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Barrett L, Hackett J, Taylor J, Papworth A, Walker G, Fraser L. Evaluating parent and public involvement activities within a paediatric palliative care research centre: Route map to impactful and meaningful engagement. Palliat Med 2024:2692163241266374. [PMID: 39127883 DOI: 10.1177/02692163241266374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Patient and Public Involvement (PPI) is an important component of healthcare research. Conducting PPI within paediatric palliative care research requires specific ethical and practical considerations. Regular reviews of PPI activity are important. AIM To evaluate a paediatric palliative care research centre's PPI activity to determine what went well, or less well; and how future activities can be improved. DESIGN Two stage evaluation: first a review of PPI study logs; second a qualitative exploration using a survey, structured interviews and a focus group. Data were analysed thematically. SETTINGS/PARTICIPANTS Parents of children with life-limiting conditions, bereaved parents and researchers, all engaged in PPI activity within a paediatric palliative care research centre. FINDINGS The review of PPI logs for 15 studies highlighted the crucial role of funding in enabling PPI throughout the research. Eight parents completed the survey, 4 parents were interviewed and 12 researchers participated in a focus group. Three themes were developed: Clarity of processes and purpose; balanced relationships created a safe space; and mutual respect and value for PPI. These themes highlight what is working well within the Centre's approach to PPI and the opportunities to improve. CONCLUSIONS To undertake meaningful PPI in paediatric palliative care research, adequate time and resources are required. Roles, processes and expectations must be explicitly agreed. Establishing relationships ensures trust and enables authenticity and vulnerability. In addition to improving research, PPI has personal benefits for researchers and parents. The evaluation led to the development of a 'route map' for establishing an impactful PPI group for paediatric palliative care research.
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Affiliation(s)
- Laura Barrett
- Paediatric Palliative Care Research Group, Department of Health Science, University of York, York, UK
| | - Julia Hackett
- Paediatric Palliative Care Research Group, Department of Health Science, University of York, York, UK
| | - Jo Taylor
- Department of Health Science, University of York, York, UK
| | - Andrew Papworth
- School for Business and Society, University of York, York, UK
| | - Gabriella Walker
- Paediatric Palliative Care Research Group Family Advisory Board, York, UK
| | - Lorna Fraser
- Cicely Saunders Institute and Department of Women's and Children's Health, King's College London, London, UK
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Payne SA, Sumerfield M, Hughes S. Opportunities and Challenges in Patient and Public Involvement and Engagement in Palliative Care Research. J Palliat Med 2024. [PMID: 39102355 DOI: 10.1089/jpm.2024.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Affiliation(s)
- Sheila Alison Payne
- Division of Health Research, Faculty of Health and Medicine, International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Marion Sumerfield
- 4DPICTURE Project Group, International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sean Hughes
- Division of Health Research, Faculty of Health and Medicine, International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
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Crooks J, Flemming K, Shulman C, Casey E, Hudson B. Development of the TIFFIN recommendations for co-producing palliative and end-of-life care research with individuals with lived experience of homelessness: A qualitative study. Palliat Med 2024; 38:746-754. [PMID: 38898648 PMCID: PMC11290014 DOI: 10.1177/02692163241259667] [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: 06/21/2024]
Abstract
BACKGROUND Palliative care for people experiencing homelessness is a complex field. Due to the intricate nuances and heterogeneity in the experience of palliative care for people without secure housing, it is essential that research is informed by people with lived experience of homelessness. However, as homelessness is often associated with loss, trauma and high levels of exposure to death, any co-production of research, particularly in the field of palliative and end-of-life-care, must be trauma-informed. AIM To produce recommendations for co-producing palliative and end-of-life-care research with people with lived experience of homelessness. DESIGN A qualitative study comprising semi-structured interviews and focus groups. Data were analysed using iterative, reflexive thematic analysis. SETTING/PARTICIPANTS Twenty-seven participants were recruited. Sixteen professionals with experience of co-producing research with people with lived experience of homelessness; eleven people with lived experience of homelessness. RESULTS Six key themes were developed: transparency, importance of engagement and rapport, facilitating equitable involvement via person centred approach, financial recognition of involvement, involvement and growth through a trauma-informed approach and navigating institutional resistance and attitudes. Recommendations corresponding to the core themes were developed (TIFFIN recommendations). CONCLUSIONS Co-production of palliative care research with people with lived experience of homelessness is essential, but must be done carefully and sensitively. As a population with high levels of premature morbidity and mortality yet low access to palliative care, the TIFFIN recommendations could help to support the involvement of people with lived experience of homelessness in palliative and end-of-life-care care research.
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Affiliation(s)
| | | | - Caroline Shulman
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Briony Hudson
- Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Forbat L, Macgregor A, Spilsbury K, McCormack B, Rutherford A, Hanratty B, Hockley J, Davison L, Ogden M, Soulsby I, McKenzie M. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-134. [PMID: 39046763 DOI: 10.3310/krwq5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Aisha Macgregor
- Faculty of Social Science, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Queen Margaret University Edinburgh, Scotland, UK
- Østfold University College, Norway
| | | | - Barbara Hanratty
- Faculty of Medical Sciences, University of Newcastle, England, UK
| | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Lisa Davison
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Margaret Ogden
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Irene Soulsby
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Maisie McKenzie
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
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Tanzi S, Artioli G, De Panfilis L, Ghirotto L, Rabitti E, Sacchi S. A qualitative study with Italian patients exploring the spiritual dimension during a chronic disease. Chronic Illn 2024; 20:335-348. [PMID: 37248628 DOI: 10.1177/17423953231178236] [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: 05/31/2023]
Abstract
BACKGROUND Spirituality is a vast dimension influenced by cultural and personal differences. Little is known about the spirituality of patients suffering from a chronic disease in Italy from palliative care hospital settings. AIM To investigate patients' perspectives about their spirituality during their illness. METHOD The research question was: 'How does living with chronic disease inform/shape the spiritual dimension of patients?'. To address it, we conducted a qualitative interview study with thematic analysis. RESULTS We enrolled 21 participants among patients suffering from rheumatic, haematologic, neurodegenerative and respiratory chronic diseases. Participants generally had great difficulty answering the questions researchers posed and often could not define 'spirituality'. We found different topics grouped under four main themes: definition of spirituality, internal dialogue, expression of spirituality in everyday life and take stock. Religion is not reported as an answer to spiritual suffering, even in a country that is felt religious-driven like Italy. DISCUSSION Patients are generally not cognizant of this dimension even living with a chronic disease; consequently, they cannot express spiritual needs because they can't recognise them. Health professionals should identify this dimension and its characteristics to recognise potential spiritual suffering.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Staats K, Grov EK, Tranvåg O. Framework for Patient and Informal Caregiver Participation in Research (PAICPAIR) Part 2. ANS Adv Nurs Sci 2024; 47:188-201. [PMID: 36598380 DOI: 10.1097/ans.0000000000000474] [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: 01/05/2023]
Abstract
Previously, we described the development of the first part of the framework of Patient and Informal Caregiver Participation in Research (PAICPAIR part 1) and how it was implemented in the empirical study Dying With Dignity . Currently, we present our choices and experiences gained in PAICPAIR part 2, highlighting how PAICPAIR guided us as a modifiable and adaptable framework, with a particular emphasis on identifying and meeting the individual needs of our vulnerable coresearchers. This framework can be used as a methodological approach and study design in future research and inspire researchers to include patients receiving palliative care and informal caregivers-as coresearchers.
