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McCaffrey N, Ratcliffe J, Currow D, Engel L, Hutchinson C. What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings. THE PATIENT 2024; 17:39-52. [PMID: 37975965 DOI: 10.1007/s40271-023-00651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. METHODS In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. RESULTS A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). CONCLUSIONS Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.
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Affiliation(s)
- Nikki McCaffrey
- Institute for Health Transformation, Deakin Health Economics, SHSD, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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2
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Borelli E, Bigi S, Potenza L, Gilioli F, Efficace F, Porro CA, Luppi M, Bandieri E. Caregiver's quality of life in advanced cancer: validation of the construct in a real-life setting of early palliative care. Front Oncol 2023; 13:1213906. [PMID: 37781192 PMCID: PMC10540081 DOI: 10.3389/fonc.2023.1213906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Early palliative care (EPC) improves the quality of life (QoL) of advanced cancer patients and their caregivers. The increasingly widespread use of this care model requires the development of measures supporting its interventions. Although the construct of patient's QoL has been extensively investigated and several QoL measures have been further validated, there is a paucity of data concerning the QoL of the caregiver. In 2018, McDonald and colleagues addressed this issue by interviewing 23 primary caregivers of advanced cancer patients who participated in an EPC randomized clinical trial to understand their perspective on the QoL construct. The Authors identified six major dimensions associated with the construct of caregiver's QoL. The present retrospective study aimed to validate these dimensions on a larger sample and in a real-life EPC setting. Methods Previously collected reports from 137 primary caregivers of advanced cancer patients on EPC answering questions about their experience with this care model were qualitatively analyzed through a deductive, thematic approach to identify and confirm the six dimensions constituting the construct of interest based on McDonald's and colleagues' results. Results The six dimensions ("living in the patient's world", "burden of illness and caregiving", "assuming the caregiver role", "renegotiating relationships", "confronting mortality", and "maintaining resilience") were consistently found in the reports from primary caregivers in a real-life EPC setting, confirming to be significant themes associated to their QoL. Conclusion A definite and recurrent construct of primary caregiver's QoL as described by McDonald and colleagues was also found in a larger sample and in a real-life EPC setting. Thus it may lay the groundwork for the development of a dedicated questionnaire.
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Affiliation(s)
- Eleonora Borelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Leonardo Potenza
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Fabio Gilioli
- Department of Internal Medicine and Rehabilitation, Unità Sanitaria Locale (USL), Modena, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Carlo Adolfo Porro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unità Sanitaria Locale (USL), Carpi, Italy
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3
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Sampaio ADSC. Music-based interventions in rehabilitation of children and adolescents with chronic diseases: Sharing an experience from a Brazilian public hospital. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1116914. [PMID: 36937104 PMCID: PMC10014532 DOI: 10.3389/fresc.2023.1116914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
Music-based interventions (MBI) in therapeutic routine have been observed as an effective tool for adjuvant therapy for patients with chronic diseases and for those with various types of disabilities. Music can serve as a pedagogical and therapeutic strategy for development of psychomotor skills in children and adolescents with long-lasting illnesses, and also as a secular way of promoting comfort and spiritual health for patients and families during difficult times; it can also be used to alleviate suffering during diagnostic and therapeutic procedures throughout the long recovery and/or rehabilitation processes. In this article, a musician and art therapist describes some simple MBI used daily in a tertiary children's hospital in Sao Paulo, where patients with chronic diseases and from lower socioeconomic background represent most of outpatients and inpatients. Some MBI developed or adapted by the author are described in detail, some of them using only the voice and others utilizing simple musical instruments, usually percussion ones, by the patients themselves. There are also reports describing MBI in special situations, such as long-lasting isolation of immunosuppressed patients (for bone marrow transplantation, for example), regular day-hospital visits for hemodialysis and religious songs for families of end-of-life or critically ill patients. In conclusion, MBI can be beneficial for improving patient experience in hospital settings, particularly for those with long-lasting or repeated stays, and can be performed in a simple and playful way, with contribution of other health professionals with some background in music, since music therapy specialists are still scarce in many countries.
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Richards K, McLaughlan R. Beyond homeliness: A photo-elicitation study of the 'homely' design paradigm in care settings. Health Place 2023; 79:102973. [PMID: 36682264 DOI: 10.1016/j.healthplace.2023.102973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/27/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
This paper examines perceptions of homeliness in palliative care environments through a photo-elicitation study involving 89 palliative care staff. The study finds that what is perceived as homely tends to exhibit a mutually exclusive relationship with a clinical antithesis. It also finds that antonymous or antithetical understandings of homeliness are as common as those based on actual attributes of homeliness. It is argued that a more nuanced understanding of the spatial and material constituents of homeliness is needed to make it a more realistic objective within the design and procurement of healthcare environments. It is also argued that the inverse relationship of homely and clinical environmental qualities could be translated into a design approach that aims to negotiate rather than negate their apparent mutual incompatibility.
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5
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Guthrie DM, Williams N, Beach C, Buzath E, Cohen J, Declercq A, Fisher K, Fries BE, Goodridge D, Hermans K, Hirdes JP, Seow H, Silveira M, Sinnarajah A, Stevens S, Tanuseputro P, Taylor D, Vadeboncoeur C, Martin TLW. A multi-stage process to develop quality indicators for community-based palliative care using interRAI data. PLoS One 2022; 17:e0266569. [PMID: 35390091 PMCID: PMC8989210 DOI: 10.1371/journal.pone.0266569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments—an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.
Methods
The development efforts took part in multiple stages, between 2017–2021, including a workshop with clinicians and decision-makers working in PC, qualitative interviews with individuals receiving PC, families and decision makers and a modified Delphi panel, based on the RAND/ULCA appropriateness method.
