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Duan L, Cui H, Zhang W, Wu S. Symptoms and experiences of frailty in lung cancer patients with chemotherapy: A mixed-method approach. Front Oncol 2022; 12:1019006. [PMID: 36276107 PMCID: PMC9582838 DOI: 10.3389/fonc.2022.1019006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the symptoms and experiences of frailty in lung cancer patients treated with chemotherapy. Methods Quantitative and qualitative research methods were implemented. A total of 302 patients aged > 18 years were recruited by convenience sampling method. Quantitative data were collected through the General Demographic Characteristics questionnaire, the Frailty Phenotype scale, the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Fourteen patients with a score of Frailty Phenotype scale ≥ 3 were drawn and their interviews were thematically analyzed. Results The mean Frailty Phenotype score was (1.63±1.35), suggesting that most of the patients were in pre-frailty conditions. A total of 64 (21.2%) patients were non-frail, 168 (55.6%) patients were pre-frail, 70 (23.2%) patients were frail. The mean CFS, HADS scores, and PSQI scores were (26.86±8.93), (15.42±9.73), and (6.18±4.39), respectively. The Number of chemotherapy times was positively associated with frailty. Anxiety fatigue, depression and poor sleep quality positively correlated with frailty. The qualitative research showed four themes. Theme 1: the most reported symptoms of frailty were physical symptoms and psychological symptoms. Physical symptoms included fatigue, low physical activity, weight loss and poor sleep quality. Psychological symptoms included anxiety, depression and low social activities. Theme 2: frailty was mainly related to lung cancer and chemotherapeutic drugs, which can cause decreased appetite, constipation and altered taste. Theme 3: patients used bad coping strategies to manage the symptoms of frailty. Theme 4: the social support of patients was weak, especially regarding emotional support. Conclusion The most frequent symptoms reported by lung cancer patients treated with chemotherapy were anxiety, fatigue, depression, low physical activity and poor sleep quality. Patients also complained of bad coping strategies and weak support. Medical staff should strengthen the management of frailty, aiming at improving the quality of life in lung cancer patients treated with chemotherapy.
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Affiliation(s)
- Liran Duan
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Huixia Cui
- College of Nursing, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Huixia Cui,
| | - Wenlu Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Shan Wu
- Department of Rheumatology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Arnold BL, Girgis PA, Dhillon AH, Descallar J, Halkett AG. Does a communication skills program enable symptom and distress screening?: The impact of training on radiation therapists' confidence, knowledge, and use of distress screening. J Med Imaging Radiat Sci 2021; 52:399-408. [PMID: 34183301 DOI: 10.1016/j.jmir.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Due to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening. METHODS A single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time. RESULTS Of 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p<0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing 'the tool is useful in identifying psychosocial problems' (p=0.029). CONCLUSIONS RT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.
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Affiliation(s)
- Belinda L Arnold
- Illawarra Shoalhaven Local Health District, New South Wales, Australia; Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
| | - Prof Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - A/Prof Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making School of Psychology, Faculty of Science. The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - A/Prof Georgia Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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ElKefi S, Asan O. How technology impacts communication between cancer patients and their health care providers: A systematic literature review. Int J Med Inform 2021; 149:104430. [PMID: 33684711 DOI: 10.1016/j.ijmedinf.2021.104430] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To ensure the well-being of their patients, health care providers (HCPs) are putting more effort into the quality of the communication they provide in oncology clinics. With the emergence of Health Information Technology (HIT), the dynamics between doctors and patients in oncology settings have changed. The purpose of this literature review is to explore and demonstrate how various health information technologies impact doctor-patient communication in oncology settings. METHOD A systematic literature review was conducted in 4 databases (PubMed, Cochrane, Web of Science, IEEE Xplore) to select publications that are in English, published between January 2009 and September 2020. This review reports outcomes related to the impacts of using health information technologies on doctor-patient communication according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Reviews and Meta-Analysis guidelines (PRISMA). RESULTS We identified 31 studies which satisfied the selection and eligibility criteria. The review revealed a diverse range of HIT used to support communication between cancer patients and their HCPs in oncology settings. Outcomes related to communication were examined to demonstrate how technology can improve access to care in clinical settings and online. When technology is used effectively to support patient knowledge and shared understanding, this increases the patient's satisfaction and ability to manage emotions, make decisions, and progress in their treatment, in addition to increasing social support and building a stronger therapeutic alliance based on shared knowledge and transparency between clinicians and patients. CONCLUSION Technology-based solutions can help strengthen the relationship and communication between patients and their doctors. They can empower the patient's well-being, help doctors make better decisions and enhance the therapeutic alliance between them. Thus, using technology to enhance communication in healthcare settings remains beneficial if its use is structured and target oriented. Future studies should focus on comparing in-depth the difference between outpatient and inpatient settings in terms of the efforts required and the extent of the impacts from both clinicians' and cancer patients' perspectives.
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Affiliation(s)
- Safa ElKefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, 07047, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, 07047, USA.
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Mcpherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Self-Perceived Burden to Others: Patient and Family Caregiver Correlates. J Palliat Care 2019. [DOI: 10.1177/082585970702300303] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To provide further evidence about the prevalence and correlates of the sense of “self-perceived burden” (SPB) to others, and to examine its association with caregiver reports of burden. Methods The participants were 65 patients with advanced cancer and their family caregivers. Patients completed measures of SPB and family members completed a caregiver burden scale. Results SPB was experienced at minimal to mild levels by 35% of patients, and at moderate to extreme levels by another 28%. It was correlated with some physical symptoms, but more frequently with psychological symptoms. The family members of patients who reported that SPB was a significant problem had higher scores on the caregiver burden scale than family members of other patients (p=0.048), although the overall correlation was modest. Conclusions SPB is a common and distressing concern for many patients receiving palliative care and is associated with a number of other distressing concerns.
