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Mills K, McGeagh L, Waite M, Aveyard H. The perceptions and experiences of community nurses and patients towards shared decision-making in the home setting: An integrative review. J Adv Nurs 2024. [PMID: 39039800 DOI: 10.1111/jan.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
AIM To explore patients' and community nurses' perceptions and experiences of shared decision-making in the home. DESIGN Integrative review. DATA SOURCES CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023. REVIEW METHODS A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed. RESULTS Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described tension in managing patients' involvement in decision-making. CONCLUSION The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled. IMPACT This paper demonstrates how the idea of shared decision-making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision-making in theory and how it plays out in practice. REPORTING METHOD The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021). PATIENT OR PUBLIC CONTRIBUTION This review was carried out as part of a wider study for which service users have been consulted.
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Affiliation(s)
- Katie Mills
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Lucy McGeagh
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Marion Waite
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Ødbehr L, Hov R, Sanaker H, Jensen ÅS, Korup A, Sandsdalen T. Physicians' understandings and experience of advance care planning in Norwegian nursing homes: a qualitative study. BMC Palliat Care 2024; 23:158. [PMID: 38915021 PMCID: PMC11194902 DOI: 10.1186/s12904-024-01481-9] [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: 12/20/2023] [Accepted: 06/04/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Advance care planning is a way of facilitating conversations with patients about future health care, values, and preferences at end of life. Nursing home physicians have the medical responsibility and the main obligation to facilitate planned meetings with patients. Although there has been a great deal of focus on establishing advance care planning in Norwegian nursing homes, it has yet to be widely implemented. Stated reasons are that the work routines in a nursing home do not include such meetings or that implementation seems complex due to frail patients. The aim of this study is thus to explore how physicians understand and experience advance care planning and follow-up of care plans in Norwegian nursing homes. METHODS The study has a qualitative research design with a phenomenological-hermeneutic approach based on interviews of twelve nursing home physicians working in community care. Interviews were conducted in February 2023 to May 2023, using a semi-structured interview guide. All interviews were recorded on audio files, transcribed, and analyzed using structural text analysis. RESULTS The findings are presented based on the following themes: (1) advance care planning is a dialog and a process, (2) advance care planning implies clarifying mutual expectations, and (3) advance care planning that brings relief and hope to patients is a medical art. CONCLUSIONS Advance care planning is a complex and dynamic process that implies medical treatment, decisions on treatment level, pain relief, and formulation of care plans where the patient's self-determination and personal values are respected. It implies an ongoing dialogue between physicians, patients, and their relatives about values such as dignity, self-understanding, social relations, and existential questions at end of life. Advance care planning requires a holistic approach that meets patients' psychological and existential needs such as comfort, trust, hope, and respect as well as their preferences and concerns.