Results
Based on the workshop results, and qualitative interviews, a set of 27 candidate QIs were defined. They capture issues such as caregiver burden, pain, breathlessness, falls, constipation, nausea/vomiting and loneliness. These QIs were further evaluated by clinicians/decision makers working in PC, through the modified Delphi panel, and five were removed from further consideration, resulting in 22 QIs.
Conclusions
Through in-depth and multiple-stakeholder consultations we developed a set of QIs generated with data already collected with interRAI assessments. These indicators provide a feasible basis for quality benchmarking and improvement systems for care providers aiming to optimize PC to individuals and their families.
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Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
| | - Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Cheryl Beach
- Integrated Community Services, Fraser Health, Surrey, British Columbia, Canada
| | - Emma Buzath
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anja Declercq
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO – Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Brant E. Fries
- Department of Health Management and Policy and Department of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kirsten Hermans
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Maria Silveira
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Susan Stevens
- Nova Scotia Health, Halifax, Halifax, Nova Scotia, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deanne Taylor
- Research Department, Interior Health Authority, Kelowna, British Columbia, Canada
- Rural Coordination Centre of BC, Penticton, British Columbia, Canada
| | - Christina Vadeboncoeur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
| | - Tracy Lyn Wityk Martin
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
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Axelsson L, Alvariza A, Carlsson N, Cohen SR, Sawatzky R, Årestedt K. Measuring quality of life in life-threatening illness - content validity and response processes of MQOL-E and QOLLTI-F in Swedish patients and family carers. BMC Palliat Care 2020; 19:40. [PMID: 32213170 PMCID: PMC7098088 DOI: 10.1186/s12904-020-00549-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background The McGill Quality of Life Questionnaire - Expanded (MQOL-E) and the Quality of Life in Life-Threatening Illness-Family Carer/Caregiver version (QOLLTI-F) are developed for use with patients facing the end of life and their family carers, respectively. They are also developed for possible use as companion instruments. Contemporary measurement validity theory places emphasis on response processes, i.e. what people feel and think when responding to items. Response processes may be affected when measurement instruments are translated and adapted for use in different cultures. The aim of this study was to translate and examine content validity and response processes during completion of MQOL-E and QOLLTI-F version 2 (v2) among Swedish patients with life-threatening illness and their family carers. Methods The study was conducted in two stages (I) translation and adaptation (II) examination of content validity and response processes using cognitive interviews with 15 patients and 9 family carers. Participants were recruited from the hemodialysis unit, heart clinic, lung clinic and specialized palliative care of a Swedish county hospital. Patients had life-threatening illness such as advanced heart failure, advanced chronic obstructive pulmonary disease, end-stage kidney disease or advanced cancer. Patients were outpatients, inpatients or receiving home care. Results Patients and family carers respectively believed that the items of the MQOL-E and QOLLTI-F v2 reflect relevant and important areas of their quality of life. Although some items needed more time for reflection, both instruments were considered easy to understand. Some changes were made to resolve issues of translation. Participants expressed that reflecting on their situation while answering questions was valuable and meaningful to them, and that responding was an opportunity to express feelings. Conclusions The results of response processes pertaining to the Swedish translations of both MQOL-E and QOLLTI-F v2 contribute evidence regarding content validity, linguistic equivalence and cultural appropriateness of the translated instruments. In addition, results show that the instruments may support conversations on matters of importance for quality of life between patients and/or family carers and health care professionals. Further research is needed to study the psychometric properties of Swedish translations.
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Affiliation(s)
- Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, Sweden.
| | - Anette Alvariza
- Department of Health Care Sciences/ Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen hospital, Stockholm, Sweden
| | - Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence HealthCare, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
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7
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Salsman JM, Pustejovsky JE, Schueller SM, Hernandez R, Berendsen M, McLouth LES, Moskowitz JT. Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect. J Cancer Surviv 2019; 13:943-955. [PMID: 31741250 DOI: 10.1007/s11764-019-00811-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/21/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors. METHODS We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for positive affect and conducted synthesis using random effects models with robust variance estimation. Tests for moderation included demographic, clinical, and intervention characteristics. RESULTS Interventions had a modest effect on positive affect (g = 0.35, 95% CI [0.16, 0.54]) with substantial heterogeneity of effects across studies ([Formula: see text]; I2 = 78%). Three significant moderators were identified: in-person interventions outperformed remote interventions (P = .046), effects were larger when evaluated against standard of care or wait list control conditions versus attentional, educational, or component controls (P = .009), and trials with survivors of early-stage cancer diagnoses yielded larger effects than those with advanced-stage diagnoses (P = .046). We did not detect differential benefits of psychosocial interventions across samples varying in sex, age, on-treatment versus off-treatment status, or cancer type. Although no conclusive evidence suggested outcome reporting biases (P = .370), effects were smaller in studies with lower risk of bias. CONCLUSIONS In-person interventions with survivors of early-stage cancers hold promise for enhancing positive affect, but more methodological rigor is needed. IMPLICATIONS FOR CANCER SURVIVORS Positive affect strategies can be an explicit target in evidence-based medicine and have a role in patient-centered survivorship care, providing tools to uniquely mobilize human strengths.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, 27157, USA.
| | - James E Pustejovsky
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Mark Berendsen
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie E Steffen McLouth
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, 27157, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Guthrie DM, Harman LE, Barbera L, Burge F, Lawson B, McGrail K, Sutradhar R, Seow H. Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces. J Palliat Med 2019; 22:1346-1356. [DOI: 10.1089/jpm.2019.0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa E. Harman
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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9
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Cohen SR, Russell LB, Leis A, Shahidi J, Porterfield P, Kuhl DR, Gadermann AM, Sawatzky R. More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire - Expanded. BMC Palliat Care 2019; 18:92. [PMID: 31672131 PMCID: PMC6823967 DOI: 10.1186/s12904-019-0473-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) - Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL - Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. METHODS Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. RESULTS Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). CONCLUSIONS MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
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Affiliation(s)
- S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montréal, Canada. .,Lady Davis Research Institute of the Jewish General Hospital, Palliative Care Research, room E8.06, 3755 Côte Ste. Catherine Road, Montréal, Québec, H3T 1E2, Canada.