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Affiliation(s)
| | | | | | - Susan Brajtman
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Hinton J. An Assessment of Open Communication between People with Terminal Cancer, Caring Relatives, and Others during Home Care. J Palliat Care 2019. [DOI: 10.1177/082585979801400305] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John Hinton
- St. Christopher's Hospice, London, England, United Kingdom
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McCabe MP, Goldhammer D, Mellor D, Hallford D, Davison T. Evaluation of A Training Program to Assist Care Staff to Better Recognize and Manage Depression among Palliative Care Patients and Their Families. J Palliat Care 2018. [DOI: 10.1177/082585971202800203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed pre-intervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.
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Affiliation(s)
- Marita P. McCabe
- MP McCabe (corresponding author): School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Denisa Goldhammer
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Mellor
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Hallford
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - Tanya Davison
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
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Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits. BMC Health Serv Res 2018; 18:597. [PMID: 30075767 PMCID: PMC6091070 DOI: 10.1186/s12913-018-3390-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to explore the thematic content of older persons’ expressed worries in home care visits, and how nursing staff respond to different thematic contents. Methods The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff’s responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff’s responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson’s chi-squared test, Fisher’s exact test, and adjusted residuals. Results The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). “Ageing and bodily impairment” was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about “Relationships with others” (9%), “Health care-related issues” (15%) and “Life narratives and value issues” (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of “Ageing and bodily impairment”, Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher’s exact test, p< 0.001). For the sub-themes of “Relationships with others”, Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher’s exact test, p = 0.009). Conclusion “Ageing and bodily impairment” was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients’ spontaneous expressions of pain. Further research should explore the influence of nursing staff’s responses on quality of care and patient satisfaction.
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Garcia MA, Kalecinski J, Oriol M, Bonne A, Lofti M, Espenel S, Tinquaut F, Fournel P, Collard O, Vassal C, Rivoirard R, Regnier V, Chauvin F, Bourmaud A. Cancer patients treated with intravenous chemotherapy for the first time. What are their needs? What do they lack? A qualitative-quantitative mixed approach. Patient Prefer Adherence 2018; 12:1853-1861. [PMID: 30288026 PMCID: PMC6159784 DOI: 10.2147/ppa.s169810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The announcement of cancer coupled with initiation of its treatment impacts patients' psychological and physical states as well as their lifestyles. The objective of this study was to identify and confirm the needs of patients starting off on anticancer chemotherapy treatment. METHODS This study was based on a qualitative-quantitative mixed method. In 2009, a qualitative study was conducted at the Lucien Neuwirth Cancer Institut for cancer patients undergoing intravenous chemotherapy for the first time. Exploratory and semi-directed interviews were carried out by a sociologist. In 2014, a questionnaire was hetero-administered to 100 patients starting off on chemotherapy. RESULTS Forty patients were interviewed in 2009. Ninety-seven patients answered the questionnaire in 2014. Food was a theme that was identified by a majority of patients in 2009 (13/40) and confirmed in 2014: 63% needed help in identifying favorable food and 67% in identifying those that had to be avoided. The other needs identified were those linked to better understanding of the treatment, of how it may affect the couple, its side effects, hygiene and beauty, and knowledge about other treatments. These needs were confirmed in 2014. New needs were elicited in 2014: activities and leisure (33%), psychological needs (32.6%), and family relations (29.9%). CONCLUSION This study enabled us to identify, confirm, and enrich our knowledge of the needs of cancer patients starting off on intravenous chemotherapy. These results led to the modification of an existing patient education program for these patients, in order to fulfill their needs in an updated and tailored manner.
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Affiliation(s)
- Max-Adrien Garcia
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Julie Kalecinski
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Mathieu Oriol
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Jean Monnet University, Saint Etienne, France
| | - Armand Bonne
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Mohamed Lofti
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Sophie Espenel
- Radiotherapy Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Fabien Tinquaut
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
| | - Pierre Fournel
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Olivier Collard
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Cécile Vassal
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Romain Rivoirard
- Medical Oncology Department, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
| | - Véronique Regnier
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
| | - Franck Chauvin
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Jean Monnet University, Saint Etienne, France
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
| | - Aurélie Bourmaud
- Hygee Center, Lucien Neuwirth Cancer Institut, INSERM - CIC-EC, CIC 1408, Saint Priest en Jarez, France,
- Quality Safety Performance in Health (HESPER) EA7425, Lyon 1 University, Lyon, France,
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Griffiths J. Person-centred communication for emotional support in district nursing: SAGE and THYME model. Br J Community Nurs 2017; 22:593-597. [PMID: 29189053 DOI: 10.12968/bjcn.2017.22.12.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a 'can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.
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Affiliation(s)
- Jane Griffiths
- Senior Lecturer, School of Health Sciences, Division of Nursing Midwifery and Social Work, University of Manchester
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Zweers D, de Graaf E, Teunissen S. Suitable support for anxious hospice patients: what do nurses ‘know’, ‘do’ and ‘need’? An explanatory mixed method study. BMJ Support Palliat Care 2017; 10:e15. [DOI: 10.1136/bmjspcare-2016-001187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 02/16/2017] [Accepted: 05/16/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveTo provide insight into what nurses know, do and need to provide support to anxious patients in hospice care (HC).MethodsA mixed method study consisted of an online survey and focus groups (FGs) about what nurses know, do, and need was conducted. 336 HC nurses were invited to participate. Descriptive statistics were computed using SPSS. The χ2 and t-tests were conducted to compare. The FGs were transcribed verbatim and thematically analysed.ResultsThe survey was completed by 265 nurses (79%), and five FGs (n=25) were conducted. Most nurses had >10 years working experience; mean age was 52. The majority (59%) felt that they were equipped with sufficient knowledge; however, lack of knowledge (31%) as well as lack of time (50%) were hampering factors. Identification of anxiety was difficult due to the variety of its expression. Tools for identifying were used by 37%. Interventions were generally chosen intuitively. A major responsibility was experienced in caring for patients with panic attacks during late night shifts, making immediate decisions necessary.ConclusionThis study highlights the struggles of nurses caring for anxious patients in HC. Anxiety management is dependent on the competencies and preferences of the individual nurse. One-third of the nurses require additional training. According to HC nurses, the intervention set should include guidelines for applying assessment tools, effective communication strategies and decision models as well as prediction models in order to select tailored interventions. Future research should focus on patients’ perspectives in order to understand crucial measures for anxiety management.
