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Busch H. Evidence of an Indirect Effect of Generativity on Fear of Death Through Ego-Integrity Considering Social Desirability. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:998-1015. [PMID: 34874193 DOI: 10.1177/00302228211053159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent research has shown an indirect effect of generativity on fear of death through ego-integrity in older adults. The present paper aims at demonstrating that the indirect effect is valid even when controlling for social desirability. For that purpose, participants (N = 260 German adults) in study 1 provided self-reports on generativity, ego-integrity, fear of death, and social desirability. Analyses confirmed the indirect effect when the tendency for socially desirable responding was statistically controlled. In study 2, participants (N = 133 German adults) also reported on their generativity and ego-integrity. Fear of death, however, was assessed with a reaction time-based measure (i.e., the Implicit Associations Test). Again, the indirect effect could be confirmed. Taken together, the studies lend further credibility to the extant findings on the indirect effect of generativity on fear of death through ego-integrity.
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Merrilees J, Mayotte C, Vong E, Matice M, Prioleau C. Using personal narrative to promote person-centered values in aging, dementia, and caregiving. Front Neurol 2023; 14:1167895. [PMID: 37789887 PMCID: PMC10544890 DOI: 10.3389/fneur.2023.1167895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Personal narrative is a powerful way to include people in their care and to understand their values that drive their needs. In this paper, we describe a program designed to teach oral history to clinicians and trainees in the field of aging, dementia and caregiving. The training uses empathic listening, open-ended interviewing, and the discovery of individual values and experience to breakdown stigma and preconceptions of what it means to age with cognitive impairment. Sharing these stories of aging, dementia, and caregiving becomes an important tool to break down stereotypes, promote person-centered care, and advocate for the unheard. The profound impact of the oral history process is felt by the narrator, the interviewer and the listener. Human beings are wired for stories, and oral history taps into that power to connect us and provide better care through better understanding.
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Affiliation(s)
- Jennifer Merrilees
- University of California San Francisco Memory and Aging Center and Global Brain Health Institute, San Francisco, CA, United States
| | | | - Erin Vong
- Voice of Witness, San Francisco, CA, United States
| | - Mindy Matice
- University of California San Francisco Memory and Aging Center and Global Brain Health Institute, San Francisco, CA, United States
| | - Caroline Prioleau
- University of California San Francisco Memory and Aging Center and Global Brain Health Institute, San Francisco, CA, United States
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Lindhardt CL, Winther SB, Pfeiffer P, Ryg J. Information provision to older patients receiving palliative chemotherapy: a quality study. BMJ Support Palliat Care 2021:bmjspcare-2021-003074. [PMID: 34969697 DOI: 10.1136/bmjspcare-2021-003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options. METHODS Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65-76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke. RESULTS The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth. CONCLUSIONS Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.
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Affiliation(s)
- Christina Louise Lindhardt
- Research Department of Patient Communication, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Stine Brændegaard Winther
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S. Timely community palliative and end-of-life care: a realist synthesis. BMJ Support Palliat Care 2021:bmjspcare-2021-003066. [PMID: 34887313 DOI: 10.1136/bmjspcare-2021-003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community-based and home-based palliative and end-of-life care (PEoLC) services, often underpinned by primary care provision, are becoming increasingly popular. One of the key challenges associated with them is their timely initiation. The latter requires an accurate enough prediction of how close to death a patient is. METHODS Using 'realist synthesis' tools, this review sought to develop explanations of how primary care and community PEoLC programmes generate their outcomes, with the explanations presented as context-mechanism-outcome configurations. Medline, Embase, CINAHL, PsycINFO, Web of Science, ASSIA, Sociological Abstracts and SCIE Social Care Online were originally searched. A multistage process of focusing the review was employed, with timely identification of the EoL stage and timely initiation of associated services representing the final review focus. Synthesised sources included 21 full-text documents and 324 coded abstracts, with 253 'core contents' abstracts generating >800 codes. RESULTS Numerous PEoLC policies and programmes are embedded in a framework of Preparation and Planning for Death and Dying, with identification of the dying stage setting in motion key systems and services. This is challenged by: (1) accumulated evidence demonstrating low accuracy of prognostic judgements; (2) many individuals' orientation towards Living and Hope; (3) expanding grey zones between palliative and curative care; (4) the complexity of referral decisions; (5) the loss of pertinent information in hierarchical relationships and (6) the ambiguous value of having 'more time'. CONCLUSION Prioritising temporal criteria in initiating PEoLC services is not sufficiently supported by current evidence and can have significant unintended consequences. PROSPERO REGISTRATION NUMBER CRD42018097218.