| | - Lara B Russell
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Anne Leis
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - David R Kuhl
- Departments of Family Practice and Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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10
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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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11
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Pang SM, Chan KS, Chung BP, Lau KS, Leung EM, Leung AW, Chan HY, Chan TM. Assessing Quality of Life of Patients with Advanced Chronic Obstructive Pulmonary Disease in the End of Life. J Palliat Care 2019. [DOI: 10.1177/082585970502100311] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given the limitations of existing health-related quality-of-life (QOL) measures in capturing the end-of-life experience of patients with advanced chronic diseases, an empirically grounded instrument, the quality-of-life concerns in the end of life questionnaire (QOLC-E), was developed. Though it was built on the McGill quality of life questionnaire (MQOL), its sphere is more holistic and culturally specific for the Chinese patients in Hong Kong. One hundred and forty-nine patients with advanced chronic obstructive pulmonary disease (COPD) or metastatic cancer completed the questionnaire. Seven factors (28 items) which emerged from the factor analysis were grouped into four positive (support, value of life, food-related concerns, and healthcare concerns) and four negative (physical discomfort, negative emotions, sense of alienation, and existential distress) subscales. Good internal consistency and concurrent validity were shown. The results also revealed that these two groups of patients had similar QOL concerns. The validity of applying QOLC-E as an outcome measure to evaluate the effectiveness of palliative and psychoexistential interventions has yet to be tested.
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Affiliation(s)
| | - Kin-Sang Chan
- Pulmonary and Palliative Care, Haven of Hope Hospital
| | | | - Kam-Shing Lau
- Department of Respiratory Medicine, Ruttonjee Hospital
| | | | | | | | - Tony M.F. Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
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12
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Abstract
While much attention has been directed at improving the quality of care at the end of life, few studies have examined what determines a good death in different individuals. We sought to identify common domains that characterize a good death in a diverse range of community-dwelling individuals, and to describe differences that might exist between minority and non-minority community-dwelling individuals’ views. Using data from 13 focus groups, we identified 10 domains that characterize the quality of the death experience: 1) physical comfort, 2) burdens on family, 3) location and environment, 4) presence of others, 5) concerns regarding prolongation of life, 6) communication, 7) completion and emotional health, 8) spiritual care, 9) cultural concerns, 10) individualization. Differences in minority compared to non-minority views were apparent within the domains of spiritual concerns, cultural concerns, and individualization. The findings may help in efforts to encourage more culturally sensitive and humane end-of-life care for both minority and non-minority individuals.
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Zadeh RS, Eshelman P. Palliative Design Meets Palliative Medicine: A Strategic Approach to the Design, Construction, and Operation of Healthcare Facilities to Improve Quality of Life and Reduce Suffering for Patients, Families, and Caregivers. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:179-186. [DOI: 10.1177/1937586718820663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A built environment designed to be appropriate for palliative care can make a profound difference for people with life-limiting illnesses. The built environment affects a patient’s quality of life, the management of physical and psychological symptoms, and the quality of social interactions with loved ones and caregivers. This article is informed by the emerging trends in the research and practice in the disciplines of architecture, design, medicine, and nursing. The article is intended to provide a definition of palliative design and invite discussion of its potential impact on patients, families, and caregivers. Our goal is to initiate conversation about palliative design, foster sharing of experiences and feedback among building professionals, and discuss future paths for formal adoption into practice.
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Affiliation(s)
- Rana Sagha Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Paul Eshelman
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
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Shahidi J, Bernier N, Cohen SR. Quality of Life in Terminally Ill Cancer Patients: Contributors and Content validity of Instruments. J Palliat Care 2018. [DOI: 10.1177/082585971002600204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last few decades, improvement in the quality of life (QOL) of cancer patients has received a lot of attention in oncology. This study aims to further explore what factors terminally ill cancer patients report as influencing their QOL. Content analysis of 110 terminally ill cancer patients’ answers to the McGill Quality of Life Questionnaire open-ended question was performed. Negative and positive factors reported by patients as having an impact on their QOL were identified then categorized into eight domains: “physical condition and symptoms,” “psychological status,” “existential,” “relationships and support,” “quality of care,” “physical environment and living facilities,” “hobbies and daily activities,” and “finances.” The “physical condition and symptoms” and “relationships and support” domains were the two most often described by participants as important to their QOL. The results support previous work identifying domains important to the QOL of terminally ill patients with cancer, but they also identify “finances” as a new domain. Based on these findings, we suggest including “finances” in QOL instruments for the terminally ill as an experimental domain.
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Affiliation(s)
- Javad Shahidi
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Send mail to: SMBD Jewish General Hospital, H-364, 3755 Cote Sainte Catherine Road, Montreal, Quebec, Canada H3T 1E2
| | - Nadine Bernier
- Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec
| | - S. Robin Cohen
- Department of Oncology and Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, and Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Quebec, Canada
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Gourdji I, Mcvey L, Purden M. A Quality end of Life from A Palliative Care Patient's Perspective. J Palliat Care 2018. [DOI: 10.1177/082585970902500105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients — five women and five men — took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients’ approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to “do the things that I usually do,” “be helpful to others,” and “live in a caring environment,” The findings highlight the importance of understanding each of these factors: patients’ approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.