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Affiliation(s)
- Liv Ødbehr
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
| | - Reidun Hov
- Development Center for Nursing Homes and Home Services, Hamar Municipality, Hamar, Norway
| | - Harald Sanaker
- Municipal Medical Center, Ringsaker Municipality, Brumunddal, Norway
| | - Åsa Serholt Jensen
- Development Center for Nursing Homes and Home Services, Hamar Municipality, Hamar, Norway
| | - Aina Korup
- Municipal Medical Center, Ringsaker Municipality, Brumunddal, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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White S, O’Cathain A, Halliday V, Bradburn M, McDermott CJ. Supporting people with Motor Neuron Disease (MND) to make decisions about gastrostomy feeding tube placement: a survey of UK healthcare professionals' practice and beliefs. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:290-298. [PMID: 38337170 PMCID: PMC11262427 DOI: 10.1080/21678421.2024.2314061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Understand the practice and beliefs of healthcare professionals (HCPs) supporting the decision-making of people with MND (pwMND) about gastrostomy placement, including identifying differences between professions. METHODS An online cross-sectional survey disseminated to HCPs who support the decision-making of pwMND about gastrostomy placement. RESULTS A total of 139 participants completed the survey including representation from a range of healthcare professions. A third (36/101, 36%) initiated discussions about gastrostomy later in practice than they believed was ideal. In relation to the outcome of declining compared to accepting gastrostomy, participants were more likely to discuss aspiration (80% vs. 68%), choking (76% vs. 58%) and prognosis (36% vs. 22%). Participants believed gastrostomies should be placed after a mean 8.1% weight loss since symptom-onset. More participants favored gastrostomy placement before pwMND presented with respiratory symptoms (45%) compared to onset of dysphagia (11%). Half believed pwMND placed gastrostomies too late. Participants were more likely to 'often'/'always' recommend pwMND to have a gastrostomy (23%) than continue without (7%) or decline (4%) gastrostomy, when believing these were the best option for pwMND. Nurses and dietitians discussed the broadest range of information, while doctors were more likely to discuss mortality risk and prognosis. CONCLUSION There is variation in HCPs practice and beliefs about initiating discussions, the sharing of information and recommendations, and timing, about gastrostomy placement. The information shared varies by profession and there is evidence of sub-optimal communication between HCPs. Further research is required to understand how these findings may impact on the decision-making of pwMND about gastrostomy.
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Affiliation(s)
- Sean White
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
| | - Vanessa Halliday
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
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Rabben J, Vivat B, Fossum M, Rohde GE. Shared decision-making in palliative cancer care: A systematic review and metasynthesis. Palliat Med 2024; 38:406-422. [PMID: 38481012 PMCID: PMC11025308 DOI: 10.1177/02692163241238384] [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: 04/19/2024]
Abstract
BACKGROUND Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations. AIM To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care. DESIGN A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis. DATA SOURCES We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches. RESULTS We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems. CONCLUSION Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.
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Affiliation(s)
- Jannicke Rabben
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
| | - Gudrun Elin Rohde
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Clinical Research, Sorlandet hospital, Kristiansand, Vest-Agder, Norway
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Beetham B, Fasola C, Howard F. Preferred Place of Death Discussions: Are They Informing and Empowering Patients and their Family Caregivers? OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221115587. [PMID: 35861425 DOI: 10.1177/00302228221115587] [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: 06/15/2023]
Abstract
Factors influencing preferred place of death (PPoD) are variable between individuals. However, there is little understanding of how these preferences are formed and how consistent they are in the final months of life. In particular, the expectation and responsibility of family caregivers to provide unpaid caregiving support to their dying loved one in the home is often overlooked. There is a need for clinicians to take an individualised approach to PPoD conversations that is inclusive of the needs of both the patient and the family caregiver. More Good Deaths - A Change Programme responds to this gap in care by advancing the skills of clinicians having PPoD conversations with patients and their family caregivers. This paper describes the programme, providing insight into its benefits to advanced care planning and communication, as well as to our newest service - Cottage Hospice.
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Affiliation(s)
- Bryony Beetham
- Hospice in the Weald, Tunbridge Wells, UK
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | | | - Faith Howard
- Hospice in the Weald, Tunbridge Wells, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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Tarberg AS, Thronaes M, Landstad BJ, Kvangarsnes M, Hole T. Physicians' perceptions of patient participation and the involvement of family caregivers in the palliative care pathway. Health Expect 2022; 25:1945-1953. [PMID: 35765248 PMCID: PMC9327811 DOI: 10.1111/hex.13551] [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: 01/03/2022] [Revised: 05/01/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Patient participation is essential for quality palliative care, and physicians play a crucial role in promoting participation. This study explores physicians' perceptions of patients and family caregivers' involvement in the different phases of the palliative pathway and employs a qualitative design with thematic analysis and a hermeneutic approach. Methods A purposive sampling included physicians who worked in different phases of the palliative pathway. In‐depth, semi‐structured interviews were conducted with 13 physicians in Norway between May and June 2020. Results Three main themes illustrate physicians' perceptions of patients' and family caregivers' involvement: (1) beneficence for the patient and the family caregivers in the early phase, (2) autonomy and shared decision‐making in the middle phase, and (3) family involvement in the terminal phase. Conclusion The physicians perceived bereavement conversations as essential, particularly if the pathway had been challenging. They also perceived patient participation and family caregivers' involvement as contextual. The results reveal that participation differs across the different phases of the palliative pathway. This type of knowledge should be included in the education of health‐care professionals. Future research should explore elements vital to successful patient participation and family involvement in the different phases of care. Patient or Public Contributions Family caregivers were involved in a previous study through individual interviews. The same interview guide used for the family caregivers was used when interviewing the physicians. The family caregivers' contribution led to nuanced questions in the interviews with the physicians, questions leaning on their stories told.