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Affiliation(s)
- Mila Petrova
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffied Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Foster Akard T, Dietrich MS, Friedman DL, Wray S, Gerhardt CA, Given B, Hendricks-Ferguson VL, Hinds PS, Cho E, Gilmer MJ. Effects of a Web-Based Pediatric Oncology Legacy Intervention on Parental Coping. Oncol Nurs Forum 2021; 48:309-316. [PMID: 33855995 DOI: 10.1188/21.onf.309-316] [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: 11/17/2022]
Abstract
OBJECTIVES To examine the effects of a legacy intervention for children with advanced cancer and their parents on parental coping strategies. SAMPLE & SETTING The authors recruited 150 children with advanced cancer and their parents via Facebook. METHODS & VARIABLES Child-parent dyads were randomly assigned to the intervention or usual care. Children in the intervention group created electronic digital storyboards to assist in documenting their legacies. Parents completed the Responses to Stress Questionnaire at baseline/preintervention (T1) and postintervention (T2). Linear regressions were used to test for differences between the groups in the amount of change from T1 to T2 for each parent coping score. RESULTS Although not statistically significant, the legacy intervention showed trends toward increasing use of primary control and disengagement coping strategies in parents over time relative to usual care. IMPLICATIONS FOR NURSING Nurses can help to facilitate opportunities for parents to use adaptive coping strategies. More work is needed to determine how legacy interventions in pediatric oncology can facilitate adaptive coping strategies for parents of children with cancer.
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Bluck S, Mroz EL, Wilkie DJ, Emanuel L, Handzo G, Fitchett G, Chochinov HM, Bylund CL. Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy. Am J Hosp Palliat Care 2021; 39:54-61. [PMID: 33926243 DOI: 10.1177/10499091211011712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested. AIM The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy. DESIGN Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions. PARTICIPANTS Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited. RESULTS Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1-12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r = .46), greater spiritual distress (r = .44), and lower quality of life (r = -.56). CONCLUSION Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.
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Affiliation(s)
- Susan Bluck
- Department of Psychology, 3463University of Florida, Gainesville, FL, USA
| | - Emily L Mroz
- Department of Psychology, 3463University of Florida, Gainesville, FL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, 3463University of Florida, Gainesville, FL, USA
| | - Linda Emanuel
- Division of General Internal Medicine, 3270Northwestern University, Chicago, IL, USA
| | | | - George Fitchett
- Department of Religion, Health and Human Values, 2468Rush University Medical Center, Chicago, IL, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology CancerCare Manitoba, , Winnipeg, Manitoba, Canada.,Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,College of Medicine, 3463University of Florida, Gainesville, FL, USA
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Roikjaer SG, Timm H, Simonÿ C. First steps to integrate general palliative care into a cardiac hospital setting - using dialogue-based workshops. Scand J Caring Sci 2021; 36:203-214. [PMID: 33656179 DOI: 10.1111/scs.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/15/2021] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart failure is a chronic, life-threatening illness with multiple acute events. Palliative care alongside standard treatment is recommended for these patients. There is a lack of knowledge and research literature on how to integrate palliative care interventions for heart failure patients in a general hospital setting. AIM The aim of this study was to produce new insight for developing and integrating general palliative care into heart failure treatment. METHODS Guided by action research, we conducted an interdisciplinary workshop inspired by Tsoukas dialogue theory, where tension between perspectives is used as a facilitator of dialogue and the generation of new insights. Perspectives were incorporated through selected patient narratives and professionals' experiences. Data from the workshop were analysed using a thematic analysis. The findings are interpreted with Kleinman's theory on illness and disease and discussed using Tsoukas theory and additional research. RESULTS General palliative care must be initiated from the patient's perspective and wishes. Doing so requires understanding and uniting the different perspectives and objectives of heart failure treatment and palliative care. One way of doing this is through a narrative approach with interdisciplinary teams. However, this requires organisational efforts and adaptation to the specific cardiac setting. CONCLUSION Integrating palliative care principles into cardiology is a complex issue. Developing palliative care for heart failure patients requires more than simply designing a set of guidelines. Rather, a wider outlook involving perspectives, competences and organisation is necessary. Acknowledging such considerations, we designed an intervention centred on three elements: standard heart failure treatment, integrated sessions applying a narrative approach and monthly interdisciplinary conferences. RELEVANCE This article adds to the current research literature on changing palliative care practice for heart failure patients and the value of integrating different perspectives.