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Affiliation(s)
- Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, USA
| | - Kathleen Dracup
- Department of Physiological Nursing, University of California, San Francisco, USA
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Rodenbach RA, Brandes K, Fiscella K, Kravitz RL, Butow PN, Walczak A, Duberstein PR, Sullivan P, Hoh B, Xing G, Plumb S, Epstein RM. Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists. J Clin Oncol 2017; 35:842-851. [PMID: 28135140 DOI: 10.1200/jco.2016.68.5651] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P < .001). Patients in the intervention group were nearly three times more likely to ask about prognosis (16.7% v 5.8%; P =.03). Of 262 topics of interest identified during coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions.
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Affiliation(s)
- Rachel A Rodenbach
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Kim Brandes
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Fiscella
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard L Kravitz
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Walczak
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul R Duberstein
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Sullivan
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Beth Hoh
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Guibo Xing
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandy Plumb
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald M Epstein
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
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13
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Griep ECM, Noordman J, van Dulmen S. Practice nurses mental health provide space to patients to discuss unpleasant emotions. J Psychiatr Ment Health Nurs 2016; 23:77-85. [PMID: 26710237 DOI: 10.1111/jpm.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with mild psychosocial and psychological problems provide signs of worrying or express a clear unpleasant emotion in 94% of consultations with a practice nurse mental health. Nurses' responses to patients' signs of worrying or clear unpleasant emotions were mostly characterized by providing space for patients to talk about these emotions, by using minimal responses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Practice nurses' mental health have passive listening skills, and to a lesser extent, use active listening techniques. Accurate emotion detection and the ability to pick out emotional signs during consultations must also be considered as an important skill for health providers to improve patient-centred communication. AIM Patients with physical problems are known to express their emotional concerns in an implicit way only. Whether the same counts for patients presenting mental health problems in primary care is unknown. This study aims to examine how patients with mild psychosocial and psychological complaints express their concerns during consultations with the practice nurse mental health and how practice nurses respond to these expressions. METHOD Fifteen practice nurses mental health working in Dutch general practices participated in the study. Their consultations with 116 patients with mild psychosocial or psychological complaints were video recorded. patients' explicitly expressed emotional concerns and more implicit expressions of underlying emotional problems (cues) as well as nurses' responses to these expressions were rated using the Verona Coding Definition of Emotional Sequences. RESULTS Almost all consultations contained at least one cue or concern (94%). Nurses' responses were mostly characterized by providing space for patients to talk about their cue or concern in a non-explicit way (62%), by using minimal responses (42%). DISCUSSION Practice nurses mental health have passive listening skills, and to a lesser extent, use active listening techniques. However, there are no strict rules which way of responding is the best and patients value responses differently.
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Affiliation(s)
| | | | - S van Dulmen
- NIVEL, Utrecht, The Netherlands.,Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.,Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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14
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Bar-Sela G, Yochpaz S, Gruber R, Lulav-Grinwald D, Mitnik I, Koren D. The association between the strength of the working alliance and sharing concerns by advanced cancer patients: a pilot study. Support Care Cancer 2015; 24:319-325. [DOI: 10.1007/s00520-015-2794-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
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15
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Hafskjold L, Sundler AJ, Holmström IK, Sundling V, van Dulmen S, Eide H. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol. BMJ Open 2015; 5:e007864. [PMID: 25877282 PMCID: PMC4401848 DOI: 10.1136/bmjopen-2015-007864] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. METHODS AND ANALYSIS This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. ETHICS AND DISSEMINATION Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.
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Affiliation(s)
- Linda Hafskjold
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Annelie J Sundler
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Vibeke Sundling
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Sandra van Dulmen
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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16
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Porter LS, Pollak KI, Farrell D, Cooper M, Arnold RM, Jeffreys AS, Tulsky JA. Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers. Support Care Cancer 2015; 23:2907-16. [PMID: 25701437 DOI: 10.1007/s00520-015-2656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/08/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers. METHODS The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study. RESULTS The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %. CONCLUSIONS This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.
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17
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Poddubnaya T. Empathy problematic in psychological aspects of professional medical care (review). КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2015. [DOI: 10.17759/cpp.2015230202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article covers summary report of the main aspects of empathy research in medical care. Data of an empathy level diagnostics depending on social aspects is pre¬sented, as well as an issue of empathy consideration as a stable personal characteristic, its dependency on experience and doctor's specialization, context of medical activity (necessary pain infliction, emergency aid assistance) is discussed. Aspects of empathic communication for medical workers of various specialties, inter alia psychiatrists and oncologists, as well as communication strategies, developed for coping with cocurrent negative emotions are analyzed. An example of a medical interview facilitating the quality of interpersonal relationship in the pair patient-doctor alliance" is given. In conclusion there are presented actual scientific contra¬dictions and set the possible main lines of future researches.
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18
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Taylor HN, Bryan K. Palliative cancer patients in the acute hospital setting – Physiotherapists attitudes and beliefs towards this patient group. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Abstract
BACKGROUND Symptom assessment is critical to understand the effectiveness of cancer treatment. Traditionally, clinicians have provided the information about cancer patients' symptoms. However, current research has shown that there are discrepancies on symptom assessment results reported by patients themselves and clinicians. OBJECTIVE The objective of this study was to present an integrative review on studies comparing patient-reported symptoms and clinician-observed symptoms in patients with a diagnosis of cancer. METHODS This was a review of published articles from PubMed, CINAHL, and the Cochrane Database, using the key words symptom or toxicity, and patient-reported, patient-rated, patient-assessed or patient-evaluated, which were combined with cancer, oncology, neoplasm, or tumor. RESULTS Clinicians have the propensity to underestimate the incidence, severity, or distress of symptoms experienced by cancer patients. These discrepancies appear to be consistently demonstrated over time and become even more apparent when symptoms are more severe and distressing to patients. In addition, patients report both symptom frequency and severity earlier than clinicians do; patients' symptom assessments are more predictable for daily health status, whereas clinicians' symptom measurements are more related to clinical outcomes. CONCLUSIONS Healthcare professionals must appreciate that there can be discordance between what they perceive and what patients experience and report. Further research needs to address methodological limitations and weaknesses of existing literature. IMPLICATIONS FOR PRACTICE Symptoms reported by patients themselves provide the necessary and different insight into cancer and its treatment, compared with those observed by clinicians. The use of patient-reported symptoms should be incorporated into routine clinical practice and not just research studies.
