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Snijders RAH, Brom L, Simons SO, Langenberg SMCH, van der Linden YM, Raijmakers NJH. Referrals to Palliative Care Services for Hospitalised COVID-19 Patients: A Systematic Literature Review. Am J Hosp Palliat Care 2024; 41:1085-1093. [PMID: 37975523 DOI: 10.1177/10499091231215797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The increase in the incidence of the coronavirus disease 2019 (COVID-19) led to more hospital admissions and deaths, and coincided with an increased need for palliative care. The new circumstances required palliative care services to be flexible and to develop response strategies. AIM To synthesise studies including COVID-19 patients to gain insight into how many patients were referred to hospital-based palliative care services, the characteristics and palliative care needs of these patients and the reasons for referral. DESIGN A systematic literature search was conducted in January 2022 using the PubMed, Embase, CINAHL, and PsycInfo databases. RESULTS Twenty-seven studies were identified. The results show that in 16% of all COVID-19 inpatients and 55% of all deceased COVID-19 inpatients were referred to a palliative care service. The median time from hospital admission to referral was 4 days and from referral to death was 2 days. COVID-19 inpatients were frequently referred for end-of-life care management (52%), had ≥1 comorbidities (84%), and suffered from shortness of breath/dyspnea (45%). CONCLUSIONS The care provided was generally acute, with a high proportion of end-of-life care referrals and a short time period from hospital admission to referral and from referral to death. This highlights the importance of early integration of palliative care into emergency department (ED) care of critically ill patients.
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Affiliation(s)
- Rolf A H Snijders
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Simone M C H Langenberg
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvette M van der Linden
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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Spacey A, Heaslip V, Szczepura K. Exploring end of life care provision during medical imaging in hospitals: Analysis of survey data from the UK radiography workforce. Radiography (Lond) 2024; 30:1308-1316. [PMID: 39053187 DOI: 10.1016/j.radi.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Patients receiving end-of-life care often undergo medical imaging examinations in hospitals to inform symptom management and care. Yet little is known about the experiences of the radiography workforce who deliver it. This study aims to describe and explore experiences of the UK radiography workforce delivering medical imaging as part of patients' end-of-life care. METHODS A mixed method cross-sectional online survey disseminated via social media and national organisations from September 2023 to January 2024. Diagnostic radiographers, assistant practitioners and radiology assistants involved in the medical imaging of patients receiving end-of-life care in UK hospitals. RESULTS 120 valid responses were received. Most respondents received no education/training (91.6%) on the role of medical imaging in end-of-life care, despite 87.7% expressing a need for education, particularly around adopting supportive/palliative-centric communication techniques. Although most respondents (89.2%) had heard of end-of-life care, some had difficulty understanding the role of medical imaging in end-of-life care. Insufficient information provided on imaging requests hindered the workforces' ability to determine and understand the appropriate use of medical imaging during end-of-life care. These uncertainties exacerbated negative emotions, with 80.8% of respondents indicating that they felt emotional during or after imaging patients on end-of-life care. CONCLUSION Educational and policy needs were identified around facilitating more supportive/palliative-centric communication techniques and providing the radiography workforce with the knowledge to better understand, explain, deliver and where necessary, challenge the use of medical imaging in end-of-life care. IMPLICATIONS FOR PRACTICE This study has evidenced the important role the radiography workforce play in generalist end-of-life care. However, there is a need for training to support practitioners as well as appropriate policies to develop supportive and high-quality end-of-life care in medical imaging.
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Affiliation(s)
- A Spacey
- School of Health and Society, University of Salford, UK.
| | - V Heaslip
- School of Nursing Society, University of Salford, UK.
| | - K Szczepura
- School of Health and Society, University of Salford, UK.
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Singh GK, Mudge A, Matthews R, Yates P, Phillips JL, Virdun C. Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM). BMC Palliat Care 2024; 23:177. [PMID: 39026237 PMCID: PMC11256639 DOI: 10.1186/s12904-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
| | - Alison Mudge
- Greater Brisbane Medical School, The University of Queensland, Herston, QLD, Australia
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Robyn Matthews
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Jane L Phillips
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Claudia Virdun
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
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Alshammari F, Sim J, Mcerlean G, Lapkin S. Registered Nurses' beliefs about end-of-life care: A mixed method study. Nurs Open 2023; 10:7796-7810. [PMID: 37846434 PMCID: PMC10643821 DOI: 10.1002/nop2.2027] [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: 04/06/2023] [Revised: 08/04/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
AIMS To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care. DESIGN A sequential explanatory mixed methods study. METHOD An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021. RESULTS A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.' IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.