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Affiliation(s)
- Iris Gourdji
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Lynne Mcvey
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Margaret Purden
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
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Sagha Zadeh R, Eshelman P, Setla J, Kennedy L, Hon E, Basara A. Environmental Design for End-of-Life Care: An Integrative Review on Improving the Quality of Life and Managing Symptoms for Patients in Institutional Settings. J Pain Symptom Manage 2018; 55:1018-1034. [PMID: 28935129 PMCID: PMC5856462 DOI: 10.1016/j.jpainsymman.2017.09.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT The environment in which end-of-life (EOL) care is delivered can support or detract from the physical, psychological, social, and spiritual needs of patients, their families, and their caretakers. OBJECTIVES This review aims to organize and analyze the existing evidence related to environmental design factors that improve the quality of life and total well-being of people involved in EOL care and to clarify directions for future research. METHODS This integrated literature review synthesized and summarized research evidence from the fields of medicine, environmental psychology, nursing, palliative care, architecture, interior design, and evidence-based design. RESULTS This synthesis analyzed 225 documents, including nine systematic literature reviews, 40 integrative reviews, three randomized controlled trials, 118 empirical research studies, and 55 anecdotal evidence. Of the documents, 192 were peer-reviewed, whereas 33 were not. The key environmental factors shown to affect EOL care were those that improved 1) social interaction, 2) positive distractions, 3) privacy, 4) personalization and creation of a home-like environment, and 5) the ambient environment. Possible design interventions relating to these topics are discussed. Examples include improvement of visibility and line of sight, view of nature, hidden medical equipment, and optimization of light and temperature. CONCLUSION Studies indicate several critical components of the physical environment that can reduce total suffering and improve quality of life for EOL patients, their families, and their caregivers. These factors should be considered when making design decisions for care facilities to improve physical, psychological, social, and spiritual needs at EOL.
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Affiliation(s)
- Rana Sagha Zadeh
- Design and Environmental Analysis, Cornell University, Ithaca, New York, USA.
| | - Paul Eshelman
- Design and Environmental Analysis, Cornell University, Ithaca, New York, USA
| | - Judith Setla
- Department of Medicine Voluntary Faculty, SUNY Upstate Medical University, Syracuse, New York, USA; The Hospice of Central New York, Liverpool, New York, USA
| | - Laura Kennedy
- Design & Environmental Analysis, Cornell University, Portland, Oregon, USA
| | - Emily Hon
- New York Medical College, Valhalla, New York, USA
| | - Aleksa Basara
- Department of Economics, Cornell University, Ithaca, New York, USA
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McDonald J, Swami N, Pope A, Hales S, Nissim R, Rodin G, Hannon B, Zimmermann C. Caregiver quality of life in advanced cancer: Qualitative results from a trial of early palliative care. Palliat Med 2018; 32:69-78. [PMID: 29130418 DOI: 10.1177/0269216317739806] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early involvement of palliative care improves patient quality of life; however, quantitative studies have not yet demonstrated a similar effect for caregivers, for whom the construct of quality of life is less well developed. AIM To conceptualise quality of life of caregivers from their own perspective and to explore differences in themes between those who did or did not receive an early palliative care intervention. DESIGN Qualitative grounded theory study. SETTING Tertiary comprehensive cancer centre. PARTICIPANTS Following participation in a cluster-randomised trial of early palliative care, 23 caregivers (14 intervention and 9 control) of patients with advanced cancer participated in semi-structured interviews to discuss their quality of life. RESULTS The core category was 'living in the patient's world'. Five related themes were 'burden of illness and caregiving', 'assuming the caregiver role', 'renegotiating relationships', 'confronting mortality' and 'maintaining resilience'. There was thematic consistency between trial arms, except for the last two themes, which had distinct differences. Participants in the intervention group engaged in open discussion about the end of life, balanced hope with realism and had increased confidence from a range of professional supports. Controls tended to engage in 'deliberate ignorance' about the future, felt uncertain about how they would cope and lacked knowledge of available supports. CONCLUSIONS Caregiver quality of life is influenced profoundly by the interaction with the patient and should be measured with specific questionnaires that include content related to confronting mortality and professional supports. This would improve delineation of quality of life for caregivers and allow greater sensitivity to change. Registration: clinicaltrials.gov NCT01248624.
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Affiliation(s)
- Julie McDonald
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nadia Swami
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ashley Pope
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rinat Nissim
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,4 The Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Breffni Hannon
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,4 The Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Cohen SR, Sawatzky R, Russell LB, Shahidi J, Heyland DK, Gadermann AM. Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire-Revised. Palliat Med 2017; 31:120-129. [PMID: 27412257 DOI: 10.1177/0269216316659603] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The McGill Quality of Life Questionnaire has been widely used with people with life-threatening illnesses without modification since its publication in 1996. With use, areas for improvement have emerged; therefore, various minor modifications were tested over time. AIM To revise the McGill Quality of Life Questionnaire (McGill Quality of Life Questionnaire-Revised) while maintaining or improving its psychometric properties and length, keeping it as close as possible to the McGill Quality of Life Questionnaire to enable reasonable comparison with existing McGill Quality of Life Questionnaire literature. DESIGN Data sets from eight studies were used (four studies originally used to develop the McGill Quality of Life Questionnaire, two to develop new McGill Quality of Life Questionnaire versions, and two with unrelated purposes). The McGill Quality of Life Questionnaire-Revised was developed using analyses of measurement invariance, confirmatory factor analysis, and calculation of correlations with the McGill Quality of Life Questionnaire's global quality of life item. SETTING/PARTICIPANTS Data were from 1702 people with life-threatening illnesses recruited from acute and palliative care units, palliative home care services, and oncology and HIV/AIDS outpatient clinics. RESULTS The McGill Quality of Life Questionnaire-Revised consists of 14 items (plus the global quality of life item). A new Physical subscale was created combining physical symptoms and physical well-being and a new item on physical functioning. The Existential subscale was reduced to four items. The revised Support subscale, renamed Social, focuses more on relationships. The Psychological subscale remains unchanged. Confirmatory factor analysis results provide support for the measurement structure of the McGill Quality of Life Questionnaire-Revised. The overall scale has good internal consistency reliability ( α = 0.94). CONCLUSION The McGill Quality of Life Questionnaire-Revised improves on and can replace the McGill Quality of Life Questionnaire since it contains improved wording, a somewhat expanded repertoire of concepts with fewer items, and a single subscale for the physical domain, while retaining good psychometric properties.
