R Jordan
- School of Population Health, University of Toledo, Toledo, Ohio, Toledo
| | - Amy J Wotring
- Department of Applied Sciences, Indiana State University, Terre Haute, Indiana, USA
| | - Colette A McAfee
- School of Nursing and Health Sciences, Westminster College, Salt Lake City, Utah, USA
| | | | - Derek Cegelka
- Department of Kinesiology and Health Science, Stephen F. Austin State University, Nacogdoches, Texas, USA
| | - Victoria R Wagner-Greene
- Department of Kinesiology and Health Science, Stephen F. Austin State University, Nacogdoches, Texas, USA
| | - Zena Hamdan
- Department of Health Administration, Capella University, Minneapolis, Minnesota, USA
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Guirimand F, Bouleuc C, Sahut d'Izarn M, Martel-Samb P, Guy-Coichard C, Picard S, Devalois B, Ghadi V, Aegerter P. Development and Validation of the QUALI-PALLI-FAM Questionnaire for Assessing Relatives' Perception of Quality of Inpatient Palliative Care: A Prospective Cross-Sectional Survey. J Pain Symptom Manage 2021; 61:991-1001.e3. [PMID: 32979519 DOI: 10.1016/j.jpainsymman.2020.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022]
Abstract
CONTEXT Relatives of patients receiving palliative care are at risk for psychological and physical distress, and their perception of quality of care can influence patients' quality of life. OBJECTIVES The purpose of this study was to develop and validate the QUALI-PALLI-FAM questionnaire (QUAlity of PALLIative car from FAMilies' perspective) to measure families' perception of and satisfaction with palliative care. METHODS An exploratory factor analysis was conducted, and we evaluated the questionnaire's internal consistency using Cronbach's alpha, its stability across various strata, and the correlation between the QUALI-PALLI-FAM (factors, total score, and global satisfaction) and the total score of the FAMCARE (FAMily satisfaction with CARE) questionnaire. RESULTS This multicentric prospective cross-sectional survey was conducted in seven French hospitals, namely, three palliative care units and four standard medical units with a mobile palliative care team. The questionnaire was completed by 170 relatives of patients (more than 90% of patients had advanced cancer). The final questionnaire included 14 items across three domains: organization of care and availability of caregivers, medical information provision, and confidence and involvement of relatives. Internal consistency was good for all subscales (Cronbach's α = 0.74-0.86). Our questionnaire was stable across various strata: age and gender (patients and relatives), Palliative Performance Scale scores, and care settings. The QUALI-PALLI-FAM total score was correlated with the total FAMCARE score. CONCLUSION The QUALI-PALLI-FAM appears to be a valid, reliable, and well-accepted tool to explore relatives' perception of quality of inpatient palliative care and complements the QUALI-PALLI-PAT questionnaire. Further testing is required in various settings and countries.
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Affiliation(s)
- Frédéric Guirimand
- Pôle Recherche SPES 'Soins Palliatifs en Société' Maison Médicale Jeanne Garnier, Paris and Université Paris-Saclay, UVSQ, Versailles, France.
| | - Carole Bouleuc
- Institut Curie, Département interdisciplinaire des Soins de Support, Paris, France
| | - Marine Sahut d'Izarn
- AP-HP, Hôpital Ambroise Paré, Equipe Mobile de Soins Palliatifs, Boulogne, France
| | - Patricia Martel-Samb
- AP-HP, Unité de Recherche Clinique URC HU PIFO, Hôpital Ambroise Paré, Boulogne, France
| | | | - Stéphane Picard
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Unité de Soins Palliatifs, Paris, France
| | - Bernard Devalois
- Centre de Recherche et d'Enseignement interprofessionnel Bientraitance et fin de vie and AGORA (EA7892) université CY Cergy Paris Université, Cergy, France
| | | | - Philippe Aegerter
- GIRCI-IDF, Cellule Méthodologie, Paris, France et Université Paris-Saclay, UVSQ, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP - Centre de recherche en Epidémiologie et Santé des Populations U1018 INSERM UPS UVSQ, 94807, Villejuif, France
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Montagnini M, Smith HM, Price DM, Strodtman L, Ghosh B. An Instrument to Assess Self-Perceived Competencies in End-of-Life Care for Health Care Professionals: The End-of-Life Care Questionnaire. Am J Hosp Palliat Care 2021; 38:1426-1432. [PMID: 33787330 DOI: 10.1177/10499091211005735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). METHODS The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach's alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. RESULTS Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). CONCLUSION Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.