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Affiliation(s)
- Katrine Staats
- Author Affiliations Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Kjeller, Norway (Dr Staats); Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (Dr Grov); and Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Norwegian Research Center for Women's Health, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway (Dr Tranvåg)
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Liabo K, Asare L, Ruthen P, Burton J, Staunton P, Day J. Emotion in public involvement: A conceptual review. Health Expect 2024; 27:e14020. [PMID: 38504467 PMCID: PMC10951420 DOI: 10.1111/hex.14020] [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: 11/01/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Experiential knowledge can aid in designing research by highlighting what an idea looks like from a patient and carer perspective. Experiential knowledge can be emotional, and this can create challenges at formal research meetings. OBJECTIVE The aim of this study was to consider the role of emotions in public involvement. METHODS This is a conceptual review informed by relevant literature and reflection within the author team. A structured Scopus search was conducted in November 2021 and December 2022, identifying 18 articles that presented findings from patient and public involvement (PPI) research related to 'emotion'. We complemented the search with theory-generating articles related to the role of emotion and emotional labour in human life. FINDINGS Study findings from the structured search were tabulated to identify recurring themes; these were as follows: emotional connections to the research topic can cause stressful as well as cathartic experiences of PPI, 'emotional work' is part of PPI when people are contributing with their experiential knowledge and the emotional aspect of 'lived experience' needs to be recognised in how PPI is planned and facilitated. These points were considered in relation to theoretical works and experiences within the author team. DISCUSSION 'Emotion work' is often required of public collaborators when they contribute to research. They are asked to contribute to research alongside researchers, with knowledge that often contains emotions or feelings. This can be both upsetting and cathartic, and the environment of the research study can make the experience worse or better. CONCLUSIONS The emotional component of experiential knowledge can be challenging to those invited to share this knowledge. It is imperative that researchers, research institutions and health and care professionals adjust research meeting spaces to show an awareness of the emotional labour that is involved in PPI. PATIENT OR PUBLIC CONTRIBUTION This review was initiated after a meeting between carers and family members of residents in care homes and researchers. The review is co-written by a group of three researchers and three carers and family members. Regular online meetings were held during the draft stages to incorporate people's views and ideas. Data extracted from the review were presented to the group of public collaborators in a variety of formats (e.g., posters, slideshows, text and verbally) to facilitate shared sense-making and synthesis of the literature.
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Affiliation(s)
- Kristin Liabo
- Department of Community and Health Sciences, Faculty of Health and Life Sciences, University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Lauren Asare
- Department of Community and Health Sciences, Faculty of Health and Life Sciences, University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Philip Ruthen
- Exeter Lived Experience Group (LEG), Department of Psychology, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Julia Burton
- National Institute for Health Research Applied Research Collaboration South West Peninsula Public Engagement Group (PenPEG)University of ExeterExeterUK
| | - Pamela Staunton
- National Institute for Health Research Applied Research Collaboration South West Peninsula Public Engagement Group (PenPEG)University of ExeterExeterUK
| | - Joanne Day
- Department of Community and Health Sciences, Faculty of Health and Life Sciences, University of Exeter Medical SchoolUniversity of ExeterExeterUK
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Mitchell S, Turner N, Fryer K, Beng J, Ogden ME, Watson M, Gardiner C, Bayly J, Sleeman KE, Evans CJ. A framework for more equitable, diverse, and inclusive Patient and Public Involvement for palliative care research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:19. [PMID: 38331966 PMCID: PMC10851547 DOI: 10.1186/s40900-023-00525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND There are marked inequalities in palliative care provision. Research is needed to understand how such inequalities can be addressed, so that everyone living with advanced illness can receive the care they need, when they need it. Research into inequalities in palliative care should be guided by Patient and Public Involvement (PPI) that includes people from diverse backgrounds, who are less likely to receive specialist services. Multi-disciplinary research partnerships, bringing together primary care (the main providers of palliative care to diverse communities) and specialist palliative care, have the potential to work together in new ways to do research to address inequalities and improve palliative care in practice. This report describes a research partnership between primary care and palliative care that aimed to: (1) create opportunities for more inclusive PPI in palliative care research, (2) co-design new resources to support more equitable, diverse and inclusive PPI for palliative care, (3) propose a new framework for inclusive PPI in palliative care research. METHODS PPI members were recruited via primary care and palliative care research networks from three diverse areas of the UK. A pragmatic, collaborative approach was taken to achieve the partnership aims. Online workshops were carried out to understand barriers to inclusive PPI in palliative care and to co-design resources. Evaluation included a "you said, we did" impact log and a short survey. The approach was informed by good practice principles from previous PPI, and existing theory relating to equity, equality, diversity, and inclusion. RESULTS In total, 16 PPI members were recruited. Most were White British (n = 10), other ethnicities were Asian (n = 4), Black African (n = 1) and British mixed race (n = 1). The research team co-ordinated communication and activities, leading to honest conversations about barriers to inclusive PPI. Resources were co-designed, including a role description for an Equity, Equality, Diversity and Inclusion Champion, a "jargon buster", an animation and an online recipe book ( http://www.re-equipp.co.uk/ ) to inform future PPI. Learning from the partnership has been collated into a new framework to inform more inclusive PPI for future palliative care research. CONCLUSION Collaboration and reciprocal learning across a multi-disciplinary primary care and palliative care research partnership led to the development of new approaches and resources. Research team commitment, shared vision, adequate resource, careful planning, relationship building and evaluation should underpin approaches to increase equality, diversity and inclusivity in future PPI for palliative care research.
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Affiliation(s)
- Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, Leeds Institute of Health Sciences, University of Leeds, Clarendon Road, Leeds, UK.
| | - Nicola Turner
- School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Kate Fryer
- Academic Unit of Primary Medical Care, University of Sheffield, Herries Road, Sheffield, UK
| | - Jude Beng
- Academic Unit of Primary Medical Care, University of Sheffield, Herries Road, Sheffield, UK
| | - Margaret E Ogden
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
| | - Melanie Watson
- Health Sciences School, University of Sheffield, 3a Clarkehouse Rd, Sheffield, UK
| | - Clare Gardiner
- Health Sciences School, University of Sheffield, 3a Clarkehouse Rd, Sheffield, UK
| | - Joanne Bayly
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
- St Barnabas Hospices, Worthing, UK
| | - Katherine E Sleeman
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
| | - Catherine J Evans
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
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Roberts A. A Two-Phase Qualitative Enquiry Into Storytelling's Potential to Support Palliative Care Patient-Led Change, Using a Systematic Review Approach. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228231223270. [PMID: 38194348 DOI: 10.1177/00302228231223270] [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: 01/10/2024]
Abstract
A terminal diagnosis can diminish an individual's sense of agency and identity. Leading change appears to restore a sense of agential self. The first phase of this literature review explores factors influencing patient-led change across the palliative care ecosystem. The second phase illuminates how storytelling can support palliative care patients in leading ecosystem-wide change. 35 studies were identified in Phase 1 and 36 in Phase 2. This research highlights the need to situate patient leadership activity within a palliative care ecosystem to understand factors likely to support or hinder patient leadership activity within it. The evidence indicates the potential use of storytelling to support patients with a life-limiting illness to lead change across the palliative care ecosystem. This challenges current conceptualisations of such patients and offers them instead as an additional source of palliative care support.
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Affiliation(s)
- Amanda Roberts
- Department of Education, University of Hertfordshire Schools of Law and Education, Hatfield, UK
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Hoda W, Pandey K. Advancing Evidence-based Palliative Care Research: Navigating Challenges and Proposing Solutions. Indian J Palliat Care 2024; 30:89-92. [PMID: 38633675 PMCID: PMC11021051 DOI: 10.25259/ijpc_243_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/16/2023] [Indexed: 04/19/2024] Open
Abstract
Amid the increasing demand for palliative care, driven by demographic shifts and medical progress, evidence-based practices face obstacles due to limited research. Complex patient conditions and ethical considerations challenge traditional methodologies, while the absence of comprehensive clinical trials hinders innovative interventions. Empowering practitioners with research skills and establishing a palliative care research network are efforts aimed at bridging these gaps. It is important to emphasise that these initiatives collectively aspire to enhance evidence-based practices, ensuring quality care for individuals facing severe illnesses.
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Affiliation(s)
- Wasimul Hoda
- Department of Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Khushboo Pandey
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Kishino M, Koffman J, Nagatomi H, Yuasa M, Ellis-Smith C. Complexity and function of family involvement in advance care planning: A qualitative study of perspectives from people living with advanced cancer, family members and healthcare professionals. Palliat Med 2023; 37:1434-1446. [PMID: 37723885 PMCID: PMC10548778 DOI: 10.1177/02692163231194202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Family members can support advance care planning conversations. However, how family involvement in advance care planning operates to achieve goal-concordant care remains unclear. AIM To explore how family involvement impacts the process of advance care planning for advanced cancer patients and their family members to achieve goal-concordant care in Japan. DESIGN Qualitative study incorporating semi-structured in-depth interviews with thematic analysis informed by Family Systems Theory. SETTING/PARTICIPANTS Medical oncology departments at two tertiary hospitals in Japan. A purposive sample of 13 advanced cancer patients, 10 family members and 9 healthcare professionals who cared for them. RESULTS Twenty-five interviews were conducted, comprising 7 dyads of patients and their family members and 18 individual interviews. Four themes were identified: characteristics of patients and family members and their views on illness and advance care planning; family context and communication; interactions with healthcare professionals and societal and cultural influences; and family members' acceptance, preparation and confidence. Family involvement was observed as being variable at an individual level and also across generations. Family members provided patients with the instrumental and emotional support that facilitated the advance care planning process. Family involvement enabled family members to better prepare for realising patients' wishes. It increased family members' confidence in surrogate decision-making. CONCLUSIONS Two mechanisms of how family involvement may enable goal-concordant care were identified: family members' support provision and their preparation for realising patients' wishes. Healthcare professionals should assess family's readiness to engage in advance care planning, and the time required to prepare them for the process.