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Affiliation(s)
- Fares Alshammari
- School of NursingUniversity of WollongongNew South WalesWollongongAustralia
- College of Applied Medical SciencesUniversity of Hafr Al BatinHafr Al BatinKingdom of Saudi Arabia
| | - Jenny Sim
- School of NursingUniversity of WollongongNew South WalesWollongongAustralia
- School of Nursing & MidwiferyUniversity of NewcastleNew South WalesCallaghanAustralia
- World Health Organization Collaborating Centre for Nursing, Midwifery & Health DevelopmentUniversity of Technology SydneySydneyAustralia
| | - Gemma Mcerlean
- School of NursingUniversity of WollongongNew South WalesWollongongAustralia
| | - Samuel Lapkin
- School of NursingUniversity of WollongongNew South WalesWollongongAustralia
- Discipline of Nursing, Faculty of HealthSouthern Cross University, Gold Coast CampusNew South WalesLismoreAustralia
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Devik SA, Lersveen GL. Specialist and Primary Physicians' Experiences and Perspectives of Collaboration While Caring for Palliative Patients-A Qualitative Study. Healthcare (Basel) 2023; 11:2188. [PMID: 37570428 PMCID: PMC10419283 DOI: 10.3390/healthcare11152188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to explore and describe how physicians in hospitals and municipalities experience their roles and interactions in the care of palliative patients. Pair interviews were performed with seven physicians working in hospitals, primary care and nursing homes in Mid-Norway. Systematic text condensation was used to analyse the data, resulting in three main themes: The boundaries of palliative care, Alternating understandings of roles and Absence of planning. The physicians' interactions with palliative patients appeared as a fragmented distribution of tasks rather than a real collaboration with shared responsibility. At both levels, the physicians seemed to assume withdrawn roles as a reaction to unclear and unspoken expectations and to avoid interfering with others' responsibilities. Moreover, their understanding of palliative care and which groups should be included varied. Realising a collaboration between physicians that is beneficial for both patients and physicians, greater openness and real arenas for discussion and decision-making support are required.
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Affiliation(s)
- Siri Andreassen Devik
- Centre for Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, 8026 Bodø, Norway
| | - Gunhild Lein Lersveen
- Centre for Development of Institutional and Home Care Services in Trøndelag, 7650 Verdal, Norway;
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Dignity in the care of people with advanced illness in emergency services from the perspective of family members: A qualitative study. Int Emerg Nurs 2022; 65:101216. [DOI: 10.1016/j.ienj.2022.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/26/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
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Silvia T, Gianfranco M, Cristina A, Sara A, Carlo P, Giovanna A. Consultations’ demand for a hospital palliative care unit: how to increase appropriateness? Implementing and evaluating a multicomponent educational intervention aimed at increase palliative care complexity perception skill. BMC Palliat Care 2022; 21:90. [PMID: 35619110 PMCID: PMC9133822 DOI: 10.1186/s12904-022-00968-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2022] [Indexed: 02/06/2023] Open
Abstract
Background Planned, multidisciplinary teams’ discussions of cases are common in cancer care, but their impact on patients’ outcome is not always clear. Palliative care (PC) needs might emerge long before the last weeks of life. Many palliative care patients could be managed from the usual care staff, if appropriately trained; specialist palliative care should be provided to patients with more complex needs. Staff needs adequate training, so that only patients presenting a higher complexity are properly referred to the second level (“specialized”) PC services. In the considered hospital setting, “tumour boards” (multidisciplinary discussions) refer often to a low number of patients. Overall complexity of patients’ needs is hardly considered. Methods A mixed method pilot study with data triangulation of professionals’ interviews and an independently structured evaluation of complexity of referred patients, before and after the intervention, using the PALCOM instrument. We trained four teams of professionals to deliver first-level palliation and to refer patients with complex needs detected in multidisciplinary discussions. A multicomponent, first level PC educational intervention, including information technology’s adaptation, a training course, and bedside training was offered from the specialized PC Services, to all the HPs involved in multidisciplinary pancreas, lung, ovarian, and liver tumour boards. Results While the level of complexity of referred patients did not increase, trainees seemed to develop a better understanding of palliative care and a higher sensitivity to palliative needs. The number of referred patients increased, but patients’ complexity did not. Qualitative data showed that professionals seemed to be more aware of the complexity of PC needs. A “meaning shift” was perceived, specifically on the referral process (e.g., “when” and “for what” referring to specialist PC) and on the teams’ increased focus on patients’ needs. The training, positively received, was adapted to trainees’ needs and observations that led also to organizational modifications. Conclusions Our multicomponent intervention positively impacted the number of referrals but not the patients’ complexity (measured with the PALCOM instrument). Hospital staff does not easily recognize that patients may have PC needs significantly earlier than at the end of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00968-7.