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Affiliation(s)
- S Robin Cohen
- 1 Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,2 Lady Davis Research Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Richard Sawatzky
- 3 School of Nursing, Trinity Western University, Langley, BC, Canada.,4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Lara B Russell
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,5 School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Daren K Heyland
- 7 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.,8 Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Anne M Gadermann
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,9 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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McCaffrey N, Bradley S, Ratcliffe J, Currow DC. What Aspects of Quality of Life Are Important From Palliative Care Patients' Perspectives? A Systematic Review of Qualitative Research. J Pain Symptom Manage 2016; 52:318-328.e5. [PMID: 27216362 DOI: 10.1016/j.jpainsymman.2016.02.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/03/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Despite the availability of numerous tools professing to measure quality of life (QOL) in the palliative care setting, no single instrument includes all patient-valued domains. OBJECTIVES To identify which aspects of QOL are important from palliative care patients' perspectives, aiding coverage, and content validity evaluation of available tools. METHODS A systematic review and synthesis of qualitative research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ASSIA, CINAHL, Cochrane library, Embase, Medline, PsycINFO, and PubMed were searched from database inception to December 31, 2015. Published, peer-reviewed, English-language articles reporting primary qualitative data investigating QOL domains in adults with a progressive, life-limiting illness were included. Studies a priori exploring a chosen aspect of QOL were not included. Articles scoring ≤2 on reporting quality were excluded. Framework synthesis was used to identify key themes across the studies. RESULTS Overall, 3589 articles were screened and 24 studies were included. Eight important aspects of QOL were identified: physical; personal autonomy; emotional; social; spiritual; cognitive; healthcare; and preparatory. All but one study discussed spiritual aspects, whereas only six studies mentioned cognitive aspects. CONCLUSION A broad range of domains are important to the QOL of people with life-limiting illnesses receiving palliation. Refinement of measures is needed to help ensure services address issues valued by patients such as preparation for death and aspects of health care provision, elements which are seldom included in currently available preference-based measures used to inform value for money decisions in palliative care.
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Affiliation(s)
- Nicola McCaffrey
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, South Australia, Australia; Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia.
| | - Sandra Bradley
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Julie Ratcliffe
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, South Australia, Australia
| | - David C Currow
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
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Masko MK. Music Therapy and Spiritual Care in End-of-Life: A Qualitative Inquiry into Ethics and Training Issues Identified by Chaplains and Music Therapists: Table 1. J Music Ther 2016; 53:309-335. [DOI: 10.1093/jmt/thw009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 11/13/2022]
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Ren H, Liu C, Li J, Yang R, Ma F, Zhang M, Wang R, Gan L. Self-perceived Burden in the Young and Middle-aged Inpatients with Stroke: A Cross-sectional Survey. Rehabil Nurs 2016; 41:101-11. [DOI: 10.1002/rnj.193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/12/2022]
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Turner K, Tookman A, Bristowe K, Maddocks M. 'I am actually doing something to keep well. That feels really good': Experiences of exercise within hospice care. PROGRESS IN PALLIATIVE CARE 2016; 24:204-212. [PMID: 27453639 PMCID: PMC4940895 DOI: 10.1080/09699260.2015.1123441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation. Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life. Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life.
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Affiliation(s)
- Karen Turner
- Royal Free London NHS Foundation Trust, London, UK; Marie Curie Hospice Hampstead, UK
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Siemens W, Wehrle A, Gaertner J, Henke M, Deibert P, Becker G. Implementing a home-based exercise program for patients with advanced, incurable diseases after discharge and their caregivers: lessons we have learned. BMC Res Notes 2015; 8:509. [PMID: 26419844 PMCID: PMC4588256 DOI: 10.1186/s13104-015-1523-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care (PC) patients experience loss of physical function which usually impedes mobility, autonomy and quality of life. We aimed at examining the feasibility of a home-based exercise program for patients with advanced, incurable diseases after discharge. RESULTS This was a single-arm pilot study (WHO-ICTRP: DRKS00005048). The 12-week home-based program comprised strength, balance, flexibility and endurance components. Patients with a presumed life expectancy of 6-12 months were recruited during a 6-months period on a specialized PC and a radiation therapy ward. We chose the De Morton Mobility Index as primary outcome. Secondary outcomes were quality of life, 6-min walk test and others. A total of 145 patients were screened, 103 (98%) out of 105 patients on the specialized PC ward could not be included, mostly because of a low performance status [n = 94; 90%; Eastern Cooperative Oncology Group (ECOG) >2]. The only two eligible patients declined to participate. Eleven out of 40 patients (28%) were eligible on the radiation therapy ward. However, only one patient (9%) participated but dropped out 2 days later (upcoming surgery). Distance to the hospital (n = 3; 30%) and considering additional tasks as "too much" (n = 3; 30%) were most common reasons for non-participation. CONCLUSIONS Establishing a home-based exercise program for inpatients after discharge was not feasible mainly due to non-eligibility and lack of demand. For future trials, we suggest that choosing (1) outpatients with (2) an ECOG of ≤2 and (3) an estimated survival of ≥9 months could enhance participation in home-based exercise programs.