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Affiliation(s)
- Megumi Kishino
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Hiroaki Nagatomi
- Department of Nursing, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Misuzu Yuasa
- Hospice Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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Vinnicombe S, Bianchim MS, Noyes J. A review of reviews exploring patient and public involvement in population health research and development of tools containing best practice guidance. BMC Public Health 2023; 23:1271. [PMID: 37391764 PMCID: PMC10311710 DOI: 10.1186/s12889-023-15937-9] [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] [Received: 12/20/2022] [Accepted: 05/19/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) is increasingly seen as something that is integral to research and of importance to research funders. There is general recognition that PPI is the right thing to do for both moral and practical reasons. The aim of this review of reviews is to examine how PPI can be done 'properly' by looking at the evidence that exists from published reviews and assessing it against the UK Standards for Public Involvement in Research, as well as examining the specific features of population health research that can make PPI more challenging. METHODS A review of reviews and development of best practice guidance was carried out following the 5-stage Framework Synthesis method. RESULTS In total 31 reviews were included. There is a lack of current research or clarity around Governance and Impact when findings are mapped against UK Standards for Public Involvement in Research. It was also clear that there is little knowledge around PPI with under-represented groups. There are gaps in knowledge about how to ensure key specific attributes of population health research are addressed for PPI team members - particularly around how to deal with complexity and the data-driven nature of the research. Four tools were produced for researchers and PPI members to further improve their PPI activity within population health research and health research more generally, including a framework of recommended actions to address PPI in population health research, and guidance on integrating PPI based on the UK Standards for Public Involvement in Research. CONCLUSIONS Facilitating PPI in population health research is challenging due to the nature of this type of research and there is far less evidence on how to do PPI well in this context. The tools can help researchers identify key aspects of PPI that can be integrated when designing PPI within projects. Findings also highlight specific areas where more research or discussion is needed.
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Affiliation(s)
- Soo Vinnicombe
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Mayara S Bianchim
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK.
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Gazaway S, Bakitas M, Underwood F, Ekelem C, Duffie M, McCormick S, Heard V, Colvin A, Elk R. Community Informed Recruitment: A Promising Method to Enhance Clinical Trial Participation. J Pain Symptom Manage 2023; 65:e757-e764. [PMID: 36871774 PMCID: PMC10192118 DOI: 10.1016/j.jpainsymman.2023.02.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
CONTEXT Low recruitment rates in palliative care clinical trials amongst Black and rural individuals have been attributed to lack of trust and procedural barriers. Community engagement strategies have increased clinical trial participation of under-represented populations. OBJECTIVE Describe a successful community-engaged recruitment strategy in an ongoing multi-site randomized clinical trial (RCT). STUDY DESIGN AND METHODS Using community-based participatory research principles and input from a prior pilot study's community advisory group (CAG), we designed a novel recruitment strategy for Community Tele-Pal, a three-site, culturally based palliative care tele-consult RCT for Black and White seriously ill inpatients and their family caregivers. Local site CAGs helped design and implement a recruitment strategy in which a CAG member accompanied the study coordinators to introduce the study to eligible patients. Initially, CAG members could not accompany study coordinators in person due to pandemic restrictions. Hence, they created videos of themselves introducing the study, just as they would have done in person. We examined outcomes to date by the three recruitment methods and race. RESULTS Of the 2879 patients screened, 228 were eligible and approached. Overall, the proportions of patients who consented 102 (44.7%) vs. not consented 126 (55.3%) were similar by race- White (consented= 75 [44.1%]) vs; Black (consented = 27 [46.6%]). Proportionally, consent rates favored CAG-involved methods: coordinator only- 47 approached and 13 (12.7%) consented vs. coordinator/CAG video-105 approached and 60 (58.8%) consented. CONCLUSION A novel community-enhanced recruitment strategy demonstrated the potential to increase clinical trial participation from historically under-represented populations.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (S.G., M.B.,), Birmingham, AL, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA.
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham (S.G., M.B.,), Birmingham, AL, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Felicia Underwood
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Christiana Ekelem
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Marlee Duffie
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Russell Medical Center (M.D., V.H.), Alexander City, AL, USA
| | - Sheila McCormick
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Aiken Regional Medical Center (S.M.), Aiken, SC, USA
| | - Vantrice Heard
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Russell Medical Center (M.D., V.H.), Alexander City, AL, USA
| | | | - Ronit Elk
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
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14
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Crooks J, Flemming K, Shulman C, Hudson B. Opportunities and challenges in involving people with lived experience of inclusion health as co-researchers in palliative and end of life research: a rapid review and thematic synthesis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:25. [PMID: 37081580 PMCID: PMC10116696 DOI: 10.1186/s40900-023-00436-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Co-research is a collaborative approach to research, promoting involvement of individuals with lived experience of a research area as experts by experience. Recently, the importance of co-research within palliative and end of life care (PEoLC) has been highlighted, yet few recommendations exist regarding best practice for involving inclusion health groups (i.e., groups that are socially excluded, typically experiencing multiple disadvantages that contribute to poor health outcomes). AIMS To identify and synthesise qualitative literature outlining barriers and facilitators for involving four inclusion health groups (individuals with lived experience of: homelessness, substance use disorder, incarceration or exchanging sex for money) in PEoLC research, from the perspectives of both the researchers and individuals with lived experience. METHODS This report is a rapid review with thematic synthesis methodology. Three electronic databases were searched (2012-30th August 2022). Thematic synthesis was used to generate themes across qualitative studies. RESULTS Three qualitative studies were eligible for inclusion. Two involved individuals with lived experience of incarceration, and one lived experience of homelessness. No papers outlined best-practice guidance for co-research; all offered reflections on the co-research process. Challenges for involvement included: facilitating appropriate reimbursement; overcoming stigma; fear of tokenism; pre-conceived views and the emotional burden of research. Successes and benefits included: advanced level of insight, a two-way learning opportunity and relatability of lived experience co-researchers. CONCLUSIONS This review did not identify any best-practice guidance for co-production of PEoLC research with inclusion health groups. There are few, good quality, qualitative studies offering insight into challenges and facilitators for lived experience co-researcher involvement. Further research and formal policy development is required to produce formal best-practice guidance to support safe, impactful inclusion in PEoLC research. It is important that researchers work together with people who have lived experience of the topic they are researching. Palliative care is specialised medical care for people living with a terminal illness. There is some collaboration between researchers and people with lived experience in palliative and end-of-life care research. However, some groups of people have been excluded. This includes people experiencing homelessness, or people with drug or alcohol addictions. This review aimed to understand what works and what doesn't work when involving four excluded groups in palliative and end-of-life research. These groups were people experiencing homelessness, those who had spent time in prison, people with drug or alcohol disorders, and people who exchanged sex for money. This review used a shortened methodology, which allowed it to be done quickly. Three online academic databases (Medline, PubMed, PsychINFO) were searched for research projects: three papers were included in the review. No clear guidance for working with these groups was found. Analysis identified themes across papers. Challenges for collaboration included: appropriate payment methods; overcoming stigma; fear of being talked down to,; assumptions made before meeting people, and the potential of becoming upset. Successes and benefits included: better understanding of the research topic, the opportunity to learn from one another, and how research participants could relate to lived experience co-researchers. There are few, good quality papers, but more research is needed to produce guidance to support safe, impactful collaboration.