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Affiliation(s)
- Anett S Tarberg
- Medical Department, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Unit of Research, Education and Development, Ostersund Hospital, Ostersund, Sweden
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Torstein Hole
- Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice. Support Care Cancer 2022; 30:2679-2691. [PMID: 34825279 PMCID: PMC9067598 DOI: 10.1007/s00520-021-06631-w] [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: 05/20/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Shared decision making has been a long-standing practice in oncology and, despite a lack of research on the subject, is a central part of the philosophical foundation of hospice. This mixed methods study examined the perceptions of staff regarding shared decision making and their use of shared decision elements in hospice interdisciplinary team meetings. METHODS The revised Leeds Attitude to Concordance scale (LatConII) was used to measure the attitudes of hospice staff toward shared decision making. Field notes and transcripts of hospice interdisciplinary team meetings that included family caregivers as participants were coded to identify 9 theory-driven shared decision making elements. The results were mixed in a matrix analysis comparing attitudes with practice. Three transcripts demonstrate the variance in the shared decision making process between hospice teams. RESULTS Hospice staff reported overall positive views on shared decision making; however, these views differed depending on participants' age and position. The extent to which staff views were aligned with the observed use of shared decision making elements in hospice interdisciplinary team meetings varied. CONCLUSION Policy and practice conditions can make shared decision making challenging during hospice interdisciplinary team meetings despite support for the process by staff. TRIAL REGISTRATION This study is a sub-study of a parent study registered with clinicaltrials.gov (NCT02929108).
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Lin MH, Lin SC, Lee YH, Wang PY, Wu HY, Hsu HC. The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan. PLoS One 2021; 16:e0257902. [PMID: 34582501 PMCID: PMC8478250 DOI: 10.1371/journal.pone.0257902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Shared decision-making (SDM) is significantly associated with promoting the quality of end-of-life (EOL). The attitude of nurses toward the end of life can affect EOL care, but there are few SDM-related clinical learning programs focused on EOL. In this study, therefore, we evaluated the effectiveness of an EOL-simulation education program on attitudes toward SDM among nurses, using an objective structured clinical examination (OSCE). Methods We used a quasi-experimental study design to evaluate nurses working at a medical center in Taiwan. We recruited 100 nurses and assigned them to an experimental group (n = 50) and a control group (n = 50). The experimental group received the SDM attitude (SDMA) cultivation program, and the control group did not. After the intervention, all participants were examined in an OSCE to assess the efficacy of their learning. A p value of.05 was considered statistically significant. Results The average score of the experimental group was higher than that of the control group in the dimensions “empathic communication” and “mastery learning”, but these differences were not significant. SDMA score is significantly and positively correlated with SDMA global score, standardized patient survey (SPS) score, and SPS global score (r = .92, .56, and .50, respectively; p < .01). Conclusions Simulations concerning EOL care that incorporate SDM components would be effective for training clinical nurses. This study can serve as a reference for nursing-administration managers who may consider designing SDM-related education programs to improve the quality of clinical nursing care.