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Flaherty SJ, Delaney H, Matvienko-Sikar K, Smith V. Maternity care during COVID-19: a qualitative evidence synthesis of women's and maternity care providers' views and experiences. BMC Pregnancy Childbirth 2022; 22:438. [PMID: 35619069 PMCID: PMC9132752 DOI: 10.1186/s12884-022-04724-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background As COVID-19 continued to impact society and health, maternity care, as with many other healthcare sectors across the globe, experienced tumultuous changes. These changes have the potential to considerably impact on the experience of maternity care. To gain insight and understanding of the experience of maternity care during COVID-19, from the perspectives of women and maternity care providers, we undertook a qualitative evidence synthesis (QES). Methods The population of interest for the QES were pregnant and postpartum women, and maternity care providers, who provided qualitative data on their experiences of maternity care during COVID-19. The electronic databases of MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane COVID study register were systematically searched from 01 Jan 2020 to 13 June 2021. The methodological quality of the included studies was appraised using a modified version of the quality assessment tool, based on 12-criteria, designed by the Evidence for Policy and Practice Information coordinating Centre (EPPI-Centre). Data were extracted by two reviewers independently and synthesised using the Thomas and Harden framework. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results Fifty records relating to 48 studies, involving 9,348 women and 2,538 maternity care providers, were included in the QES. The methodological quality of the studies varied from four studies meeting all 12 quality criteria to two studies meeting one quality criterion only. The synthesis revealed eight prominent themes. Five of these reflected women’s experiences: 1) Altered maternity care (women), 2) COVID-related restrictions, 3) Infection prevention and risk, 4) ‘the lived reality’ – navigating support systems, and 5) Interactions with maternity services. Three themes reflected maternity care providers’ experiences: 6) Altered maternity care (providers), 7) Professional and personal impact, and 8) Broader structural impact. Confidence in the findings was high or moderate. Conclusion Although some positive experiences were identified, overall, this QES reveals that maternity care during COVID-19 was negatively experienced by both women and maternity care providers. The pandemic and associated changes evoked an array of emotive states for both populations, many of which have the potential to impact on future health and wellbeing. Resource and care planning to mitigate medium- and longer-term adverse sequelae are required. PROSPERO registration CRD42021232684. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04724-w.
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Affiliation(s)
| | - Hannah Delaney
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland.,Health Research Board-Trials Methodology Research Network (HRB-TMRN), National University of Ireland, Galway, Ireland
| | | | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland.
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Baque Hidalgo JE, Vallejo Martínez MC, Frias-Toral E. Propuesta de modelo integral de intervención terapéutica paliativa en salud. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Los Cuidados Paliativos (CP) constituyen un valor y una responsabilidad de los sistemas sanitarios y sociales. En vista de la alta demanda de servicios para la atención integral y humanizada del paciente con enfermedad crónica, degenerativa e irreversible, es necesario crear un modelo de atención integral paliativa con el fin de ejecutarlo en una población requiriente del mismo. Los CP son un derecho de la persona, reconocido internacionalmente, que ha de prestarse en 3 niveles de atención: primario (básico), secundario (atención especializada - AE) y terciario (Unidades de Cuidados Paliativos - UCP). El primer nivel de atención es responsable de los cuidados paliativos domiciliarios y debe garantizarlos cuando la complejidad no es elevada.
La presente revisión bibliográfica propone un modelo integral, integrado e integrador de cuidados paliativos CP que permita justificar las intervenciones terapéuticas con el objetivo de obtener bienestar o atenuación del sufrimiento en pacientes que acuden al primer nivel de atención.
Palabras claves. Cuidados paliativos, evaluación integral, evaluación de necesidades multidimensionales, derivación, complejidad.