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Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Caroline Shulman
- Pathway, London, UK
- Healthy London Partnership, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Briony Hudson
- Research and Policy, Marie Curie, London, UK
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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15
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Downey J, Fornasiero M, Cooper S, Bassett L, Doherty M, Dubeibe Fong A, Bradley N, Cornwall J. Combining realist evaluation and transformative evaluation to advance research in palliative care: The case of end of life companionship. Palliat Med 2023; 37:413-420. [PMID: 36732901 DOI: 10.1177/02692163231152524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Palliative care requires innovative methods to understand what works, for whom, in what circumstances and why. Realist evaluation has become one prominent approach due to its preoccupation with building, and testing, causal theories to explain the influence of contextual factors on outcomes. Undertaking realist evaluation is not without challenges and may amplify issues of underrepresentation, disempower those working in palliative care, and produce results with poor ecological validity. Complementary approaches are needed which mitigate these challenges, whilst producing credible findings that advances knowledge. PURPOSE In this article it is outlined how realist evaluation provides a toolkit to advance research to explain, and empirically test, the complex contours of palliative care. Moreover, it is proposed that transformative evaluation can provide a catalyst to engage and empower those within palliative care, create the opportunity for care transformation, and produce more informed and authentic theories. DISCUSSION Contemporary issues in palliative care pertain to the complexity of palliative care, the insufficiency of experimental designs alone, and the challenges of achieving inclusive research participation. In this article it is argued that theory led, participatory, opportunistic and naturalistic approaches can provide an antidote to the issues in the literature. The combination also mitigates many methodological critiques of the individual approaches, by increasing the transformative potential of realist evaluation, and explanatory potential of transformative evaluation.
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Affiliation(s)
- John Downey
- Sport, Health, and Wellbeing, Plymouth Marjon University, UK
| | | | - Susan Cooper
- Institute of Education, Plymouth Marjon University, UK
| | - Lynn Bassett
- The Centre for the Art of Dying Well), St Mary's University, UK
| | | | | | - Natasha Bradley
- Centre for Health & Clinical Research, University of the West of England, UK
| | - Jon Cornwall
- Memberships Department, St Vincent De Paul, Englang and Wales
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16
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Gould DJ, Glanville-Hearst M, Bunzli S, Choong PFM, Dowsey MM. Research Buddy partnership in a MD-PhD program: lessons learned. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:4. [PMID: 36803954 PMCID: PMC9938357 DOI: 10.1186/s40900-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND AIMS There is increasing recognition of the importance of patient involvement in research. In recent years, there has also been growing interest in patient partnerships with doctoral studies students. However, it can be difficult to know where to start and how to go about such involvement activities. The purpose of this perspective piece was to share experiential insight of the experience of a patient involvement program such that others can learn from this experience. BODY: This is a co-authored perspective piece centred on the experience of MGH, a patient who has had hip replacement surgery, and DG, a medical student completing a PhD, participating in a Research Buddy partnership over the course of over 3 years. The context in which this partnership took place was also described to facilitate comparison with readers' own circumstances and contexts. DG and MGH met regularly to discuss, and work together on, various aspects of DG's PhD research project. Reflexive thematic analysis was conducted on reflections from DG and MGH regarding their experience in the Research Buddy program to synthesise nine lessons which were then corroborated with reference to published literature on patient involvement in research. These lessons were: learn from experience; tailor the program; get involved early; embrace uniqueness; meet regularly; build rapport; ensure mutual benefit; broad involvement; regularly reflect and review. CONCLUSIONS In this perspective piece, a patient and a medical student completing a PhD reflected upon their experience co-designing a Research Buddy partnership within a patient involvement program. A series of nine lessons was identified and presented to inform readers seeking to develop or enhance their own patient involvement programs. Researcher-patient rapport is foundational to all other aspects of the patient's involvement.
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Affiliation(s)
- Daniel J Gould
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
| | - Marion Glanville-Hearst
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, QLD, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Peter F M Choong
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
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Shabnam J, Timm HU, Nielsen DS, Raunkiaer M. Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families. Eur J Oncol Nurs 2023; 62:102238. [PMID: 36459811 DOI: 10.1016/j.ejon.2022.102238] [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: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark. METHODS The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark. RESULTS The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care. CONCLUSION This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.
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Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, K, Denmark; University Hospitals Center for Health Research (UCSF), Rigshospital, Denmark.
| | - Dorthe Susanne Nielsen
- Geriatric Department G, Odense, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark.
| | - Mette Raunkiaer
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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18
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Low C, Namasivayam P, Barnett T. Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review. Palliat Med 2023; 37:40-60. [PMID: 36349547 PMCID: PMC9843546 DOI: 10.1177/02692163221132089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to provide responsive, individualised and personalised care, there is now greater engagement with patients, families and carers in designing health services. Out-of-hours care is an essential component of community palliative care. However, little is known about how patients, families and carers have been involved in the planning and design of these services. AIM To systematically search and review the research literature that reports on how out-of-hours palliative care services are provided in the community and to identify the extent to which the principles of co-design have been used to inform the planning and design of these services. DESIGN Systematic literature search and review. DATA SOURCES A systematic search for published research papers from seven databases was conducted in MEDLINE, PsycINFO, Embase, Emcare, PubMed, CINAHL and Web of Science, from January 2010 and December 2021. Reference list searches of included papers were undertaken to source additional relevant literature. A manifest content analysis was used to analyse the data. RESULTS A total of 77 papers were included. The majority of out-of-hours services in the community were provided by primary care services. The review found little evidence that patients, families or carers were involved in the planning or development of out-of-hours services. CONCLUSION Incorporating patients, families and carers priorities and preferences in the planning and designing of out-of-hours palliative care service is needed for service providers to deliver care that is more patient-centred. Adopting the principles of co-design may improve how out-of-hours care scan be delivered.
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Affiliation(s)
- Christine Low
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
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19
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Sy MP, Panotes A, Cho D, Pineda RC, Martin P. A Rapid Review of the Factors That Influence Service User Involvement in Interprofessional Education, Practice, and Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16826. [PMID: 36554707 PMCID: PMC9779295 DOI: 10.3390/ijerph192416826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Service user involvement in interprofessional education and collaborative practice remains limited despite the increasing push for this by governments and grant funding bodies. This rapid review investigated service user involvement in interprofessional education, practice, and research to determine factors that enable or hinder such involvement. Following the Cochrane and the World Health Organization's rapid review guidelines, a targeted search was undertaken in four databases. Subsequent to the screening processes, included papers were critically appraised, and extracted data were synthesized narratively. Sixteen studies met inclusion criteria. Most studies were related to interprofessional collaborative practice, as opposed to education and research. Service user involvement was more in the form of consultation and collaboration, as opposed to consumer-led partnerships. Enablers and barriers to service user involvement in IPECP were identified. Enablers included structure, the valuing of different perspectives, and relationships. Barriers included time and resources, undesirable characteristics, and relationships. This rapid review has added evidence to a swiftly expanding field, providing timely guidance. Healthcare workers can benefit from targeted training. Policy makers, healthcare organizations, and governments can investigate strategies to mitigate the time and resource challenges that impede service user involvement in IPECP.
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Affiliation(s)
- Michael Palapal Sy
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila 1000, Philippines
| | - Arden Panotes
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila 1000, Philippines
| | - Daniella Cho
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350, Australia
| | - Roi Charles Pineda
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Priya Martin
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350, Australia
- Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
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20
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Koffman J, Bajwah S, Davies JM, Hussain JA. Researching minoritised communities in palliative care: An agenda for change. Palliat Med 2022; 37:530-542. [PMID: 36271636 DOI: 10.1177/02692163221132091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care access, experiences and outcomes of care disadvantage those from ethnically diverse, Indigenous, First nation and First people communities. Research into this field of inquiry raises unique theoretical, methodological, and moral issues. Without the critical reflection of methods of study and reporting of findings, researchers may inadvertently compromise their contribution to reducing injustices and perpetuating racism. AIM To examine key evidence of the place of minoritised communities in palliative care research to devise recommendations that improve the precision and rigour of research and reporting of findings. METHODS Narrative review of articles identified from PubMed, CINAHL and Google Scholar for 10 years augmented with supplementary searches. RESULTS We identified and appraised 109 relevant articles. Four main themes were identified (i) Lack of precision when working with a difference; (ii) 'black box epidemiology' and its presence in palliative care research; (iii) the inclusion of minoritised communities in palliative care research; and (iv) the potential to cause harm. All stymie opportunities to 'level up' health experiences and outcomes across the palliative care spectrum. CONCLUSIONS Based on the findings of this review palliative care research must reflect on and justify the classification of minoritised communities, explore and understand intersectionality, optimise data quality, decolonise research teams and methods, and focus on reducing inequities to level up end-of-life care experiences and outcomes. Palliative care research must be forthright in explicitly indentifying instances of structural and systemic racism in palliative care research and engaging in non-judgemental debate on changes required.