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Affiliation(s)
- Waldemar Siemens
- Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
| | - Anja Wehrle
- Department of Internal Medicine, Institute for Exercise- and Occupational Medicine, University Medical Center Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Jan Gaertner
- Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
| | - Michael Henke
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
| | - Peter Deibert
- Department of Internal Medicine, Institute for Exercise- and Occupational Medicine, University Medical Center Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Gerhild Becker
- Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
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Lang A, Toon L, Cohen SR, Stajduhar K, Griffin M, Fleiszer AR, Easty T, Williams A. Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/2056-5917-1-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Suitability of quality-of-life outcome measures in palliative care in the South African setting. Palliat Support Care 2015; 14:118-28. [PMID: 25800035 DOI: 10.1017/s1478951515000036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Quality of life (QoL) is a multidimensional, subjective, and highly individual phenomenon. The current study speaks to the QoL domains identified by palliative patients living in Africa. The need to identify these domains has been recognized but seemed to still be lacking. This study filled this knowledge gap by providing the domains and by giving directions in terms of the assessment of QoL in palliative patients living in resource-restricted communities in South Africa. METHOD We followed a multi-method approach and conducted a literature review to identify and describe the multidimensional QoL instruments used in African palliative care. A secondary analysis design and open-coding method was employed to identify the domains influencing the QoL of palliative patients living in a resource-restricted South African community, after which we compared these domains to the domains assessed by the identified QoL instruments. RESULTS We found that two multidimensional QoL of life instruments-the Missoula-Vitas Quality of Life Index (MVQoLI) and the Functional Assessments of Chronic Illness Therapy-Palliative Care (FACIT-Pal)-have been used in African palliative care and have identified various domains, grouped as four themes: physical concerns, psychosocial issues, financial restraints, and existential issues. The patient-identified QoL domains were to a great extent not assessed by the MVQoLI and FACIT-Pal. SIGNIFICANCE OF RESULTS Our study highlights the complexity of QoL and QoL assessment. A more accurate representation of the QoL of palliative patients living in resource-restricted communities might be obtained by using individualized measures or exploring what QoL means to these patients and selecting QoL instruments accordingly.
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Cui J, Fang F, Shen F, Song L, Zhou L, Ma X, Zhao J. Quality of life in patients with advanced cancer at the end of life as measured by the McGill quality of life questionnaire: a survey in China. J Pain Symptom Manage 2014; 48:893-902. [PMID: 24793079 DOI: 10.1016/j.jpainsymman.2014.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/27/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Quality of life (QOL) is the main outcome measure for patients with advanced cancer at the end of life. The McGill Quality of Life Questionnaire (MQOL) is designed specifically for palliative care patients and has been translated and validated in Hong Kong and Taiwan. OBJECTIVES This study aimed to investigate the QOL of patients with advanced cancer using the MQOL-Taiwan version after cultural adaptation to the Chinese mainland. METHODS A cross-sectional survey design was used. QOL data from patients with advanced cancer were gathered from 13 hospitals including five tertiary hospitals, six secondary hospitals, and community health care service centers in Shanghai and analyzed. QOL was assessed using the MQOL-Chinese version. Statistical analyses were performed using descriptive statistics, multiple regression analysis, and Spearman rank correlation analysis. RESULTS A total of 531 cancer patients (297 male and 234 female) in 13 hospitals were recruited into the study and administered the MQOL-Chinese. The score of the support subscale was highest (6.82), and the score of the existential well-being subscale was the lowest (4.65). The five physical symptoms most frequently listed on the MQOL-Chinese were pain, loss of appetite, fatigue, powerless, and dyspnea. Participants' sex, educational level, number of children, disclosure of the disease, and hospital size were associated with their overall QOL. The Spearman rank correlation analysis found that Karnofsky Performance Status scores correlated with the MQOL-Chinese single-item score, physical well-being, psychological well-being, existential well-being, and support domains (P < 0.05). CONCLUSION Our results revealed the aspects of QOL that need more attention for Chinese palliative care patients with advanced cancer. The association between the characteristics of patients, Karnofsky Performance Status, and their QOL also was identified.
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Affiliation(s)
- Jing Cui
- School of Nursing, Second Military Medical University, Shanghai, People's Republic of China
| | - Fang Fang
- Departments of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Fengping Shen
- Oncology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Lijuan Song
- Department of Nursing, Shanghai Academy of Health Science, Shanghai, People's Republic of China
| | - Lingjun Zhou
- Institute for Translational Medicine, Second Military Medical University, Shanghai, People's Republic of China
| | - Xiuqiang Ma
- Department of Health Statistics, Second Military Medical University, Shanghai, People's Republic of China
| | - Jijun Zhao
- Nursing, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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van den Dungen IA, Verhagen CA, van der Graaf WT, van den Berg JP, Vissers KC, Engels Y. Feasibility and Impact of a Physical Exercise Program in Patients with Advanced Cancer: A Pilot Study. J Palliat Med 2014; 17:1091-8. [DOI: 10.1089/jpm.2013.0638] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ilse A. van den Dungen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Constans A. Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jan-Paul van den Berg
- Department of Rehabilitation Medicine, Anthony van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kris C. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Hu L, Li J, Wang X, Payne S, Chen Y, Mei Q. Prior Study of Cross-Cultural Validation of McGill Quality-of-Life Questionnaire in Mainland Mandarin Chinese Patients With Cancer. Am J Hosp Palliat Care 2014; 32:709-14. [PMID: 24939208 DOI: 10.1177/1049909114537400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The validation of McGill quality-of-life questionnaire (MQOLQ) in mainland China, which had already been used in multicultural palliative care background including Hong Kong and Taiwan, remained unknown. Eligible patients completed the translated Chinese version of McGill questionnaires (MQOL-C), which had been examined before the study. Construct validity was preliminarily assessed through exploratory factor analysis extracting 4 factors that construct a new hypothesis model and then the original model was proved to be better confirmed by confirmatory factor analysis. Internal consistency of all the subscales was within 0.582 to 0.917. Furthermore, test-retest reliability ranged from 0.509 to 0.859, which was determined by Spearman rank correlation coefficient. Face validation and feasibility also confirm the good validity of MQOL-C. The MQOL-C has satisfied validation in mainland Chinese patients with cancer, although cultural difference should be considered while using it.