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Affiliation(s)
| | - Heather M Smith
- Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deborah M Price
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Linda Strodtman
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Bidisha Ghosh
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
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Moon F, Mooney C, McDermott F, Miller A, Poon P. Bereaved families' experiences of end-of-life decision making for general medicine patients. BMJ Support Palliat Care 2021:bmjspcare-2020-002743. [PMID: 33722814 DOI: 10.1136/bmjspcare-2020-002743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Family involvement in decision making for hospitalised patients is associated with improved end-of-life care. Yet, these discussions can be challenging for physicians and families and associated with distress, confusion and conflict. There is a need to understand how best to support families involved in decisions regarding the transition from active to palliative treatment in hospital settings. AIM To explore bereaved families' experiences of end-of-life decision making for general medicine patients. DESIGN A qualitative exploratory study framed by social constructionism using semistructured interviews and thematic analysis. SETTING AND PARTICIPANTS The general medicine units of one large public hospital in Melbourne, Australia. We recruited 28 bereaved family members of patients who had received end-of-life care. FINDINGS Patients and families depended on physicians to explain clinical complexity and treatment beneficence; however, trust in medical judgement was mediated by participant's own interpretations of clinical progress. Families sought to be respected as advocates and experienced distress if physicians disregarded their perspectives and insight concerning patient preferences. Ideally, families supported patients to express their preferences to physicians. Otherwise, families contextualised treatment decisions through their knowledge of patient's values and quality of life. Families often felt burdened by or excluded from medical decision making and experienced distress and confusion regarding their rights to request or refuse treatment. CONCLUSION Our study highlights how families contribute to decision making to ensure end-of-life care treatments reflect patient preferences. Physicians can ease families' distress around treatment withdrawal by providing a meaningful explanation of complex clinical issues, clarifying decision-making roles and acknowledge families' desire to protect and advocate for their loved one.
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Affiliation(s)
- Felicity Moon
- Department of Social Work, Monash Health, Clayton, Victoria, Australia
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Christine Mooney
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Alistair Miller
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Peter Poon
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
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Chen SH, Lai XB, Chen LQ, Xia HO, Chen CY. A qualitative study of caring in hospice wards in Shanghai. Nurs Health Sci 2021. [DOI: 10.1111/nhs.12797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shu Hui Chen
- School of Nursing, Fudan University Shanghai China
| | - Xiao Bin Lai
- School of Nursing, Fudan University Shanghai China
| | - Li Qun Chen
- School of Nursing, Fudan University Shanghai China
| | - Hai Ou Xia
- School of Nursing, Fudan University Shanghai China
| | - Chun Yan Chen
- Department of Nursing Fudan University Shanghai Cancer Center Shanghai China
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Borghi L, Menichetti J, Vegni E. A Phone-Based Early Psychological Intervention for Supporting Bereaved Families in the Time of COVID-19. Front Public Health 2021; 9:625691. [PMID: 33604325 PMCID: PMC7884921 DOI: 10.3389/fpubh.2021.625691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
The exceptional circumstances of the Coronavirus disease (COVID-19) pandemic are making the grief processes challenging for families who are losing a relative for COVID-19. This community case study aimed to describe a phone-based primary preventive psychological intervention that has been delivered to these families by the Clinical Psychology unit of an Italian hospital. In particular, the article reports how the intervention has been organized within the overall hospital care pathway for families, the specific contents and components of the intervention, and the seven-phase structure of the intervention. The unique features and related challenges of the intervention, along with the implications for clinical practice, are discussed.