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Affiliation(s)
- Jonathan Koffman
- University of Hull, Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Sabrina Bajwah
- King's College London, Cicely Saunders Institute, London, UK
| | - Joanna M Davies
- King's College London, Cicely Saunders Institute, London, UK
| | - Jamilla Akhter Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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21
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Paolucci A, Nielssen I, Tang KL, Sinnarajah A, Simon JE, Santana MJ. The impacts of partnering with cancer patients in palliative care research: a systematic review and meta-synthesis. Palliat Care Soc Pract 2022; 16:26323524221131581. [PMID: 36274787 PMCID: PMC9583219 DOI: 10.1177/26323524221131581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Palliative care (PC) is an added layer of support provided concurrently with cancer care and serves to improve wellbeing and sustain quality of life. Understanding what is meaningful and a priority to patients, their families, and caregivers with lived experience of cancer and PC is critical in supporting their needs and improving their care provision. However, the impacts of engaging cancer patients within the context of PC research remain unknown. Objective To examine the impacts of engaging individuals with lived experience of cancer and PC as partners in PC research. Methods An a priori systematic review protocol was registered with PROSPERO (CRD42021286744). Four databases (APA PsycINFO, CINAHL, EMBASE, and MEDLINE) were searched and only published, peer-reviewed primary English studies aligned with the following criteria were included: (1) patients, their families, and/or caregivers with lived experience of cancer and PC; (2) engaged as partners in PC research; and (3) reported the impacts of engaging cancer PC patient partners in PC research. We appraised the quality of eligible studies using the Critical Appraisal Skills Program (CASP) and GRIPP2 reporting checklists. Results Three studies that included patient partners with lived experience of cancer and PC engaged at all or several of the research stages were identified. Our thematic meta-synthesis revealed impacts (benefits and opportunities) on patient partners (emotional, psychological, cognitive, and social), the research system (practical and ethical) and health care system (service improvements, bureaucratic attitudes, and inaction). Our findings highlight the paucity of evidence investigating the impacts of engaging patients, their families and caregivers with lived experience of cancer and PC, as partners in PC research. Conclusions The results of this review and meta-synthesis can inform the more effective design of cancer patient partnerships in PC research and the development of feasible and effective strategies given the cancer and PC context patient partners are coming from.
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Affiliation(s)
| | - Ingrid Nielssen
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen L. Tang
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Medicine, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
| | - Aynharan Sinnarajah
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Family Medicine, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada,Department of Medicine, School of Medicine,
Queen’s University, Kingston, ON, Canada,Department of Oncology, Faculty of Medicine,
University of Calgary, Calgary, AB, Canada
| | - Jessica E. Simon
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Medicine, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada,Department of Oncology, Faculty of Medicine,
University of Calgary, Calgary, AB, Canada
| | - Maria J. Santana
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
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22
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Kremeike K, Bausewein C, Freytag A, Junghanss C, Marx G, Schnakenberg R, Schneider N, Schulz H, Wedding U, Voltz R. [DNVF Memorandum: Health Services Research in the Last Year of Life]. DAS GESUNDHEITSWESEN 2022. [PMID: 36220106 DOI: 10.1055/a-1889-4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This memorandum outlines current issues concerning health services research on seriously ill and dying people in the last year of their lives as well as support available for their relatives. Patients in the last phase of life can belong to different disease groups, they may have special characteristics (e. g., people with cognitive and complex impairments, economic disadvantage or migration background) and be in certain phases of life (e. g., parents of minor children, (old) age). The need for a designated memorandum on health services research in the last year of life results from the special situation of those affected and from the special features of health services in this phase of life. With reference to these special features, this memorandum describes methodological and ethical specifics as well as current issues in health services research and how these can be adequately addressed using quantitative, qualitative and mixed methods. It has been developed by the palliative medicine section of the German Network for Health Services Research (DNVF) according to the guidelines for DNVF memoranda.
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Affiliation(s)
- Kerstin Kremeike
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Junghanss
- Hämatologie, Onkologie und Palliativmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Gabriella Marx
- Institut und Poliklinik Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Holger Schulz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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Fujio K, Inomata T, Fujisawa K, Sung J, Nakamura M, Iwagami M, Muto K, Ebihara N, Nakamura M, Okano M, Akasaki Y, Okumura Y, Ide T, Nojiri S, Nagao M, Fujimoto K, Hirosawa K, Murakami A. Patient and public involvement in mobile health-based research for hay fever: a qualitative study of patient and public involvement implementation process. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:45. [PMID: 36056430 PMCID: PMC9437402 DOI: 10.1186/s40900-022-00382-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Smartphones are being increasingly used for research owing to their multifunctionality and flexibility, and crowdsourced research using smartphone applications (apps) is effective in the early detection and management of chronic diseases. We developed the AllerSearch app to gather real-world data on individual subjective symptoms and lifestyle factors related to hay fever. This study established a foundation for interactive research by adopting novel, diverse perspectives accrued through implementing the principles of patient and public involvement (PPI) in the development of our app. METHODS Patients and members of the public with a history or family history of hay fever were recruited from November 2019 to December 2021 through a dedicated website, social networking services, and web briefing according to the PPI Guidebook 2019 by the Japan Agency for Medical Research and Development. Nine opinion exchange meetings were held from February 2020 to December 2021 to collect opinions and suggestions for updating the app. After each meeting, interactive evaluations from PPI contributors and researchers were collected. The compiled suggestions were then incorporated into the app, establishing an active feedback loop fed by the consistently interactive infrastructure. RESULTS Four PPI contributors (one man and three women) were recruited, and 93 items were added/changed in the in-app survey questionnaire in accordance with discussions from the exchange meetings. The exchange meetings emphasized an atmosphere and opportunity for participants to speak up, ensuring frequent opportunities for them to contribute to the research. In March 2020, a public website was created to display real-time outcomes of the number of participants and users' hay-fever-preventative behaviors. In August 2020, a new PPI-implemented AllerSearch app was released. CONCLUSIONS This study marks the first research on clinical smartphone apps for hay fever in Japan that implements PPI throughout its timeline from research and development to the publication of research results. Taking advantage of the distinct perspectives offered by PPI contributors, a step was taken toward actualizing a foundation for an interactive research environment. These results should promote future PPI research and foster the establishment of a social construct that enables PPI efforts in various fields.
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Affiliation(s)
- Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan.
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kumiko Fujisawa
- Department of Public Policy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Masahiro Nakamura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kaori Muto
- Department of Public Policy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Urayasu Hospital, Juntendo University, Chiba, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, Narita, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Ide
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Masashi Nagao
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
- Department of Orthopedic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Abstract
Hospice and palliative care is a framework of care focused on the palliation of a patient's pain and symptoms while attending to the emotional and spiritual needs of the client caregiver. Telehospice and telepalliative care is the use of telehealth services for delivering hospice and palliative care to patients remotely through videoconferencing, telephonic communication, or remote symptom monitoring and can address the needs of both patients and clients. Telehealth-based interventions can provide hospice and palliative care providers the ability to assess and address patient care needs including the delivery of effective pain and symptom management, timelier assessments and medical interventions, increased compliance, and additional teaching opportunities for clients.
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25
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Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives. J Cardiovasc Nurs 2022; 38:E110-E119. [PMID: 37027138 DOI: 10.1097/jcn.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo. AIM The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke. DESIGN AND SETTING A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically. RESULTS "Promoting comfort" stands at the core of PC and was operationalized by "meeting physical care needs," "ensuring communication," "providing psychoemotional care," "providing cognitive stimulation," and "avoiding discussion on death and dying." Caregivers who took care of older adults for a long time have described the use of "cognitive stimulation" to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning "death" to protect patients' feelings, because they believed discussion of death was hurtful. CONCLUSIONS The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.