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Affiliation(s)
- Stine Gundtoft Roikjaer
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Medicine 2, Department of Cardiology, Naestved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark.,REHPA, the Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Helle Timm
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,REHPA, the Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Charlotte Simonÿ
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Research, Naestved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark
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Boles JC, Jones MT. Legacy perceptions and interventions for adults and children receiving palliative care: A systematic review. Palliat Med 2021; 35:529-551. [PMID: 33487090 DOI: 10.1177/0269216321989565] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Legacy has been invoked as a means for strengthening human attachments, continuing bonds, and ensuring that individuals will be remembered; however, little is known about the spectrum of approaches to, outcomes associated with, and best practices for legacy interventions. AIM To systematically review research on legacy perceptions and interventions in pediatric and adult palliative care recipients. DESIGN A systematic mixed studies review synthesizing quantitative, qualitative, and mixed-methods study findings using PRISMA guidelines. DATA SOURCES PubMed, PsycINFO, and CINAHL databases were searched on October 1, 2020. GRADE criteria were used to assess quality of quantitative reports, and the Johns Hopkins Evidence Level and Quality Guide was used to rate qualitative, mixed methods, and review articles. Data were synthesized using integrative thematic analysis. RESULTS The 67 studies reviewed describe a variety of legacy perceptions and interventions with adult and pediatric patients receiving palliative care. Statistically significant improvements in various dimensions of wellbeing are documented, with significant reduction in incidence and symptoms of depression in adults. Studies highlight the utility, feasibility, and perceived benefits of legacy interventions according to adult patients and their caregivers, and parents/caregivers of pediatric patients. CONCLUSIONS Though future research with high-quality, experimental designs is needed, the positive outcomes associated with legacy interventions are documented in adult patient populations; additionally, the application of legacy interventions for children with serious illnesses receiving palliative care is reasonable based on the existing body of evidence. A consistent and operational concept of legacy is still needed for future research and practice.
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Affiliation(s)
- Jessika C Boles
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Maile T Jones
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Understanding Existential Anxiety and the Soothing Nature of Nostalgia in Life With Incurable Esophageal Cancer: A Phenomenological Hermeneutical Investigation of Patient Narratives. Cancer Nurs 2021; 45:E291-E298. [PMID: 33443956 DOI: 10.1097/ncc.0000000000000916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research has identified how people living with incurable esophageal cancer experience existential concerns. OBJECTIVE The aim of this study was to examine the phenomenon of existential anxiety when living with esophageal cancer in the context of receiving general palliative care in a hospital setting. METHODS This qualitative study is inspired by phenomenological and hermeneutical aspects of the philosophies of Ricoeur and Heidegger. Applying Heidegger's theory of existential anxiety and nostalgia, we interpreted the narratives of 18 patients receiving palliative care due to incurable esophageal cancer. RESULTS The patients experienced existential anxiety at the loss of a future and homeliness when receiving palliative care. Their existence was reduced to the present, with a break in temporal continuity. An anxious mood permeated their entire being-in-the-world in an unhomelike way. Despite this, patients initiated a restoration of home and meaning expressed as a soothing sense of nostalgia that served as an atmospheric, safe space allowing them to inhabit the borderline between past, present, and future. CONCLUSIONS The study suggests an empirical interpretation of the existential anxiety patients experience when receiving palliation for incurable esophageal cancer. It sheds light on how these patients would benefit from healthcare professionals inviting them to narrate significant aspects of their life stories in which the soothing presence of nostalgia can be supported. IMPLICATION FOR PRACTICE Providing care conditions for a life heading toward death, where the patient can live alongside anxiety, involves focusing on "being with" the patient and on incorporating a nostalgic dimension to facilitate soothing restoration of home for patients.