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Affiliation(s)
- Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Julia Menichetti
- Institute of Clinical Medicine, Akershus Universitetssykehus, University of Oslo, Oslo, Norway
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
- Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Milan, Italy
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Menichetti Delor JP, Borghi L, Cao di San Marco E, Fossati I, Vegni E. Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:498-511. [PMID: 33511652 PMCID: PMC8013378 DOI: 10.1002/ijop.12742] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/01/2021] [Indexed: 12/05/2022]
Abstract
A proportion of persons affected by coronavirus disease‐19 (COVID‐19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow‐up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID‐19; (ii) qualitative semi‐structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social‐institutional and a psychological‐human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID‐19 victims, and provided indications for supporting them within the space of a short phone call.
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Affiliation(s)
| | - Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Ivan Fossati
- Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy.,Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
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Borghi L, Menichetti J. Strategies to Cope With the COVID-Related Deaths Among Family Members. Front Psychiatry 2021; 12:622850. [PMID: 33716823 PMCID: PMC7946858 DOI: 10.3389/fpsyt.2021.622850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022] Open
Abstract
The extraordinary circumstances of deaths during COVID-19 pandemic have been challenging for the deceased's families. This contribution aims to describe some spontaneous strategies that family members may adopt to cope with the loss of a relative for COVID-19. The present reflection derives from the experience of a clinical psychology unit of one of the biggest public hospital in Milan, Italy, which supported 246 families of COVID-19 victims in the 1st days after the loss. Spontaneous strategies used by family members to deal with such a unique mourning process involved: creating alternative good-bye rituals, normalizing the loss, addressing faith and hope, highlighting the perks of isolation, supporting others in need, and delivering the bad news to others. These observed strategies may suggest how to assess and support a "normal" bereavement process during the extraordinary COVID-19 circumstances, in order to prevent further psychological distress.
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Affiliation(s)
- Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hov L, Synnes O, Aarseth G. Negotiating the turning point in the transition from curative to palliative treatment: a linguistic analysis of medical records of dying patients. Palliat Care 2020; 19:91. [PMID: 32590962 PMCID: PMC7320586 DOI: 10.1186/s12904-020-00602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many deaths in Norway occur in medical wards organized to provide curative treatment. Still, medical departments are obliged to meet the needs of patients at the end of life. Here, we analyse the electronic patient record regarding documentation of the transition from curative to palliative care (i.e. the ‘turning point’). Considering the consequences of these decisions for patients, they have received surprisingly little attention from researchers. This study aims to investigate how the patient record denotes reasons for the shift from curative treatment to palliation and how texts involve voices of the patient and their families. Methods The study comprised excerpts from electronic patient records retrieved from medical wards in three urban hospitals in Norway. We executed a retrospective analysis of anonymized extracts from 16 electronic patient records, searching for documentation on the transition from curative to palliative care. Results In the development of the turning point, the texts usually shift from statements about the patient’s clinical status and technical findings to displaying uncertainty and openness to negotiation with different textual voices. This shift may represent a need to align or harmonize the attitudes of colleagues, family, and patient towards the turning-point decision. The patient’s voice is mostly absent or reported only briefly when, in their notes, nurses gave an account of the patient’s opinion. None of the physicians’ notes provided a detailed account of patient attitudes, wishes, and experiences. Conclusion In this article, we have analysed textual representations of patient transitions from curative to end-of-life care. The ‘reality’ behind the text has not been our concern. As the only documentation left, the patient record is an adequate basis for considering how patients are estimated and cared for in their last days of life.
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Hospital patients' perspectives on what is essential to enable optimal palliative care: A qualitative study. Palliat Med 2020; 34:1402-1415. [PMID: 32857012 DOI: 10.1177/0269216320947570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere. AIM To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised. DESIGN An exploratory qualitative study using semi-structured interviews. SETTING/PARTICIPANTS Participants were recruited through five hospitals in New South Wales, Australia. RESULTS Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists. CONCLUSIONS Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.