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20
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Rayner L, Matcham F, Hutton J, Stringer C, Dobson J, Steer S, Hotopf M. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatry 2014; 36:318-24. [PMID: 24630892 DOI: 10.1016/j.genhosppsych.2013.12.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 12/05/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.
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Affiliation(s)
- L Rayner
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
| | - F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - J Hutton
- South London and Maudsley and King's College Hospital NHS Foundation Trusts, UK
| | - C Stringer
- Information and Communication Technology, King's College Hospital NHS Foundation Trust, UK
| | - J Dobson
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - S Steer
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
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21
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Clayton MF, Reblin M, Carlisle M, Ellington L. Communication Behaviors and Patient and Caregiver Emotional Concerns: A Description of Home Hospice Communication. Oncol Nurs Forum 2014; 41:311-21. [DOI: 10.1188/14.onf.311-321] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Alexander SC, Ladwig S, Norton SA, Gramling D, Davis JK, Metzger M, DeLuca J, Gramling R. Emotional distress and compassionate responses in palliative care decision-making consultations. J Palliat Med 2014; 17:579-84. [PMID: 24588656 DOI: 10.1089/jpm.2013.0551] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Seriously ill hospitalized patients and their loved ones are frequently faced with complex treatment decisions laden with expressions of emotional distress during palliative care (PC) consultations. Little is known about these emotional expressions or the compassionate responses providers make and how common these are in PC decision-making conversations. OBJECTIVES To describe the types and frequency of emotional distress that patients and loved ones express and how providers respond to these emotions during PC decision-making consultations with seriously ill hospitalized patients. METHODS We used a quantitative descriptive approach to analyze 71 audio-recorded inpatient PC decision-making consultations for emotional distress and clinicians' responses to those emotions using reliable and established methods. RESULTS A total of 69% of conversations contained at least one expression of emotional distress. The per-conversation frequency of expressions of emotional distress ranged from 1 to 10. Anxiety/fear were the most frequently encountered emotions (48.4%) followed by sadness (35.5%) and anger/frustration (16.1%). More than half of the emotions related to the patient's feelings (53.6%) and 41.9% were related to the loved ones' own emotions. The majority of emotions were moderate in intensity (65.8%) followed by strong (20.7%) and mild (13.5%). Clinicians responded to a majority of emotions with a compassionate response (75.7%) followed by those with medical content (21.9%) and very few were ignored (1.3%). CONCLUSIONS Expressions of emotional distress are common during PC consultations and are usually met with compassionate responses by the clinician.
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Affiliation(s)
- Stewart C Alexander
- 1 Department of Medicine, Duke University Medical Center , Durham, North Carolina
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23
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Hill HC, Paley J, Forbat L. Observations of professional-patient relationships: a mixed-methods study exploring whether familiarity is a condition for nurses' provision of psychosocial support. Palliat Med 2014; 28:256-63. [PMID: 23935017 DOI: 10.1177/0269216313499960] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a popular belief that the professional-patient relationship is a prerequisite in the provision of psychosocial support. Studies suggest that professionals must know, or be familiar with, a patient in order to effectively provide psychosocial support. AIM To examine the association between familiarity and the provision of psychosocial care by professionals. DESIGN A mixed-methods study involving participant observation, interviews and organisational and documentary analysis was conducted over 8 months in an inpatient hospice setting. PARTICIPANTS In total, 38 nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data were analysed using both qualitative and quantitative techniques. RESULTS The data disconfirm the belief that familiarity is either a necessary or sufficient condition for the provision of psychosocial support. Nurses familiar with patients did not necessarily respond to patients' psychosocial needs, and nurses with no prior contact with the patient immediately dealt with psychosocial needs. CONCLUSION Psychosocial support can be provided on a patient's first contact with a clinician and does not rely on building a professional-patient relationship. This suggests that high-quality psychosocial care can be provided in the short time frame available to palliative care clinicians.
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Affiliation(s)
- Hazel C Hill
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
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24
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Dean M, Street RL. A 3-stage model of patient-centered communication for addressing cancer patients' emotional distress. PATIENT EDUCATION AND COUNSELING 2014; 94:143-8. [PMID: 24169023 DOI: 10.1016/j.pec.2013.09.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 09/05/2013] [Accepted: 09/27/2013] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To describe pathways through which clinicians can more effectively respond to patients' emotions in ways that contribute to betterment of the patient's health and well-being. METHODS A representative review of literature on managing emotions in clinical consultations was conducted. RESULTS A three-stage, conceptual model for assisting clinicians to more effectively address the challenges of recognizing, exploring, and managing cancer patients' emotional distress in the clinical encounter was developed. To enhance and enact recognition of patients' emotions, clinicians can engage in mindfulness, self-situational awareness, active listening, and facilitative communication. To enact exploration, clinicians can acknowledge and validate emotions and provide empathy. Finally, clinicians can provide information empathetically, identify therapeutic resources, and give referrals and interventions as needed to help lessen patients' emotional distress. CONCLUSION This model serves as a framework for future research examining pathways that link clinicians' emotional cue recognition to patient-centered responses exploring a patient's emotional distress to therapeutic actions that contribute to improved psychological and emotional health. PRACTICAL IMPLICATIONS Specific communicative and cognitive strategies are presented that can help clinicians better recognize a patient's emotional distress and respond in ways that have therapeutic value.
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Affiliation(s)
- Marleah Dean
- Department of Communication, Texas A&M University, College Station, USA.