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Acorn M. The integration of personal narratives into hospital-based palliative care can relieve patient psychosocial and existential suffering. Evid Based Nurs 2021; 24:19. [PMID: 31871039 DOI: 10.1136/ebnurs-2019-103207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Michelle Acorn
- NP/Nursing, University of Toronto Lawrence S Bloomberg Faculty of Nursing, Janetville, Ontario, Canada
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11
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Roikjær SG, Simonÿ CP, Timm HU. Qualitative study to explore what patients with heart failure find significant during integrated palliative care sessions in a Danish clinic. BMJ Open 2020; 10:e043955. [PMID: 33384400 PMCID: PMC7780519 DOI: 10.1136/bmjopen-2020-043955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In the field of palliative care (PC) as it is integrated into heart failure (HF) treatment, it is essential to explore the patient experience and build on this knowledge for the further development of PC practice and policy. Based on an intervention study, this paper explores what patients with HF find significant in integrated sessions using a narrative S' approach. DESIGN We conducted a semistructured interview study with a qualitative analysis focused on meaning making. The study follows the guidelines of Consolidated Criteria for Reporting Qualitative Research. PARTICIPANTS AND SETTING The inclusion criteria for the PC intervention were (1) a new diagnosis of HF, (2) follow-up treatment at this local Danish HF clinic and (3) informed consent to participate in the integrated PC intervention. The only exclusion criterion was if the patient was already engaged in a PC programme. 20 patients agreed to participate in the intervention, and 12 of these completed the S' approach sessions and participated in this interview study. RESULTS Overall, the analysis showed that the integrated S' approach sessions were successful in joining an embodied patient perspective with a medical perspective. The thematic analysis resulted in three themes supporting the overall findings: sessions bring comfort, telling your story provides a sense of meaningfulness, and integrating perspectives of HF into everyday life. CONCLUSION The method using the S' approach in integrated PC and HF sessions was significant in various ways. First, patients experienced a calm and safe atmosphere and perceived that the nurse was truly interested in them. Second, the integrated sessions based on the S' approach were able to bring comfort to lived physical, psychosocial and existential issues. Last, it allowed patients to combine their embodied understanding of HF with a medical perspective, thereby finding meaning in the sense of how everything is connected.
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Affiliation(s)
- Stine Gundtoft Roikjær
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Medicine 2 Cardiology, Næstved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark
- REHPA, Knowledge Center for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Charlotte Paaske Simonÿ
- Institute for Public Health, University of Aarhus, Aarhus, Denmark
- Department of Research, Næstved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark
| | - Helle Ussing Timm
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- REHPA, Knowledge Center for Rehabilitation and Palliative Care, Nyborg, Denmark
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Bergenholtz H, Missel M, Timm H. Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses. BMC Palliat Care 2020; 19:168. [PMID: 33138799 PMCID: PMC7607873 DOI: 10.1186/s12904-020-00675-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting. Aim The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease. Methods This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting. Results This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries. Conclusion The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12904-020-00675-1.
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Affiliation(s)
- Heidi Bergenholtz
- Holbaek Hospital, Region Zealand, Smedelundsgade 60, 4300, Holbæk, Denmark. .,REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
| | | | - Helle Timm
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark
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Sinatora F, Di Florio N, Traverso A, Zanato S, Porreca A, Tremolada M, Tumino M, Marzollo A, Mainardi C, Gabelli M, Calore E, Pillon M, Cattelan C, Messina C, Basso G. A mixed-methods study of the disease experience in hematopoietic stem cell transplantation survivors: the contribution of text analysis. J Psychosoc Oncol 2020; 38:728-745. [PMID: 32907524 DOI: 10.1080/07347332.2020.1814932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Few studies have detected qualitative and quantitative aspects of patients who underwent HSCT during childhood. The aims of this study are to explore the most recurrent narrative themes of HSCT experience in families five years after the procedure, and to observe statistical correlations between meaning attributed to the experience and defined variables. METHODS Thirty-five families of pediatric HSCT survivors participated in the research. Both survivors and their families were asked to write a brief composition about their disease experiences. Qualitative analysis of the texts was performed using the T-LAB software. Information about medical aspects and psychological problems in HSCT survivors were collected with interviews and administering the Child Behavior Checklist 6-18. RESULTS HSCT survivor families that reported the presence of externalizing and internalizing symptoms focused on thematic areas concerning broken families with separation between parents and the affected child versus healthy children. CONCLUSIONS Long term psychological problems seem to be connected to the perception of family disruption. Specifically, family relationships seem to be the factor that protects from or enhances the risk of psychopathology in HSCT survivors. Moreover, the use of metaphoric terms to refer to HSCT presents higher associations with psychopathology. On the contrary, the possibility of referring directly to the transplantation is associated with psychological well-being. It is important to consider the family as a group in order to improve care.