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Affiliation(s)
- Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
| | | | - Yu-Hsia Lee
- MacKay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Pao-Yu Wang
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan, R.O.C
| | - Hon-Yen Wu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- School of Medicine, College of Medicine, National Yang Ming ChiaoTung University, Taipei, Taiwan, R.O.C
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, R.O.C
| | - Hsiu-Chin Hsu
- Department of Internal Medicine, Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital, Taoyan, Taiwan, R.O.C
- * E-mail:
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Sathiananthan MK, Crawford GB, Eliott J. Healthcare professionals' perspectives of patient and family preferences of patient place of death: a qualitative study. BMC Palliat Care 2021; 20:147. [PMID: 34544398 PMCID: PMC8454022 DOI: 10.1186/s12904-021-00842-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient's carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. METHODS Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. RESULTS Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals' perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. CONCLUSION Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.
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Affiliation(s)
| | - Gregory B Crawford
- Northern Adelaide Palliative Services, Northern Adelaide Local Health Network, Adelaide, South Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
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Gilad D, Goldblatt H, Zeilig G. End-of-life conversation from both sides of the bed: voices of family and staff. Disabil Rehabil 2020; 44:2774-2783. [PMID: 33222556 DOI: 10.1080/09638288.2020.1849426] [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: 10/22/2022]
Abstract
PURPOSE Prolonged living with chronic illness and disability expands the discussion of end-of-life conversation because of the complex role of intercommunication among patient, family, and healthcare staff. Little is known about such interaction from participants' different perspectives. This qualitative case study examined end-of-life conversation among patient, family, and staff during long-term hospitalization in a neurological rehabilitation department. METHODS After the patient's death, 18 participants responded to in-depth semi-structured interviews: 16 healthcare staff and two family members (the patient's wife and brother). In addition, we used the wife's autoethnographic documentation of her experiences during end-of-life conversation. RESULTS Thematic analysis produced three themes: (1) The Rehabilitation Department's Mission - Toward Life or Death? (2) The Staff's Perception of the Patient; (3) Containing Death: End-of-life Conversation from Both Sides of the Bed. These themes represented participants' different perspectives in the intercommunication in overt and covert dialogues, which changed over time. Death's presence-absence was expressed by movement between clinging to life and anticipating death. CONCLUSION The study findings emphasize the importance of practitioners' training to accept and openly discuss death as an inseparable part of life-long disability, and the implementation of this stance during end-of-life care via sensitive conversations with patients and their families.IMPLICATIONS FOR REHABILITATIONIt is vital for rehabilitation professionals to be trained to process and accept end-of-life issues as a natural and inseparable part of the life discourse among people with disabilities and their families.Rehabilitation professionals need to acquire tools to grasp the spoken and unspoken issues related to life and death, and to communicate their impressions and understandings with people with disabilities and their families.Rehabilitation professionals need to encourage an open dialogue when communicating with people with disabilities and their families on processes related to parting and death.
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Affiliation(s)
- Dvorit Gilad
- The Center for Research and Study of the Family, School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Gabi Zeilig
- Division of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Department of Physical Medicine and Rehabilitation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Brogan P, Hasson F, McIlfatrick S. Lessons learnt: examining the use of case study methodology for nursing research in the context of palliative care. J Res Nurs 2019; 24:446-459. [PMID: 34394560 DOI: 10.1177/1744987119867737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background An empirical social research approach, facilitating in-depth exploration of complex, contemporary contextualised phenomena, case study research has been used internationally in healthcare studies across clinical settings, to explore systems and processes of care delivery. In the United Kingdom, case study methods have been championed by nurse researchers, particularly in the context of community nursing and palliative care provision, where its applicability is well established. Yet, dogged by conceptual confusion, case study remains largely underutilised as a research approach. Method Drawing on examples from nursing and palliative care studies, this paper clarifies case study research, identifies key concepts and considers lessons learned about its potential for nursing research within the unique and complex palliative and end of life context. Conclusion A case study approach offers nurse researchers the opportunity for in-depth, contextualised understanding of the systems and processes which influence their role in palliative care delivery across settings. However, philosophical and conceptual understandings are needed and further training in case study methodology is required to enable researchers to articulate and conduct case study.