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Affiliation(s)
| | - Mariana Concepción Vallejo Martínez
- Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”.-SOLCA Matriz. Servicio de Dolor y Paliativos Escuela de Medicina, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
| | - Evelyn Frias-Toral
- Escuela de Medicina, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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Understanding the Potential for Pharmacy Expertise in Palliative Care: The Value of Stakeholder Engagement in a Theoretically Driven Mapping Process for Research. PHARMACY 2021; 9:pharmacy9040192. [PMID: 34941624 PMCID: PMC8704289 DOI: 10.3390/pharmacy9040192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Potentially avoidable medication-related harm is an inherent risk in palliative care; medication management accounts for approximately 20% of reported serious incidents in England and Wales. Despite their expertise benefiting patient care, the routine contribution of pharmacists in addressing medication management failures is overlooked. Internationally, specialist pharmacist support for palliative care services remains under-resourced. By understanding experienced practices (‘what happens in the real world’) in palliative care medication management, compared with intended processes (‘what happens on paper’), patient safety issues can be identified and addressed. This commentary demonstrates the value of stakeholder engagement and consultation work carried out to inform a scoping review and empirical study. Our overall goal is to improve medication safety in palliative care. Informal conversations were undertaken with carers and various specialist and non-specialist professionals, including pharmacists. Themes were mapped to five steps: decision-making, prescribing, monitoring and supply, use (administration), and stopping and disposal. A visual representation of stakeholders’ understanding of intended medicines processes was produced. This work has implications for our own and others’ research by highlighting where pharmacy expertise could have a significant additional impact. Evidence is needed to support best practice and implementation, particularly with regard to supporting carers in monitoring and accessing medication, and communication between health professionals across settings.
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Virdun C, Luckett T, Davidson PM, Lorenz K, Phillips J. Generating key practice points that enable optimal palliative care in acute hospitals: Results from the OPAL project's mid-point meta-inference. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Craig DP, Ray R, Harvey D, Shircore M. Advance Care Plans and the Potentially Conflicting Interests of Bedside Patient Agents: A Thematic Analysis. J Multidiscip Healthc 2021; 14:2087-2100. [PMID: 34393488 PMCID: PMC8354728 DOI: 10.2147/jmdh.s314664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022] Open
Abstract
AIM People diagnosed with a neurodegenerative disorder often contend with a threat to independence and control, leading some to complete an advance care plan. Advance care plans are commonly associated with treatment limitations; however, key patient agents (such as doctors, allied health, nurses and family) may instead make temporal, best interests or good medical practice decisions on behalf of the patient. Accordingly, there is a need to better understand ancillary decision-maker's perspectives, particularly of doctors. PURPOSE To explain how the potentially conflicting interests of bedside patient agents operates as a factor which influences doctors' application of advance care plans of people with a neurodegenerative disorder. PARTICIPANTS AND METHODS Using a constructivist grounded theory informed thematic analysis, 38 semi-structured interviews were conducted with hospital-based doctors, allied health, nurses and family of people with a neurodegenerative disorder who had an advance care plan. Data were inductively analysed using open and focused coding. RESULTS Analysis revealed two main themes: dynamics of discerning best interests; and avoiding conflict. Rather than applying advance care plans, doctors largely involved families to attempt best interests decision-making partnerships on patients' behalf. Bedside agents demonstrated significant intra and interpersonal challenges associated with their roles as patient agents. Doctors appeared protective of families and patients with neurodegenerative disorder. CONCLUSION Although bedside agents value advance care plans, doctors often favour temporal healthcare decisions in consultation with family. We suggest there are limitations to the effectiveness of advance care plans in practice, with application typically only occurring close to death. Despite the intentions of advance care planning, bedside agents may still experience considerable dissonance.