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26
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Hov R, Bjørsland B, Kjøs BØ, Wilde-Larsson B. Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
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Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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28
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Philip J, Le B, Pasanen L, Rosens E, Wong A, Mendis R, Boughey M, Coperchini M, Moran J, Hynson J, Weil J, Rosenthal M. Palliative Care Clinical Trials: Building Capability and Capacity. J Palliat Med 2021; 25:421-427. [PMID: 34788568 DOI: 10.1089/jpm.2021.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical trials are a key component of expanding the evidence base in palliative care. A key strategic objective of the Victorian Comprehensive Cancer Centre (VCCC), a multisite cancer center alliance, was to increase palliative care clinical trial expertise. The palliative care services within the VCCC alliance presented substantial trial development opportunities with large number of patients and established relationships, but few trial-active centers. Objectives: To establish a multi-site "Building Capability in Palliative Care Clinical Trials" program as a service development, and to assess the strategies, activities, and the outcomes resulting from this program. Methods: A series of strategies and activities were developed linked to the key program objectives of increasing the number of clinical sites and skilled clinicians conducting clinical trials, increasing the number of trials available and patients participating, broadening research opportunities in palliative care, and establishing the program sustainability. Results: In the two years of implementation, the program resulted in the establishment and conduct of several Phase 4 postmarketing pharmacovigilance studies, nine Phase 2 and 3 trials across five palliative care services, and a Phase 1 clinical trial. During the program, 150 patients were recruited to clinical trials, and 258 prospective pharmacovigilance monitoring cases were recorded. Five investigator-initiated trials were developed by clinical trial fellows and achieved competitive (n = 3) or commercial (n = 2) funding. Clinicians reported that undertaking clinical trials had increased attention to the evidence base of care provision, and increased service research activity more broadly. Long-term sustainability remains a challenge, particularly in the context of the COVID-19 pandemic. Conclusions: Clinical trials in palliative care services are feasible, acceptable, and result in increased attention to the evidence base of care. The strategies detailing the framework, activities, and outcomes have been collated to facilitate implementation of clinical trials in other sites and with other trial-naive disciplinary groups.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Fitzroy, Australia.,Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia.,Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Brian Le
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia
| | - Leeanne Pasanen
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Evelien Rosens
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Australia
| | - Aaron Wong
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia.,Palliative Care Service, Austin Health, Heidelberg, Australia
| | - Ruwani Mendis
- Palliative Care Service, Western Health, Footscray, Australia
| | - Mark Boughey
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | | | - Juli Moran
- Palliative Care Service, Austin Health, Heidelberg, Australia
| | - Jenny Hynson
- Palliative Care Service, Royal Children's Hospital, Melbourne, Australia
| | - Jenny Weil
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Rosenthal
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia
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29
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Cardenas V, Rahman A, Giulioni J, Coulourides Kogan A, Enguidanos S. Patient and physician perspectives on engaging in palliative and healthcare trials: a qualitative descriptive study. BMC Palliat Care 2021; 20:158. [PMID: 34645442 PMCID: PMC8515687 DOI: 10.1186/s12904-021-00856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background Researchers are encountering increasing challenges in recruiting participants for palliative and healthcare research. This paper aims to understand challenges to and methods for engaging physicians and seriously ill patients and their caregivers in research studies. Methods Between October 2019 to July 2020, we conducted qualitative interviews with 25 patients, proxies, and caregivers participants who were eligible for a randomized controlled trial of home-based palliative care and 31 physicians from participating accountable care organizations. Using thematic analysis, we analyzed participants’ responses to identify concepts and key ideas within the text. From these initial concepts, core themes around barriers to research and preferred research recruitment approaches were generated. Results Themes from patient and caregiver interviews included time constraints, privacy concerns, lack of research familiarity, disconnect with research institution, self-perceived health status, and concerns with study randomization. Physician-identified barriers focused on time constraints and study randomization. Patient and caregiver recommendations for study recruitment included in-person recruitment, recruitment at healthcare providers’ offices, recruitment via mail, additional study information, and frequent calls. Physician recommendations were related to placement of flyers at clinics, financial incentives, and formal events. Conclusions Findings demonstrated that although patients and caregivers prefer that their physicians recruit them for health-related research studies, physicians identified time constraints as a consistent barrier to research involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00856-6.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
| | - Jenna Giulioni
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, USA
| | - Alexis Coulourides Kogan
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Keck School of Medicine, Department of Family Medicine and Geriatrics, University of Southern California , Alhambra, CA, 91803, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
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30
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The Way Forward: Patients and Families as Members of the Research Team. Cancer Nurs 2021; 44:431-432. [PMID: 34415693 DOI: 10.1097/ncc.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Modigh A, Sampaio F, Moberg L, Fredriksson M. The impact of patient and public involvement in health research versus healthcare: A scoping review of reviews. Health Policy 2021; 125:1208-1221. [PMID: 34376328 DOI: 10.1016/j.healthpol.2021.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 01/18/2023]
Abstract
Many policies promote patient and public involvement (PPI) in health research and healthcare provision. However, research points to uncertainties about its impact. The aim of the article was to compare what types of impact have been reported in reviews of PPI in health research and healthcare, respectively, and to map differences and similarities between the review studies. A review of reviews was undertaken with a search strategy based on the PCC mnemonic for scoping reviews. Four online databases were searched. Studies published in English between the years 2000-2020, using a review-based method and aiming to demonstrate impact of PPI were included, resulting in sixty-one articles. More reviews of PPI impact in healthcare than in health research were found, although the latter included a larger number of empirical studies. Systematic reviews, quality assessment and quantitative studies were less common in health research. Many original studies were from the United Kingdom. In health research, reported impacts most often related to research design and delivery, while in healthcare the most commonly reported impacts were individual health outcomes/clinical outcomes. However, there is still uncertainty about the strength of evidence for PPI, in particular when it comes to collective involvement in healthcare, that is in policymaking and service improvement initiatives at hospitals or the like.
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Affiliation(s)
- Anton Modigh
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
| | - Linda Moberg
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden; Department of Government, Uppsala University, Box 514, 751 20 Uppsala, Sweden.
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
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32
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Hulbert-Williams NJ, Norwood SF, Gillanders D, Finucane AM, Spiller J, Strachan J, Millington S, Kreft J, Swash B. Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliat Care 2021; 20:96. [PMID: 34172029 PMCID: PMC8235846 DOI: 10.1186/s12904-021-00801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting. This study was pre-registered on the Open Science Framework (Ref: 46,033) and retrospectively registered on the ISRCTN registry (Ref: ISRCTN12084782).
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Affiliation(s)
| | - Sabrina F Norwood
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne M Finucane
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Marie Curie Hospice, Edinburgh, UK
| | | | | | | | - Joseph Kreft
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Brooke Swash
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
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33
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Rouncefield-Swales A, Harris J, Carter B, Bray L, Bewley T, Martin R. Children and young people's contributions to public involvement and engagement activities in health-related research: A scoping review. PLoS One 2021; 16:e0252774. [PMID: 34106978 PMCID: PMC8189547 DOI: 10.1371/journal.pone.0252774] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There has been an increasing interest in how children and young people can be involved in patient and public involvement and engagement (PPIE) in health research. However, relatively little robust evidence exists about which children and young people are reported as being involved or excluded from PPIE; the methods reported as being used to involve them in PPIE; and the reasons presented for their involvement in PPIE and what happens as a result. We performed a scoping review to identify, synthesise and present what is known from the literature about patient and public involvement and engagement activities with children and young people in health related research. METHODS Relevant studies were identified by searches in Scopus, Medline, CINAHL, Cochrane and PsychInfo databases, and hand checking of reference lists and grey literature. An adapted version of the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was used as a framework to collate the data. Two reviewers independently screened articles and decisions were consensually made. MAIN FINDINGS A total of 9805 references were identified (after duplicates were removed) through the literature search, of which 233 full-text articles were assessed for eligibility. Forty studies published between 2000 and 2019 were included in the review. The review reveals ambiguities in the quality of reporting of PPIE with children with clear reporting on demographics and health conditions. The review found that children and young people were commonly involved in multiple stages of research but there was also significant variation in the level at which children and young people were involved in PPIE. Evaluation of the impact of children and young people's involvement in PPIE was limited. CONCLUSIONS Consultation, engagement and participation can all offer children and young people worthwhile ways of contributing to research with the level, purpose and impact of involvement determined by the children and young people themselves. However, careful decisions need to be made to ensure that it is suited to the context, setting and focus so that the desired PPIE impacts are achieved. Improvements should be made to the evaluation and reporting of PPIE in research. This will help researchers and funders to better understand the benefits, challenges and impact of PPIE with children and young people on health research.