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Affiliation(s)
- Paula Brogan
- School of Communication and Media, University of Ulster, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing Research, University of Ulster, Northern Ireland, UK
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12
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[Nurses' perspectives on outpatient palliative care in Vorarlberg, Austria]. Z Gerontol Geriatr 2018; 52:667-672. [PMID: 30402739 DOI: 10.1007/s00391-018-01468-1] [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: 04/25/2018] [Revised: 09/21/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Due to the demographic development the need for palliative care in the outpatient setting will increase and challenge general practitioners and community nurses. AIM This study investigated the state of outpatient palliative care in Vorarlberg, Austria from the perspective of outpatient community nurses. The key points of the survey covered the burden of symptoms suffered by palliative patients. Another key focus was the cooperation and communication between community nurses and general practitioners. METHODS Between 8 February and 7 March 2016 all 50 community-based nursing services in Vorarlberg were invited to participate in an online survey designed to estimate outpatient palliative care. The survey collected quantitative and descriptive data and 38 nursing services returned the questionnaire (76 %). RESULTS According to community-based nurses, the proportion of patients in need of palliative care was 5.7 %. This assessment of needs correlates well with the proportion of personnel qualified in palliative care (p = 0.02). Nursing personnel estimated a high prevalence of symptom burden (76 %). Communication between outpatient nursing personnel and general practitioners relied primarily on telephone calls (79-90 %), less on joint rounds (13-21 %) and case reviews (26-45 %). According to 63 % of the nursing personnel the rate of hospitalization could be reduced with better interprofessional cooperation. DISCUSSION Symptom burden in the outpatient setting was similar to that of patients being cared for in hospitals. Healthcare personnel in general palliative care should be adequately qualified. The quality of communication via telephone calls should be critically examined in further studies.
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13
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Yonder: GP trainers, menopause, shared decision making, and coroners’ reports. Br J Gen Pract 2018; 68:191. [DOI: 10.3399/bjgp18x695573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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"All of a sudden, a lot less still makes it worthwhile to be alive:" Palliative care patients' views on life. Palliat Support Care 2018. [PMID: 29514725 DOI: 10.1017/s1478951518000081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to elucidate the views on life as narrated by patients in palliative care (PC) to find out what patients deem to be essential in their life, whether something has changed concerning their view of life in light of the disease, and whether interviewees would like to give others something to take with them. METHOD Data were collected from narrative audio and video interviews with 18 inpatients in a specialized PC unit. Interviews were recorded and transcribed verbatim and analyzed using qualitative content analysis applying MAXQDA software. CDs and DVDs with recorded interviews were provided to patients. RESULT Eighteen interviews were analyzed: 11 audio and 7 video recordings. The age range was 41-80 years. Patients reported on changes in their views on life. Despite it being a complex and painful process, patients still gave examples of benefits experienced during their illness trajectory. Patients identified resources and coping strategies such as meaningful contacts with close others and mindfulness. Shifts have occurred in terms of taking more time for themselves, enjoying the moment, being more calm, and spending more time with family and friends. What patients wanted to pass on to others was to pay attention to the needs of both the self and the others, shape your life individually, confront yourself early with issues of death and dying, and care for your fellow human beings. Patients and relatives valued the opportunity to keep their interview as a CD/DVD. SIGNIFICANCE OF RESULTS Results support the idea that many people facing terminal illness continue to focus on living and remain within their biographies and the contexts of their lives, even if their functional status declines. Patients and relatives appreciated that interviews were provided as kind of a legacy. Yet, more robust research is needed to decide whether such interviews yield any therapeutic effect.
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