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Affiliation(s)
- Denise P Craig
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Desley Harvey
- Health Practitioner Research Capacity Building, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - Mandy Shircore
- College of Business, Law and Governance, James Cook University, Cairns, Queensland, Australia
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Olsson MM, Windsor C, Chambers S, Green TL. A Scoping Review of End-of-Life Communication in International Palliative Care Guidelines for Acute Care Settings. J Pain Symptom Manage 2021; 62:425-437.e2. [PMID: 33276045 DOI: 10.1016/j.jpainsymman.2020.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT End-of-life communication in acute care settings can be challenging and many patients and families have reported low satisfaction with those conversations. OBJECTIVE To explore existing guidelines around palliative care to increase current understanding of end-of-life communication processes applicable to the acute care setting. METHODS A scoping review following the method of Arksey and O'Malley was undertaken to identify eligible documents and thematically summarize findings. Web sites of government authorities, departments, and ministries of health as well as palliative care organizations were searched as were MEDLINE, CINAHL (EBSCOhost), EMBASE, Cochrane Library, Joanna Briggs Institute, and PsycINFO databases. Searches were limited to documents published between January 2009 and August 2019 that were nondisease specific and applicable to the acute care setting. RESULTS Thirteen guidelines from nine different countries were identified. Thematic analysis produced eight themes: 1) The purpose and process of end-of-life communications, 2) cognitive understanding and language in end-of-life communication, 3) legal aspects of end-of-life communication, 4) conflicts and barriers related to end-of-life care, 5) end-of-life communication related to medical record documentation, 6) healthcare professionals' responsibilities and collaboration, 7) education and training, and 8) policies, guidelines, and tools for end-of-life communications. CONCLUSIONS Palliative and end-of-life guidelines applicable to acute care settings outline the purpose of end-of-life communication and address how, when, and by whom such conversations are best initiated and facilitated. How guidelines are developed and what aspects of communications are included and emphasized may differ across countries related to role differences of physicians and nurses and national laws and regulations.
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Affiliation(s)
- Maja Magdalena Olsson
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Carol Windsor
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; Cancer & Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Theresa L Green
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Queensland, Australia; Metro North Hospital & Health Service, Surgical Treatment & Rehabilitation Service, Herston, Queensland, Australia
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15
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Dokmai P, Meemon N, Paek SC, Tayjasanant S. Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand. BMC Health Serv Res 2021; 21:616. [PMID: 34183000 PMCID: PMC8240380 DOI: 10.1186/s12913-021-06623-w] [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: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication. Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.
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Affiliation(s)
- Parichat Dokmai
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
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16
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Shepherd J, Waller A, Sanson-Fisher R, Clark K. Nurses' perceptions, experiences and involvement in the provision of end-of-life care in acute hospitals: A mapping review of research output, quality and effectiveness. Int J Nurs Stud 2021; 122:104007. [PMID: 34298319 DOI: 10.1016/j.ijnurstu.2021.104007] [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] [Received: 02/25/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Safe and high-quality end of life care is not always achieved in acute care hospitals. Nurses represent a key source of information about current practice, and active participants in interventions to improve end of life care in these settings. Examining the volume, type and quality of publications in this field can help to determine whether research is following a natural scientific progression to inform best-practice end of life care. AIMS To systematically review: (i) whether the volume and type of publications (i.e. measurement, descriptive or interventions studies) examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals changed over time (i.e. since 2000); (ii) the proportion of intervention studies involving nurses that meet Risk of Bias research design criteria; and (iii) the effectiveness of intervention studies that met minimum Risk of Bias criteria. METHODS MEDLINE, Embase, CINAHL, and PsychInfo were searched for data-based papers published in English between Jan 2000 and Dec 2020. Studies were included if they focused on nurses' perceptions of, or role in, the provision of end-of-life care in hospitals. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were assessed against the Risk of Bias methodological criteria for research design, and their effectiveness examined. RESULTS A total of 131 papers met eligibility criteria for inclusion in the review. The number increased by 31% in each time period (p < 0.0001). Most studies were descriptive (n = 70; 53%), 11 were measurement studies (8%), and the remainder were intervention studies (n = 50; 38%). Thirteen intervention studies (26%) met eligibility criteria. Methodological quality of the eligible intervention studies was variable. Randomisation and blinding of outcome assessors were the domains of greatest concern. Results were variable, with larger, system-wide interventions that incorporated the expertise of the multidisciplinary healthcare team showing the most promise. CONCLUSION There is an increasing number of studies examining nurses' perceptions of, and involvement in, end-of-life care delivered in acute hospitals. The difficulties of conducting intervention research in this field mean that many studies are descriptive in nature. Given the importance of intervention research in establishing causal relationships, larger-scale intervention studies are essential to improving the quality of end-of-life care provided to patients dying in hospital.
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Affiliation(s)
- Jan Shepherd
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Amy Waller
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Rob Sanson-Fisher
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Katherine Clark
- Northern Sydney Local Health District, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW 2065, Australia; Northern Clinical School, The University of Sydney, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW 2065, Australia
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17
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Hospital patients' perspectives on what is essential to enable optimal palliative care: A qualitative study. Palliat Med 2020; 34:1402-1415. [PMID: 32857012 DOI: 10.1177/0269216320947570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere. AIM To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised. DESIGN An exploratory qualitative study using semi-structured interviews. SETTING/PARTICIPANTS Participants were recruited through five hospitals in New South Wales, Australia. RESULTS Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists. CONCLUSIONS Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.