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Houston Center for Quality of Care and Utilization Studies, Section of Health Service Research, Department of Medicine, Baylor College of Medicine, Houston, USA
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25
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Abstract
Uncertainty is triggered by many events during the experience of illness - from hearing bad news to meeting a new doctor. Oncology professionals need to recognize the intense feelings associated with uncertainty and respond empathically to patients. This article describes opportunities to strengthen the therapeutic connection and minimize uncertainty.
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Affiliation(s)
- Lidia Schapira
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,
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26
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Børøsund E, Ruland CM, Moore S, Ekstedt M. Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation. Int J Med Inform 2013; 83:e23-34. [PMID: 24268722 DOI: 10.1016/j.ijmedinf.2013.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/24/2013] [Accepted: 10/24/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented. OBJECTIVE To explore nurses' experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation. METHODS This investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis. RESULTS Three themes and nine sub-themes emerged: (1) "Choice as facilitator for shared understanding and engagement in patients' own care," with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) "enhancing the patients' strengths," with two sub-themes: releasing patient's internal strengths and confirming "normalcy" for the patient; and (3) "new challenges for the nurse," with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges. CONCLUSIONS Findings suggest that, from nurses' perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses' professional roles and created dilemmas such as nurses' ambivalence regarding patients' levels of disclosure of sensitive issues and the nurses' ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.
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Affiliation(s)
- Elin Børøsund
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
| | - Cornelia M Ruland
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway; Department of Medicine, University of Oslo, Norway
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mirjam Ekstedt
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway; School of Technology and Health, KTH, Royal Institute of Technology, Stockholm, Sweden
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Cherry MG, Fletcher I, O'Sullivan H. The influence of medical students' and doctors' attachment style and emotional intelligence on their patient-provider communication. PATIENT EDUCATION AND COUNSELING 2013; 93:177-187. [PMID: 23747090 DOI: 10.1016/j.pec.2013.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/30/2013] [Accepted: 05/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students' and doctors' patient-provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students' and/or doctors' attachment style and EI on their PPC. METHODS Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised. RESULTS 1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC. CONCLUSION Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult. PRACTICE IMPLICATIONS More research is needed to assess the influence of both attachment style and EI on PPC.
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Affiliation(s)
- Mary Gemma Cherry
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
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28
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McIlfatrick S, Hasson F. Evaluating an holistic assessment tool for palliative care practice. J Clin Nurs 2013; 23:1064-75. [DOI: 10.1111/jocn.12320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing Research; University of Ulster/All Ireland Institute of Hospice and Palliative Care; Northern Ireland UK
| | - Felicity Hasson
- Institute of Nursing and Health Research; University of Ulster; Northern Ireland UK
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29
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Hamilton G, Ortega R, Hochstetler V, Pierson K, Lin P, Lowes S. Teaching communication skills to hospice teams: comparing the effectiveness of a communication skills laboratory with in-person, second life, and phone role-playing. Am J Hosp Palliat Care 2013; 31:611-8. [PMID: 24037542 DOI: 10.1177/1049909113504481] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Communication skills are critical in hospice care but challenging to teach. Therefore, a hospice agency developed a communication skills laboratory for nurses and social workers. METHODS Learners role-played 3 common hospice scenarios. The role-play modalities were in-person, Second Life, and telephone. Learners were scored on 4 communication aspects. RESULTS Learners in all modalities rated the laboratory as very effective. However, learners in the Second Life and phone modality showed greater improvements from scene 1 to 3 than those in the in-person modality. There were no significant differences in improvement between the Second Life and phone modalities. CONCLUSION Results support the effectiveness of this communication skills laboratory while using different teaching modalities and show phone and Second Life role-plays were more effective than an in-person role-play.
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Affiliation(s)
| | - Rosio Ortega
- Education Department, Hospice of the Valley, Phoenix, AZ, USA
| | | | - Kristen Pierson
- Education Department, Hospice of the Valley, Phoenix, AZ, USA
| | - Peiyi Lin
- Columbia University, Teacher's College, New York, NY, USA
| | - Susan Lowes
- Columbia University, Teacher's College, New York, NY, USA
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Ghazali N, Kanatas A, Bekiroglu F, Scott B, Lowe D, Rogers SN. The Patient Concerns Inventory: A Tool to Uncover Unmet Needs in a Cancer Outpatient Clinic. ACTA ACUST UNITED AC 2013. [DOI: 10.1308/147363513x13500508919899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Patient Concerns Inventory (PCI) is a holistic, patient reported tool that aids in identifying concerns and issues. it is a 55-item checklist of issues that may be grouped into categories of general function, specific head and neck function, emotional-psychological and others, which include finances, treatment related matters and social care. The PCI also gives patients an opportunity to identify from a list of 15 multidisciplinary team (MDT) members whom they would like to see or be referred on to.
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Affiliation(s)
- N Ghazali
- Clinical Research Fellow, Aintree University Hospitals NHS Foundation Trust
| | - A Kanatas
- Specialist Registrar, Leeds Teaching Hospitals NHS Trust
| | - F Bekiroglu
- Consultant, Aintree University Hospitals NHS Foundation Trust
| | - B Scott
- Senior Physiotherapist, Aintree University Hospitals NHS Foundation Trust
| | - D Lowe
- Medical Statistician, Aintree University Hospitals NHS Foundation Trust
| | - SN Rogers
- Consultant, Aintree University Hospitals NHS Foundation Trust
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Cherry MG, Fletcher I, O'Sullivan H. Exploring the relationships among attachment, emotional intelligence and communication. MEDICAL EDUCATION 2013; 47:317-325. [PMID: 23398018 DOI: 10.1111/medu.12115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Attachment style has been shown to influence both emotional intelligence (EI) and the clinical communication of medical students and doctors. No research has assessed the relationships among attachment, EI and clinical communication in medical students. This study was conducted to evaluate the effect of EI on the relationship between medical students' attachment style and clinical communication. METHODS Medical students were invited to complete measures of attachment (using the Experiences in Close Relationships-Short Form [ECR-SF], a 12-item measure that provides attachment avoidance and attachment anxiety dimensional scores) and EI (using the Mayer-Salovey-Caruso Emotional Intelligence Test [MSCEIT], a 141-item measure of the perception, use, understanding and management of emotions) at the end of Year 1, prior to a summative objective structured clinical examination (OSCE). Clinical communication was assessed using OSCE scores. Structural equation modelling (SEM) was used to analyse a hypothetical model of the relationships among attachment style, EI and clinical communication. RESULTS A total of 200 of 358 (55.9%) students participated. Attachment avoidance was significantly negatively correlated with total EI scores (r=-0.28, p<0.01); total EI was significantly positively correlated with OSCE scores (r = 0.23, p < 0.01). A parsimonious SEM revealed that attachment avoidance accounted for 13% of the variance in students' total EI scores but did not directly predict OSCE scores, whereas total EI significantly predicted 7% of the variance in OSCE scores. CONCLUSIONS Attachment is perceived to be stable from early adulthood, whereas the literature suggests that EI can be developed through the use of targeted interventions. This has potential implications for the training of medical students in clinical communication.