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Affiliation(s)
| | - Jane Harris
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Toni Bewley
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Rachael Martin
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
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34
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Finucane AM, O'Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med 2021; 4:64. [PMID: 33824407 PMCID: PMC8024379 DOI: 10.1038/s41746-021-00430-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK. .,Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK.
| | - Hannah O'Donnell
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Tilly Gibson-Watt
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Claudia Pagliari
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
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Mitchell SJ, Slowther AM, Coad J, Khan D, Samani M, Dale J. An evaluation of the experiences of young people in Patient and Public Involvement for palliative care research. Palliat Med 2021; 35:793-798. [PMID: 33726608 PMCID: PMC8022075 DOI: 10.1177/0269216321999301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The active involvement of patients and the public in the design and conduct of research (Patient and Public Involvement) is important to add relevance and context. There are particular considerations for involving children and young people in research in potentially sensitive and emotional subject areas such as palliative care. AIM To evaluate the experiences of young people of Patient and Public Involvement for a paediatric palliative care research study. DESIGN Anonymous written feedback was collected from group members about their experiences of Patient and Public Involvement in a paediatric palliative care research study. An inductive thematic analysis of the feedback was conducted using NVivo. SETTING / PARTICIPANTS Young people aged 12-22 years who were members of existing advisory groups at a children's hospital, hospice and the clinical research network in the West Midlands, UK. RESULTS Feedback was provided by 30 young people at three meetings, held between December 2016 and February 2017. Three themes emerged: (1) Involvement: Young people have a desire to be involved in palliative care research, and recognise the importance of the subject area.(2) Impact: Researchers should demonstrate the impact of the involvement work on the research, by regularly providing feedback. (3) Learning: Opportunities to learn both about the topic and about research more widely were valued. CONCLUSIONS Young people want to be involved in palliative care research, and recognise its importance. A continuous relationship with the researcher throughout the study, with clear demonstration of the impact that their input has on the research plans, are important.
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Affiliation(s)
- Sarah J Mitchell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- School of Health Sciences, Queens Medical Centre Campus, University of Nottingham, UK
| | - Dena Khan
- NIHR CRN West Midlands Young Person’s Steering Group, Stafford, Birmingham, UK
| | - Mohini Samani
- NIHR CRN West Midlands Young Person’s Steering Group, Stafford, Birmingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Tutty E, Horsley P, Forbes Shepherd R, Forrest LE. The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences. Palliat Med 2021; 35:437-446. [PMID: 33126839 DOI: 10.1177/0269216320967595] [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: 11/16/2022]
Abstract
BACKGROUND CASCADE is a successful, Australia-first cancer rapid autopsy programme. Patients are recruited to the programme by their clinician once they understand that further treatment has only palliative intent. Despite its value, rapid autopsy is a rare research method owing partly to recruitment challenges. AIM This research aimed to explore (1) how, in practice, clinicians select and recruit patients to the programme and (2) patient experiences of this process. DESIGN This was a qualitative study grounded in phenomenology. CASCADE team members (clinicians and researchers) and patients participated in semi-structured interviews. Data were analysed using an inductive, team-based approach to thematic analysis. PARTICIPANTS Interviews were conducted with 31 participants (11 patients and 20 CASCADE team members). RESULTS Patient selection and recruitment to a rapid autopsy programme is both an art and science. In practice, patient selection is a subjective process that involves assessing a patient's psychosocial suitability for the programme. Trust and rapport are necessary for informing this assessment and to create an environment conducive to discussing rapid autopsy. Clinicians have also crafted their own ways of delivering information about CASCADE, with both clinicians and patients acknowledging that, if not handled sensitively, recruitment could cause distress. Overall, patients were satisfied with the way in which they were recruited. CONCLUSION Findings provide insight into how clinicians successfully select and recruit patients to a rapid autopsy programme and suggests that discussing such topics are acceptable to end-of-life patients. This research also raises thought-provoking questions about the 'gatekeeping' role of clinicians in recruitment.
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Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Philomena Horsley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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Bristol AA, Chaudhry S, Assis D, Wright R, Moriyama D, Harwood K, Brody AA, Charytan DM, Chodosh J, Scherer JS. An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care. Am J Hosp Palliat Care 2021; 38:1242-1249. [PMID: 33438435 DOI: 10.1177/1049909120986121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. METHODS Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. RESULTS We identified 2 themes: "Communication addressing the emotional and physical aspects of disease" and "Filling gaps in care"; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. SIGNIFICANCE OF RESULTS Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.
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Affiliation(s)
- Alycia A Bristol
- 16177University of Utah College of Nursing, Salt Lake City, UT, USA
| | | | - Dana Assis
- 1940Yale New Haven Health, New Haven, CT, USA
| | | | - Derek Moriyama
- 12223Keck School of Medicine of University of Southern California, CA, USA
| | - Katherine Harwood
- Columbia University-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY, USA.,Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - David M Charytan
- Division of Nephrology, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
| | - Jennifer S Scherer
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA.,Division of Nephrology, Department of Internal Medicine, NYU School of Medicine, New York, NY, USA
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Moser A, Melchior I, Veenstra M, Stoffers E, Derks E, Jie KS. Improving the experience of older people with colorectal and breast cancer in patient-centred cancer care pathways using experience-based co-design. Health Expect 2021; 24:478-490. [PMID: 33440059 PMCID: PMC8077111 DOI: 10.1111/hex.13189] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) in quality improvement of oncological care pathways for older patients are rare. OBJECTIVES Improve the care pathway experience of older cancer patients and explore lessons learned regarding how to engage this vulnerable group. DESIGN Experience-Based Co-Design. SETTING AND PARTICIPANTS Older cancer patients, their caregivers and healthcare professionals within colorectal and breast cancer care pathways. INTERVENTIONS Co-design quality improvement teams. MAIN OUTCOME MEASURES Colorectal cancer care pathway touchpoints were (a) availability of a contact person during diagnostic, treatment and aftercare phases; (b) collaboration between physicians and different hospital departments; (c) continuous relationship with same physician; (d) respectful treatment; (e) and information transfer with primary care. Breast cancer care pathway touchpoints were (a) comprehensive information package and information provision, (b) care planning based on patient preferences, (c) continuity of patient-professional relationship and (d) specialized care in case of vulnerability. Challenges related to PPI included (a) ability of older cancer patients to be reflective, critical and think at a collective level; (b) gaining support and commitment of professionals; (d) overcoming cultural differences and power inequalities; and (e) involving researchers and facilitators with appropriate expertise and position. CONCLUSION This multidisciplinary quality improvement project revealed several challenges of PPI with older cancer patients and their caregivers. Research teams themselves need to assume the role of facilitator to enable meaningful PPI of older cancer patients. PATIENT OR PUBLIC CONTRIBUTION Patient and caregiver representatives and advocates were involved in the design, conduct, analysis, interpretation of the data and preparation of this manuscript.
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Affiliation(s)
- Albine Moser
- Research Centre for Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Inge Melchior
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands.,Research Centre for Integrative Patient Centred Health Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Marja Veenstra
- Burgerkracht Limburg (Citizin Power Limburg), Sittard, The Netherlands
| | - Esther Stoffers
- Burgerkracht Limburg (Citizin Power Limburg), Sittard, The Netherlands
| | - Elvira Derks
- Department of Quality Improvement, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Kon-Siong Jie
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands.,Research Centre for Integrative Patient Centred Health Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Melchior I, van der Heijden A, Stoffers E, Suntjens F, Moser A. Patient and public involvement cultures and the perceived impact in the vulnerable context of palliative care: A qualitative study. Health Expect 2021; 24:456-467. [PMID: 33405359 PMCID: PMC8077136 DOI: 10.1111/hex.13186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/27/2020] [Accepted: 12/05/2020] [Indexed: 12/05/2022] Open
Abstract
Background Cultural values are crucial to the practice and impact of patient and public involvement (PPI) in research. Objective To understand different PPI cultures among research teams and the impacts of PPI associated with each culture type. Design A participatory action research design. Setting and participants The setting was 10 palliative care research projects. Seventeen patients and members of the public and 31 researchers participated. Intervention A programme consisting of four components: (1) training and coaching of patients and the public to prepare them for participation in research, (2) tailored coaching of the 10 research teams over 12‐18 months, (3) a community of practice, and (4) a qualitative evaluation. Results We identified three cultures types: relationship cultures, task cultures, and control cultures. We identified four areas of impact: the project aim became more relevant to the target audience, methodological reliability increased, the research products were better able to reach the public, and the awareness increased, associated with behavioural changes, among researchers regarding PPI. Discussion A relationship culture appears to be long‐lasting due to impacting the behaviours of the researchers during future projects. Different cultural types require different types of patients and researcher participants, assigned to different tasks. Conclusions Further research remains necessary to investigate the support required by researchers to enable relationship‐ and task‐oriented PPI cultures. Patient or public contribution Patient advocates and representatives contributed to our research team throughout the entire research process, as well as within the 10 implementation projects.