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Affiliation(s)
- Francesco Sinatora
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Nicoletta Di Florio
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Annalisa Traverso
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Silvia Zanato
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Alessio Porreca
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marta Tremolada
- Department of Development and Social Psychology, University of Padua, Padua, Italy
| | - Manuela Tumino
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Antonio Marzollo
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Chiara Mainardi
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Maria Gabelli
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Elisabetta Calore
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marta Pillon
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Chiara Cattelan
- Psychiatric Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Chiara Messina
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Giuseppe Basso
- Haematology-Oncology Division, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Dunning TL. Palliative and End-of-Life Care: Vital Aspects of Holistic Diabetes Care of Older People With Diabetes. Diabetes Spectr 2020; 33:246-254. [PMID: 32848346 PMCID: PMC7428665 DOI: 10.2337/ds20-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Palliative and end-of-life care and advance care planning are important components of holistic diabetes management, especially for older people with a long duration of diabetes and comorbidities who experience unpleasant symptoms and remediable suffering. Many diabetes clinicians do not have conversations about advance care planning with people with diabetes, often because they are reluctant to discuss these issues and are not familiar with palliative care. This article outlines palliative, terminal, and end-of-life care for older people with type 1 or type 2 diabetes and suggests when to consider changing the focus on tight blood glucose control to a focus on safety and comfort. It proposes strategies to incorporate palliative and end-of-life care into personalized holistic diabetes care, determined with older people with diabetes and their families through shared decision-making.
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Affiliation(s)
- Trisha Lynette Dunning
- Centre for Quality and Patient Safety Research, Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Geelong, Australia
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Collins A, Ayre S, Brulotte T, Crowe K, Nekolaichuk C. A Retrospective Thematic Analysis of Patient, Family, and Staff Creative Art Tiles Developed on a Tertiary Palliative Care Unit. Am J Hosp Palliat Care 2020; 38:266-275. [PMID: 32597213 DOI: 10.1177/1049909120935833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Clinical use of the creative arts in palliative care is well established, yet there are few evaluation studies of these programs. METHODS In this first phase of a 3-phase evaluation of a creative arts program entitled "Tile Tales," we conducted a retrospective thematic analysis of 85 painted tiles and accompanying stories that were publically displayed on a tertiary palliative care unit. Each story was independently coded, using content analysis. Themes were derived through consensus, using the constant comparative method. RESULTS Tiles were created by staff (n = 36, 42%), family (n = 32, 38%), patients (n = 9, 11%), or patients and family (n = 8, 9%). Six major themes emerged from the artwork: "Spirituality," "Relationships," "Journey," "Story," "Symbolism," and "Paradox." SIGNIFICANCE OF RESULTS These results illustrate how the creative arts can support the expression of diverse palliative care experiences, for patients, their families and palliative care staff, when words alone may not suffice.
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Affiliation(s)
- Andrew Collins
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Sandy Ayre
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Tiffany Brulotte
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Kim Crowe
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada.,Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Palliative Institute, Covenant Health, Edmonton, Alberta, Canada
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Dignity-conserving care for persons with palliative care needs — identifying outcomes studied in research: An integrative review. Palliat Support Care 2020; 18:722-740. [DOI: 10.1017/s1478951520000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesWith people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized.MethodsAn integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis.ResultsSeven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of “Performance, symptoms and emotional concerns” and “End-of-life and existential aspects”. Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as “Dignity-related distress” and “Quality of life” were common. However, the results lacked concrete communication outcomes.Significance of resultsThe results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.
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Heggs K. Research Roundup. Int J Palliat Nurs 2020; 26:46-48. [PMID: 32022635 DOI: 10.12968/ijpn.2020.26.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- Karen Heggs
- Lecturer in Adult Nursing, University of Manchester, UK
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