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Affiliation(s)
- M Gemma Cherry
- Centre for Excellence in Evidence-Based Learning and Teaching (CEEBLT), School of Medical Education, University of Liverpool, Liverpool, UK.
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Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial. Support Care Cancer 2012; 21:537-47. [DOI: 10.1007/s00520-012-1553-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/23/2012] [Indexed: 11/26/2022]
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Hallford DJ, McCabe MP, Mellor D, Davison TE, Goldhammer DL. Depression in palliative care settings: the need for training for nurses and other health professionals to improve patients' pathways to care. NURSE EDUCATION TODAY 2012; 32:556-560. [PMID: 21862185 DOI: 10.1016/j.nedt.2011.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
Depression is highly prevalent in patients receiving palliative care; however, detection rates are low, with many patients who suffer with depression continuing to go undetected and untreated. A number of factors unique to this setting, as well as issues relating to staff knowledge and self-efficacy working with depression, may impede the detection of patients who are depressed by professional health care staff. Although programmes aimed to train nurses and other allied health staff in depression may be an effective way to improve detection rates, there have been few studies investigating the efficacy of these interventions. This article draws upon recent literature to provide a narrative review of barriers to detection and factors relating to professional palliative care staffs' ability to provide pathways to care for patients who suffer with depression in this setting. Previously evaluated training programmes are reviewed and the argument is made that further development and empirical evaluation of depression training interventions for staff in this setting will provide services with evidence-based methods of training nurses and other professional care staff and improve the pathways to care for patients who suffer with depression.
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Grimsbø GH, Ruland CM, Finset A. Cancer patients' expressions of emotional cues and concerns and oncology nurses' responses, in an online patient-nurse communication service. PATIENT EDUCATION AND COUNSELING 2012; 88:36-43. [PMID: 22326865 DOI: 10.1016/j.pec.2012.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 01/11/2012] [Accepted: 01/14/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To (1) investigate emotional cues and concerns (C&C) of cancer patients expressed in e-mail communication with oncology nurses in an online patient-nurse communication service (OPNC), and (2) explore how nurses responded to patients' C&C. METHODS 283 e-messages sent from 38 breast and 22 prostate cancer patients and 286 e-responses from five oncology nurses were coded with the Verona Coding Definitions of Emotional Sequences. RESULTS We identified 102 cues and 33 concerns expressed in patients' messages. Cues indicating expression of uncertainty or hope, occurred most frequently (in 38.5% of messages), followed by concerns (in 24.4% of messages). Nurses responded to 85.2% of patients' C&Cs; more than half of patients' C&Cs were met with a mixture of information giving and empathic responses. CONCLUSION Patients with breast and prostate cancer express many C&C in e-mail communications with oncology nurses, who demonstrated satisfactory sensitivity to patients' emotions in their responses to patients. PRACTICE IMPLICATIONS Offering e-communication with oncology nurses to cancer patients is a promising and feasible supplement to usual care to address and relieve patients' concerns and emotional distress during illness and recovery.
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Affiliation(s)
- Gro Hjelmeland Grimsbø
- Center for Shared Decision Making and Collaborative Care, Oslo University Hospital, Rikshospitalet, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
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Mjaaland TA, Finset A, Jensen BF, Gulbrandsen P. Patients' negative emotional cues and concerns in hospital consultations: a video-based observational study. PATIENT EDUCATION AND COUNSELING 2011; 85:356-362. [PMID: 21392928 DOI: 10.1016/j.pec.2010.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 12/17/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments. METHODS Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders. RESULTS Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician. CONCLUSIONS More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early. PRACTICE IMPLICATIONS Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.
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Existential issues among health care staff in surgical cancer care – Discussions in supervision sessions. Eur J Oncol Nurs 2011; 15:447-53. [DOI: 10.1016/j.ejon.2010.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 09/20/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022]
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Dale MJ, Johnston B. An exploration of the concerns of patients with inoperable lung cancer. Int J Palliat Nurs 2011; 17:285-90. [PMID: 21727886 DOI: 10.12968/ijpn.2011.17.6.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Appraisal of the literature suggests that patients with lung cancer report more unmet supportive care needs and greater psychological distress than patients with other cancers. This study aimed to explore the concerns of patients with inoperable lung cancer and to interpret those concerns to inform specialist palliative care nursing practice. A descriptive qualitative study was undertaken using semi-structured interviews with six participants on a single site. Three main themes were identified: steadfastly living life, family support and separation, and trust in professionals. The latter is crucial for enabling patients to express their concerns, which in turn allows support to be directed appropriately and from a patient-centred perspective.
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Affiliation(s)
- Moira J Dale
- Community Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries, Scotland.