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Affiliation(s)
- Inge Melchior
- Zorgbelang Limburg (currently Burgerkracht Limburg), Sittard, the Netherlands.,Zuyd University of Applied Sciences, Heerlen, the Netherlands.,Maastricht University, Maastricht, the Netherlands
| | | | - Esther Stoffers
- Zorgbelang Limburg (currently Burgerkracht Limburg), Sittard, the Netherlands
| | - Frits Suntjens
- Zorgbelang Limburg (currently Burgerkracht Limburg), Sittard, the Netherlands
| | - Albine Moser
- Zuyd University of Applied Sciences, Heerlen, the Netherlands.,Maastricht University, Maastricht, the Netherlands
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Johnson H, Ogden M, Brighton LJ, Etkind SN, Oluyase AO, Chukwusa E, Yu P, de Wolf-Linder S, Smith P, Bailey S, Koffman J, Evans CJ. Patient and public involvement in palliative care research: What works, and why? A qualitative evaluation. Palliat Med 2021; 35:151-160. [PMID: 32912087 PMCID: PMC7797607 DOI: 10.1177/0269216320956819] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Public involvement is increasingly considered a prerequisite for high-quality research. However, involvement in palliative care is impeded by limited evidence on the best approaches for populations affected by life-limiting illness. AIM To evaluate a strategy for public involvement in palliative care and rehabilitation research, to identify successful approaches and areas for improvement. DESIGN Co-produced qualitative evaluation using focus groups and interviews. Thematic analysis undertaken by research team comprising public contributors and researchers. SETTING/PARTICIPANTS Researchers and public members from a palliative care and rehabilitation research institute, UK. RESULTS Seven public members and 19 researchers participated. Building and maintaining relationships, taking a flexible approach and finding the 'right' people were important for successful public involvement. Relationship building created a safe environment for discussing sensitive topics, although public members felt greater consideration of emotional support was needed. Flexibility supported involvement alongside unpredictable circumstances of chronic and life-limiting illness, and was facilitated by responsive communication, and opportunities for in-person and virtual involvement at a project- and institution-level. However, more opportunities for two-way feedback throughout projects was suggested. Finding the 'right' people was crucial given the diverse population served by palliative care, and participants suggested more care needed to be taken to identify public members with experience relevant to specific projects. CONCLUSION Within palliative care research, it is important for involvement to focus on building and maintaining relationships, working flexibly, and identifying those with relevant experience. Taking a strategic approach and developing adequate infrastructure and networks can facilitate public involvement within this field.
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Affiliation(s)
- Halle Johnson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Margaret Ogden
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Susanne de Wolf-Linder
- Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Pam Smith
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Sylvia Bailey
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
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Eklund R, Jalmsell L, Kreicbergs U, Alvariza A, Lövgren M. Children's experiences of the family talk intervention when a parent is cared for in palliative home care-A feasibility study. DEATH STUDIES 2020; 46:1655-1666. [PMID: 33054633 DOI: 10.1080/07481187.2020.1829747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to explore the feasibility of the family talk intervention (FTI) and its acceptability to dependent children when a parent is cared for in palliative home care. The main goal of FTI is to increase family communication about the illness. The present paper derives from a pilot study and is based on 25 children's reports, involving both questionnaires and interviews, after participation. A majority of the children appreciated the structure and content of FTI. They felt seen, heard, and acknowledged by the interventionists and recommended FTI to other children in similar situations.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
| | - Li Jalmsell
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Breast cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Ludwig C, Graham ID, Gifford W, Lavoie J, Stacey D. Partnering with frail or seriously ill patients in research: a systematic review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:52. [PMID: 32944284 PMCID: PMC7488581 DOI: 10.1186/s40900-020-00225-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND The expectation to include patients as partners in research has steadily gained momentum. The vulnerability of frail and/or seriously ill patients provides additional complexity and may deter researchers from welcoming individuals from this patient population onto their teams. The aim was to synthesize the evidence on the engagement of frail and/or seriously ill patients as research partners across the research cycle. METHODS A systematic review was conducted using PRISMA guidelines. A search strategy included MEDLINE®, EMBASE®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to April, 2019. Eligible studies were peer-reviewed qualitative, quantitative, and mixed methods research reporting on the engagement of frail and/or seriously ill patients as partners on research teams. The Mixed Methods Appraisal Tool was used to appraise study quality. Narrative analysis was conducted. RESULTS Of 8763 citations, 30 were included. Most studies included individuals with cancer on the research team (60%). Barriers included: lack of time and resources (50%), discontinuity in contribution (37%), and concerns for well-being (33%). Facilitators included: trust and mutual respect (60%), structural accessibility (57%), flexibility in timing and methods of engagement (43%), and attention to care and comfort, (33%). Perceived impacts for patients included: renewed personal sense of agency (37%) and emotional/peer support (37%). Impacts for researchers included sensitization to the lived experience of disease (57%) and an increased appreciation of the benefits of patient engagement (23%). Research design, execution, and outcomes, developed with patients, were deemed more suitable, relevant and reflective of patients' priorities. CONCLUSIONS There is emerging evidence to suggest that research partnerships with frail and/or seriously ill patients can be achieved successfully. Patients mostly report benefit from partnering with research teams. Frailty and/or serious illness do present legitimate concerns for their well-being but appear to be successfully mitigated when researchers ensure that the purpose of engagement is well-defined, the timing and methods of engagement are flexible, and the practical and emotional needs of patient partners are addressed throughout the process. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).
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Affiliation(s)
- Claire Ludwig
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Ian D. Graham
- University of Ottawa, Faculty of Medicine, School of Epidemiology and Public Health, Ottawa, Ontario, Canada and Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Wendy Gifford
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Josee Lavoie
- Geriatric Psychiatry Program, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4 Canada
| | - Dawn Stacey
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
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Breen LJ, Johnson AR, O'Connor M, Howting D, Aoun SM. Challenges in Palliative Care Research on Family Caregivers: Who Volunteers for Interviews? J Palliat Med 2020; 24:112-115. [PMID: 32255736 DOI: 10.1089/jpm.2019.0672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Interviews are a common method of data collection in palliative care research because they facilitate the gathering of rich, experiential data that are important for theory and practice. What is less clear is the extent to which those interviewed are representative of the larger group. Objective: The aim of this study was to determine if family caregivers who volunteer to be interviewed were similar or different to those who do not. Design: This study used data from the Caregiving and Bereavement study, a prospective, longitudinal mixed-methods study of family caregivers' general health, quality of life, and grief. Setting/Subjects: The 16 caregivers who volunteered to be interviewed were compared to the 20 who did not. Measurements: Comparisons were made in terms of the caregivers' demographic characteristics as well as measures of their quality of life, general health, general grief, and caregiver prolonged grief (i.e., before death). Results: Compared to caregivers who did not volunteer for an interview, those who volunteered were significantly older and reported less caregiver prolonged grief. Logistic regression showed that for each 1-unit increase in the caregiver prolonged grief score, individuals were 13% less likely to agree to an interview. Conclusions: Research findings based upon family caregivers who volunteer for research interviews might not provide a full picture of their experiences and needs. Researchers are encouraged to consider strategies that sample broadly and promote the participation of the full range of family caregivers in research to address the neglected areas of pre- and postdeath bereavement care.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrew R Johnson
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Denise Howting
- Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Samar M Aoun
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Victoria, Australia
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