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Affiliation(s)
- Claudia Virdun
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Karl Lorenz
- VA Palo Alto-Stanford Palliative Care Program and Professor of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Nursing and Member of IMPACCT, University of Technology Sydney, Broadway, NSW, Australia.,Cardiovascular Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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18
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Virdun C, Luckett T, Davidson PM, Phillips J. Strengthening palliative care in the hospital setting: a codesign study. BMJ Support Palliat Care 2020:bmjspcare-2020-002645. [PMID: 33115832 DOI: 10.1136/bmjspcare-2020-002645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families. METHODS A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus. RESULTS More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care. CONCLUSIONS Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.
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Affiliation(s)
- Claudia Virdun
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
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19
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Ghaffari F, Ghahramanian A, Zamanzadeh V, Onyeka TC, Davoodi A, Mazaheri E, Asghari-Jafarabadi M. Patient-centred communication for women with breast cancer: Relation to body image perception. J Clin Nurs 2020; 29:4674-4684. [PMID: 32956571 DOI: 10.1111/jocn.15508] [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] [Received: 01/27/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the predictive values of patient-centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients. BACKGROUND Patient-centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients. DESIGN AND METHODS This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient-centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline. RESULTS A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants' limitations were significantly affected by surgery type and participants' perception of the nurses' PCC skills. Arm concern was significantly affected by surgery type and nurses' PCC skills. CONCLUSION Patient-centred skills in nurse-patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment. RELEVANCE TO CLINICAL PRACTICE Patient-centred communication skills can be taught nurses in the clinical setting to help alleviate patients' BI problems.
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Affiliation(s)
- Fariba Ghaffari
- Department of Medical Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Medical Surgical Department, Nursing and Midwifery Faculty, Hematology & Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Medical Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Arefeh Davoodi
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Effat Mazaheri
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Waller A, Chan S, Chan CWH, Chow MCM, Kim M, Kang SJ, Oldmeadow C, Sanson-Fisher R. Perceptions of optimal end-of-life care in hospitals: A cross-sectional study of nurses in three locations. J Adv Nurs 2020; 76:3014-3025. [PMID: 32888206 DOI: 10.1111/jan.14510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022]
Abstract
AIM To examine whether nurses' location of employment, demographics, or training influences their perceptions of what constitutes optimal care for dying patients in hospital. DESIGN Questionnaire-based, cross-sectional study. METHODS Between December 2016-June 2018, 582 registered or enrolled nurses from Australia (N = 153), South Korea (N = 241), and Hong Kong (N = 188) employed in a variety of hospital care units rated the extent to which they agreed with 29 indicators of optimal end-of-life care across four domains: patient, family, healthcare team, and healthcare system. Latent class analysis identified classes of respondents with similar responses. RESULTS Top five indicators rated by participants included: 'physical symptoms managed well'; 'private rooms and unlimited visiting hours'; 'spend as much time with the patient as families wish'; 'end-of-life care documents stored well and easily accessed' and 'families know and follow patient's wishes'. Four latent classes were generated: 'Whole system/holistic' (Class 1); 'Patient/provider-dominated' (Class 2); 'Family-dominated' (Class 3) and 'System-dominated' (Class 4). Class 1 had the highest proportion of nurses responding positively for all indicators. Location was an important correlate of perceptions, even after controlling for individual characteristics. CONCLUSION Nurses' perceptions of optimal end-of-life care are associated with location, but perhaps not in the direction that stereotypes would suggest. Findings highlight the importance of developing and implementing location-specific approaches to optimize end-of-life care in hospitals. IMPACT The findings may be useful to guide education and policy initiatives in Asian and Western countries that stress that end-of-life care is more than symptom management. Indicators can be used to collect data that help quantify differences between optimal care and the care actually being delivered, thereby determining where improvements might be made.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sally Chan
- Pro Vice-Chancellor and Chief Executive Officer (UoN Singapore), The University of Newcastle, Singapore
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Meyrick C M Chow
- School of Nursing, Tung Wah College, Homantin, Hong Kong SAR, China
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seodaemun-gu, Seoul, Republic of Korea
| | - Sook Jung Kang
- College of Nursing, Ewha Womans University, Seodaemun-gu, Seoul, Republic of Korea
| | - Christopher Oldmeadow
- Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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