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Brennan J, Gingell P, Brant H, Hollingworth W. Refinement of the distress management problem list as the basis for a holistic therapeutic conversation among UK patients with cancer. Psychooncology 2011; 21:1346-56. [PMID: 21905157 DOI: 10.1002/pon.2045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Originally devised in the USA, the Distress Thermometer is being deployed in many cancer settings in the UK. It is commonly used with a Problem List (PL), which has never been validated with a UK population. This study aimed to refine the PL items based upon the concerns of a sample of UK patients attending a regional cancer centre. METHODS Existing versions of the PL were scrutinised by a focus group comprising five ex-patients, six health care staff and two academics. This group considered the intelligibility, ambiguity and redundancy of items, sometimes making alternative suggestions or pooling items. The resulting 46 candidate items were sent to 735 patients with mixed cancer, asking them to endorse items that had been 'a source of concern or distress' during their recently finished treatment. We used multivariate logistic regression to evaluate the association between the prevalence of problems and patient characteristics. RESULTS In this study, 395 (53%) people responded. 'Fatigue, exhaustion or extreme tiredness' (70%), 'worry, fear or anxiety' (45%) and 'sleep problems' (38%) were the most frequently endorsed items. Items not appearing on the original PL were commonly endorsed such as 'memory or concentration' (30%) and 'loneliness or isolation' (15%), suggesting that they should be routinely included in the Distress Thermometer Problem List. CONCLUSIONS The current study offers a more comprehensive PL, on the basis of actual patients' concerns, using words that are understood by UK patients. The reluctance of some patients to volunteer their concerns suggests that screening for distress should be undertaken within the context of a structured conversation.
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Affiliation(s)
- James Brennan
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol, BS2 8ED, UK.
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Kale E, Finset A, Eikeland HL, Gulbrandsen P. Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: an exploratory study. PATIENT EDUCATION AND COUNSELING 2011; 84:325-331. [PMID: 21652163 DOI: 10.1016/j.pec.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify potential barriers in communication with non-Western immigrant patients by comparing the frequency and nature of emotional cues and concerns, as well as physician responses during consultations, between ethnically Norwegian patients and immigrant patients in a general hospital setting. METHODS Consultations with 56 patients (30 non-Western immigrants and 26 ethnic Norwegians) were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P). RESULTS There were no significant differences in frequencies of cues and concerns between immigrant and Norwegian patients. However, the immigrant patients with high language proficiency expressed more concerns compared to immigrant patients with language problems and Norwegian patients. Moreover, more concerns were expressed during consultations with female physicians than with male physicians. CONCLUSION Expression of cues and concerns in immigrant patients is dependent on the patient's language proficiency and the physician's gender. PRACTICE IMPLICATIONS Providers should recognize that immigrant patients may have many emotional cues and concerns, but that language problems may represent a barrier for the expression of these concerns.
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Affiliation(s)
- Emine Kale
- Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway.
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Mjaaland TA, Finset A, Jensen BF, Gulbrandsen P. Physicians' responses to patients' expressions of negative emotions in hospital consultations: a video-based observational study. PATIENT EDUCATION AND COUNSELING 2011; 84:332-337. [PMID: 21454033 DOI: 10.1016/j.pec.2011.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Patients express their negative emotions in medical consultations either implicitly as cue to an underlying unpleasant emotion or explicitly as a clear, unambiguous concern. The health provider's response to such cues and concerns is important for the outcome of consultations. Yet, physicians often neglect patient's negative emotions. Most studies of this subject are from primary health care. We aimed to describe how physicians in a hospital respond to negative emotions in an outpatient setting. METHODS Ninety six consultations were videotaped in a general teaching hospital. The Verona Coding Definitions of Emotional Sequences was used to identify patients' expression of negative emotions in terms of cue and concern and to code physicians' subsequent responses. Cohen's kappa was used as interrater reliability measure. Acceptable kappa level was set to .60. RESULTS We observed 163 expressions of negative emotions. In general, the physician responses to patients' cues and concerns did not include follow up or exploration. Concerns more often than cues led to lack of emotional exploration. CONCLUSIONS When patients expressed negative emotions or cues to such, hospital physicians tended to move away from emotional communication, particularly if the emotion was expressed as an explicit concern. PRACTICE IMPLICATIONS Medical training should enable physicians' to explore the patients' emotions in situations where it will improve the medical treatment.
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Affiliation(s)
- Trond A Mjaaland
- HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
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41
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Richards CT, Gisondi MA, Chang CH, Courtney DM, Engel KG, Emanuel L, Quest T. Palliative care symptom assessment for patients with cancer in the emergency department: validation of the Screen for Palliative and End-of-life care needs in the Emergency Department instrument. J Palliat Med 2011; 14:757-64. [PMID: 21548790 DOI: 10.1089/jpm.2010.0456] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department. METHODS An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools. RESULTS A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant. CONCLUSION The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.
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Johnson C, Paul C, Girgis A, Adams J, Currow DC. Australian General Practitioners' and Oncology Specialists' Perceptions of Barriers and Facilitators of Access to Specialist Palliative Care Services. J Palliat Med 2011; 14:429-35. [DOI: 10.1089/jpm.2010.0259] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Claire Johnson
- Centre for Health Research and Psycho-oncology, Cancer Council NSW, University of Newcastle, Hunter Medical Research Institute and Priority Research Centre for Health Behaviour, New South Wales, Australia
| | - Chris Paul
- Centre for Health Research and Psycho-oncology, Cancer Council NSW, University of Newcastle, Hunter Medical Research Institute and Priority Research Centre for Health Behaviour, New South Wales, Australia
| | - Afaf Girgis
- Centre for Health Research and Psycho-oncology, Cancer Council NSW, University of Newcastle, Hunter Medical Research Institute and Priority Research Centre for Health Behaviour, New South Wales, Australia
| | - Jon Adams
- School of Population Health, University of Queensland, Queensland, Australia
| | - David C. Currow
- Flinders Centre for Clinical Change, Flinders University and Institute of Palliative and Supportive Care Research, Adelaide, South Australia, Australia
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Rayner L, Lee W, Price A, Monroe B, Sykes N, Hansford P, Higginson IJ, Hotopf M. The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: cross-sectional survey with four-week follow-up. Palliat Med 2011; 25:229-41. [PMID: 21228092 DOI: 10.1177/0269216310387458] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This cross-sectional survey aimed to determine the prevalence and remission of depression in patients receiving palliative care and to ascertain the predictive value of somatic symptoms in making the diagnosis. Three hundred consecutive patients were interviewed within one week of their initial assessment by a specialist nurse at a palliative care service with in-patient and homecare facilities in south London, UK. Depression was assessed using the PRIME-MD PHQ-9. Presence of somatic symptoms (fatigue, sleep disturbance, poor appetite) was determined using the EORTC-QLQ-C30 quality of life questionnaire. Fifty-eight (19.3% [15.3 to 23.3]) patients met criteria for Major Depressive Disorder; 109 (36.3% [32.3 to 40.3]) met criteria for 'Any depressive syndrome'. Patients with Major Depressive Disorder were more likely to be male, and to have non-malignant disease, pain, poor performance status and desire for an early death. Of those patients with Major Depressive Disorder at baseline, 69% (27/39) had remitted four weeks later. Of those not depressed at baseline, 11% (19/174) met criteria for depression at follow-up. The positive predictive values of sleep disturbance, poor appetite and fatigue were low (<24%), whereas the negative predictive values of these symptoms were high (>89%). The high prevalence of depression in palliative care attests to the need for psychological assessment and support. Depression in patients receiving palliative care is unstable, suggesting that symptoms should be carefully monitored.