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Affiliation(s)
- Claudia Virdun
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Karl Lorenz
- VA Palo Alto-Stanford Palliative Care Program and Professor of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Nursing and Member of IMPACCT, University of Technology Sydney, Broadway, NSW, Australia.,Cardiovascular Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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48
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Virdun C, Luckett T, Davidson PM, Phillips J. Strengthening palliative care in the hospital setting: a codesign study. BMJ Support Palliat Care 2020:bmjspcare-2020-002645. [PMID: 33115832 DOI: 10.1136/bmjspcare-2020-002645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families. METHODS A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus. RESULTS More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care. CONCLUSIONS Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.
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Affiliation(s)
- Claudia Virdun
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
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49
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Meeker MA, White D. Transition to comfort-focused care: Moral agency of acute care nurses. Nurs Ethics 2020; 28:529-542. [PMID: 34085584 DOI: 10.1177/0969733020952128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families. AIM The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care. RESEARCH DESIGN Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes. PARTICIPANTS AND CONTEXT A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews. ETHICAL CONSIDERATIONS The study received approval from the university's Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent. FINDINGS Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout. DISCUSSION Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices. CONCLUSION Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.
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Affiliation(s)
- Mary Ann Meeker
- 12292University at Buffalo, The State University of New York, USA
| | - Dianne White
- 12292University at Buffalo, The State University of New York, USA
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50
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Vogt A, Stiel S, Heckel M, Goebel S, Mai SS, Seifert A, Gerlach C, Ostgathe C, Weber M. Assessment of the quality of end-of-life care: translation and validation of the German version of the "Care of the Dying Evaluation" (CODE-GER) - a questionnaire for bereaved relatives. Health Qual Life Outcomes 2020; 18:311. [PMID: 32962706 PMCID: PMC7507719 DOI: 10.1186/s12955-020-01473-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background International studies indicate deficits in end-of-life care that can lead to distress for patients and their next-of-kin. The aim of the study was to translate and validate the “Care of the Dying Evaluation” (CODE) into German (CODE-GER). Methods Translation according to EORTC (European Organisation for Research and Treatment of Cancer) guidelines was followed by data collection to evaluate psychometric properties of CODE-GER. Participants were next-of-kin of patients who had died an expected death in two hospitals. They were invited to participate at least eight, but not later than 16 weeks after the patient’s death. To calculate construct validity, the Palliative care Outcome Scale (POS) was assessed. Difficulty and perceived strain of answering the questionnaire were assessed by a numeric scale (0–10). Results Out of 1137 next-of-kin eligible, 317 completed the questionnaire (response rate: 27.9%). Data from 237 main sample participants, 38 interraters and 55 next-of-kin who participated for repeated measurement were analysed. Overall internal consistency, α = 0.86, interrater reliability, ICC (1) = 0.79, and retest-reliability, ICC (1, 2) = 0.85, were good. Convergent validity between POS and CODE-GER, r = −.46, was satisfactory. A principal component analysis with varimax rotation showed a 7-factor solution. Difficulty, M = 2.2; SD ± 2.4, and perceived strain, M = 4.1; SD ± 3.0, of completing the questionnaire were rather low. Conclusion The results from the present study confirm CODE-GER as a reliable and valid instrument to assess the quality of care of the dying person. More over our study adds value to the original questionnaire by proposing a deepened analysis of obtained data. The development of seven subscales increases its potential for further surveys and research. Trial registration This study was registered retrospectively on the 25th of January 2018 at the German Clinical Trials Register (DRKS00013916).
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Affiliation(s)
- Annika Vogt
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Stephanie Stiel
- Hannover Medical School, Institute for General Practice, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Maria Heckel
- Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Department of Palliative Medicine, CCC Erlangen -EMN, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Swantje Goebel
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Sandra Stephanie Mai
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Andreas Seifert
- Centre for Educational Research and Teacher Training (PLAZ), Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Christoph Ostgathe
- Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Department of Palliative Medicine, CCC Erlangen -EMN, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany.
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