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Affiliation(s)
- Liya Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingwen Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Wang
- Faculty of Health & Social Sciences, Psychology, Leeds Metropolitan University, Leeds, United Kingdom
| | - Sheila Payne
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Yuan Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Mei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Validation of the “Quality of Life in Life-Threatening Illness—Family Carer Version” (QOLLTI-F) in German-speaking carers of advanced cancer patients. Support Care Cancer 2014; 22:2783-91. [DOI: 10.1007/s00520-014-2272-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/28/2014] [Indexed: 01/26/2023]
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McGrillen K, McCorry NK. A physical exercise programme for palliative care patients in a clinical setting: Observations and preliminary findings. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ursaru M, Crumpei I, Crumpei G. Quality of Life and Religious Coping in Women with Breast Cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2013.12.705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eickmeyer SM, Gamble GL, Shahpar S, Do KD. The role and efficacy of exercise in persons with cancer. PM R 2013; 4:874-81. [PMID: 23174553 DOI: 10.1016/j.pmrj.2012.09.588] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 12/25/2022]
Abstract
Improvements in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors with impairments in physical function, cancer-related symptoms, and reduced quality of life. Exercise and physical activity have therapeutic value at multiple points along the cancer disease continuum, spanning disease prevention, treatment, survivorship, prognostic outcomes, and end-of-life issues. Molecular mechanisms for the influence of exercise in persons with cancer include altering tumor initiation pathways and affecting hormonal, inflammatory, immune, and insulin pathways. Physical activity has been found to play a role in the prevention of certain malignancies, including breast, colon, and other cancers. An increasing amount of evidence indicates that physical activity may affect prognostic outcomes in certain cancer diagnoses, especially breast cancer. Structured exercise and physical activity interventions can be helpful in addressing specific survivorship issues, including overall quality of life, cardiorespiratory impairment, cancer-related fatigue, and lymphedema. Exercise also may be helpful during the palliative care phase to alleviate symptoms and increase physical well-being. This article will familiarize physiatrists with the current state of evidence regarding the role and efficacy of exercise in persons with cancer.
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Affiliation(s)
- Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
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Quality of life of community-based palliative care clients and their caregivers. Palliat Support Care 2012; 11:323-30. [PMID: 23083944 DOI: 10.1017/s1478951512000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to investigate health-related quality of life of palliative care (PC) clients and their caregivers, at baseline and follow-up, following a referral to a community PC service. METHOD Quality of life of clients and their caregivers was respectively measured using the McGill Quality of Life instrument (MQoL) and the Caregiver Quality of Life Cancer Index (CQoLC) instruments. Participants were recruited from June 8 to October 27, 2006. This study was undertaken in one zone of an Area Health Service in New South Wales, which has a diverse socioeconomic population. The zone covers an area of 6237 km2 and is divided into five sectors, each with a PC service, all of which participated in this study. RESULTS Data were obtained from 49 clients and 43 caregivers at baseline, and 22 clients and 12 caregivers at 8 week follow-up. Twenty-one participants died and six moved out of the area during the study. At baseline, clients reported a low mean score for physical symptoms (3.3 ± 1.9) and a high score for support (8.7 ± 1.0). Caregivers scored a total CQoLC of 63.9 ± 21.4 and clients had a total QOL of 6.1 ± 1.3. At follow up, matched data for 22 clients and 13 caregivers demonstrated no statistical differences in quality of life. SIGNIFICANCE OF RESULTS This study has provided evidence that health-related quality of life questionnaires show lower scores for physical health and higher scores for support, which can directly inform specific interventions targeted at the physical and support domains.
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Oeki M, Mogami T, Hagino H. Self-perceived burden in patients with cancer: Scale development and descriptive study. Eur J Oncol Nurs 2012; 16:145-52. [DOI: 10.1016/j.ejon.2011.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/16/2022]
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Jones JM, McPherson CJ, Zimmermann C, Rodin G, Le LW, Cohen SR. Assessing agreement between terminally ill cancer patients' reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage 2011; 42:354-65. [PMID: 21454041 DOI: 10.1016/j.jpainsymman.2010.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/22/2010] [Accepted: 11/23/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Proxy ratings, if valid, may provide an alternative approach to evaluating patient quality of life (QoL) at the end of life. OBJECTIVES To examine agreement between terminally ill cancer patients' self-reported QoL and proxy assessment of patient QoL by their family caregiver (FCG) and palliative care physicians (PCPs) at two time points. METHODS Patients admitted to an acute palliative care unit and their FCGs and PCPs completed the McGill Quality of Life Questionnaire (MQOL) at Days 3 and 6 after admission. Response bias and response precision were examined at the individual and group levels. Furthermore, we examined patient factors affecting agreement and responsiveness of proxy MQOL scores to changes in patients' QoL between Days 3 and 6. RESULTS Statistically and clinically significant mean differences were detected between the patient and both proxy groups' reports of QoL on Day 3, with the magnitude of the differences decreasing somewhat by Day 6. Proxies underestimated patients' QoL compared with patients' self-report. Response precision based on intraclass correlation values and proportion of approximate agreement was poor to fair at both time points. Agreement was better for patients with greater physical burden and more cognitive difficulties. Proxies' responsiveness to change from Day 3 to Day 6 was low, and proxies were not able to detect minimally important changes in QoL. CONCLUSION The findings suggest that moderate agreement between patient and proxy ratings of QoL develops over time but that precision at the individual level, which is more clinically relevant, is less reliable. New strategies for improving proxy reliability are needed.
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Affiliation(s)
- Jennifer M Jones
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada.