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Affiliation(s)
- Lauren Rayner
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, UK.
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Waller A, Girgis A, Johnson C, Lecathelinais C, Sibbritt D, Seldon M, Bonaventura T, Currow D. Implications of a needs assessment intervention for people with progressive cancer: Impact on clinical assessment, response and service utilisation. Psychooncology 2011; 21:550-7. [DOI: 10.1002/pon.1933] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 12/16/2010] [Accepted: 12/27/2010] [Indexed: 11/12/2022]
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Strohbuecker B, Gaertner J, Stock S. Informing Severely III Patients: Needs, Shortcomings and Strategies for Improvement. ACTA ACUST UNITED AC 2011; 6:8-13. [PMID: 21547020 DOI: 10.1159/000324563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SUMMARY: The scope of palliative care has expanded gradually over the last decade. Provision of palliative care is not restricted to the last months of life as in some out-dated concepts. It addresses the needs of severely ill patients in all care settings (in- and outpatients, home care, hospices). Particularly in the last years, the value of integrating palliative care early in the disease trajectory of life-threatening and incurable diseases has become increasingly acknowledged. In order for patients to fully benefit from the concept of early integration of palliative care, they need to be provided with information tailored to their disease trajectory. For example, patients and relatives need to know how symptoms such as pain, depression, fatigue, breathlessness, or anxiety can be alleviated. The patients' knowledge and understanding will support the coping process, improve comfort and enhance patient participation and autonomy. Since information needs are highly individual and vary throughout the course of the disease, an interactive approach of assessing the patients' needs and responding to them adequately is mandatory. In this article, the information needs of advanced cancer patients and their families are explained, shortcomings of the present information concepts are discussed, and an integrative approach to responding to patients' information needs throughout the care pathway is advocated.
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Affiliation(s)
- Barbara Strohbuecker
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany
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Eide H, Sibbern T, Johannessen T. Empathic accuracy of nurses’ immediate responses to fibromyalgia patients’ expressions of negative emotions: an evaluation using interaction analysis. J Adv Nurs 2011; 67:1242-53. [DOI: 10.1111/j.1365-2648.2010.05579.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eide H, Eide T, Rustøen T, Finset A. Patient validation of cues and concerns identified according to Verona coding definitions of emotional sequences (VR-CoDES): a video- and interview-based approach. PATIENT EDUCATION AND COUNSELING 2011; 82:156-162. [PMID: 20570460 DOI: 10.1016/j.pec.2010.04.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 04/01/2010] [Accepted: 04/22/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE A challenging but main task for clinicians is to identify patients' concerns related to their medical conditions. The study aim was to validate a new coding scheme for identifying patients' cues and concerns. METHODS 12 videotaped consultations between nurses and pain patients were coded according to the Verona Coding Scheme for Emotional Sequences (VR-CoDES). During a metainterview each patient watched his/her own video interview with the researcher to confirm or disconfirm the identified cues and concerns. A directive or an open format was applied. Quantitative and qualitative data analyses were performed. RESULTS Patients' confirmation in relation to the coding gave a sensitivity of 0.95 and specificity of 0.99 in the directive format and a sensitivity of 0.99 and specificity of 0.70 applying the open format. Through a qualitative analysis 83% of researcher-identified cues and concerns were validated. 17% were not confirmed or uncertain. CONCLUSION The VR-CoDES seems to capture what are experienced as real concerns to patients, and proves to be a coding scheme with a high degree of ecological validity. PRACTICE IMPLICATIONS The VR-CoDES provides a valid framework for detecting patients' cues and concerns, and should be explored as a training tool to develop clinicians' empathic accuracy.
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Affiliation(s)
- Hilde Eide
- Oslo University College, Faculty of Nursing, Norway.
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48
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Kidman A. Psycho-oncology and the terminally ill patient. CLIN PSYCHOL-UK 2010. [DOI: 10.1080/13284200310001707321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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UITTERHOEVE R, BENSING J, GROL R, DEMULDER P, VAN ACHTERBERG T. The effect of communication skills training on patient outcomes in cancer care: a systematic review of the literature. Eur J Cancer Care (Engl) 2009; 19:442-57. [DOI: 10.1111/j.1365-2354.2009.01082.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH. Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 2009; 23:739-53. [PMID: 19825894 DOI: 10.1177/0269216309106978] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a diagnostic system. There were in total few case definitions of depression. Among these, the classifications were in general based on cut-off scores (77%) and not according to diagnostic systems. The full range of the DSM-IV diagnostic criteria was seldom assessed, i.e. less than one-third of the assessments in the review took into account the duration of symptoms and 18% assessed consequences and impact upon patient functioning. A diversity of assessment methods had been used. Few studies classified depression by referring to a diagnostic system or by using cut-off scores. Evidently, there is a need for a consensus on how to assess and conceptualize depression and related conditions in palliative care.
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Affiliation(s)
- Elisabet Wasteson
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), N-7006 Trondheim, Norway.
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