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Connell T, Griffiths R, Fernandez RS, Tran D, Agar M, Harlum J. Quality-of-life trajectory of clients and carers referred to a community palliative care service. Int J Palliat Nurs 2011; 17:80-5. [PMID: 21378692 DOI: 10.12968/ijpn.2011.17.2.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Palliative care clients often have a reduced quality of life (QOL). The purpose of this study was to explore the QOL trajectory of clients and carers newly referred to a community palliative care service. A total of 49 clients and 43 carers respectively completed the McGill QOL scale (MQOL) and the caregiver QOL cancer scale (CQOLC) questionnaires. Baseline data relating to demographics, health status, and QOL are presented for the 49 participants and their 43 carers, and these are compared with follow-up data from 22 clients and 13 carers (matched pairs). On average, there were no significant differences between baseline and follow-up QOL scores in any respects for either clients or carers, including measures of burden, disruptiveness, positive adaptation, and financial concerns. Whether this indicates that the care administered succeeded in cancelling out the worsening of the clients' conditions or whether it indicates a shortcoming of the care was not assessed.
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Thomsen TG, Rydahl-Hansen S, Wagner L. A review of potential factors relevant to coping in patients with advanced cancer. J Clin Nurs 2011; 19:3410-26. [PMID: 20609033 DOI: 10.1111/j.1365-2702.2009.03154.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aim was to identify characteristics that are considered to describe coping in patients with advanced cancer, as seen from a patient perspective. Based on the identified characteristics, the second aim was to identify potential factors that are relevant to coping in patients with advanced cancer. BACKGROUND Patients with advanced or incurable cancer often express a need for professional help to cope with their complex situation. Furthermore, the support of health care professionals may often be dominated by a focus on symptom treatment and its effectiveness and less on the kind of needs that the patients consider most important. DESIGN Systematic review. METHODS Based on guidelines from the Centre for Review and Dissemination, York University, a systematic literature search identified 30 articles. Using Lazarus and Folkman's theory of coping as the theoretical framework, relevant data were extracted, analysed and synthesised. RESULTS Based on the identification of 160 characteristics, seven potential factors emerged: 'Creating meaning', 'Support systems', 'Minimising the impact of cancer', 'Bodily and mental functioning', 'Control' and 'Uncertainty' and 'Emotions'. CONCLUSIONS The results indicate that emotion-focused coping may be used more often by patients with advanced cancer than problem-focused coping. However, it cannot be ruled out that this finding relates to a nomenclature of coping function that is too limited. Furthermore, the results indicate that the seven potential factors may be related to both the appraisal process and the coping process. RELEVANCE TO CLINICAL PRACTICE By choosing, as the theoretical framework, Lazarus and Folkman's theory about the connection between the stress, appraisal and coping processes, it has been possible to highlight how the identified factors may be used as the underlying basis of clinical questions focusing on the patients' appraisal of and coping with the concrete situation.
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Affiliation(s)
- Thora Grothe Thomsen
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark.
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Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011; 41:604-18. [PMID: 21145202 DOI: 10.1016/j.jpainsymman.2010.05.010] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/26/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
CONTEXT Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention over the past decade. OBJECTIVES To review the literature specifically related to existential suffering in palliative care in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and interventions. METHODS A systematic approach was undertaken with the aim of identifying emerging themes in the literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search engine of Google Scholar were searched under the key words existential suffering, existential distress, existential pain, palliative and end of life care. RESULTS The search yielded a total of 156 articles; 32% were peer-reviewed empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4) recommendations for future research. Findings from this comprehensive review reveal that existential suffering and deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are dying, and yet the way such suffering is treated in the last days is not well understood. CONCLUSION Given the broad range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own choices and consider treatment options from a critical perspective.
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Affiliation(s)
- Patricia Boston
- Division of Palliative Care, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
Palliative care is an interdisciplinary and holistic approach aimed at alleviating suffering from physical, psychosocial, and spiritual issues in progressive, advanced disease. Progressive fatigue and anorexia-cachexia syndrome can contribute to loss of physical function in the palliative cancer patient, to the detriment of overall quality of life. Physical activity is one potential intervention, which may address these needs in the palliative cancer patient. There is preliminary evidence that at least some palliative cancer patients are willing and able to tolerate physical activity interventions, with some patients demonstrating improvement in select supportive care outcomes postintervention. Methodologically rigorous studies and consensus on common definitions are required to advance this area of research.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Drive NW, Edmonton, T6G 1Z2, Alberta, Canada.
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41
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Making sense of health and illness in palliative care: Volunteers' perspectives. Palliat Support Care 2010; 8:325-34. [DOI: 10.1017/s147895151000012x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To encourage communication and contribute to the palliative care movement's need for interdisciplinary care, this article offers to explore the stance of volunteers on two fundamental concepts, “health” and “illness,” as well as their related understanding of “palliative care.” Volunteers' understandings are then compared with the concepts put forth by the Canadian Hospice Palliative Care Association (CHPCA) in its “Model to Guide Hospice Palliative Care.”Method:Focus groups with volunteers, and individual interviews with coordinators from five selected palliative care community action organizations from across Canada, are used. A total of 65 participants from three Canadian provinces were interviewed.Results:Participants view illness as a subjective, multidimensional, and transformative experience that requires multiple adjustments. It is an impediment to personal equilibrium and a challenge for the terminally ill and their close ones. Health, on the other hand, is a complex phenomenon that consists of physical, psychological, social, and spiritual well-being. For participants, health is most often embodied by a person's capacity to adjust to their challenging circumstances. Both volunteers and coordinators see palliative care as an alternative approach to care that centers on helping patients and their families through their ordeal by offering comfort and respite, and helping patients enjoy their life for as long as possible.Significance of Results:Participants describe illness as a destabilizing loss and palliative care as a means to compensate for the numerous consequences this loss brings; their actions reflect these principles and are compatible with the CHPCA model.
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Prince-Paul M, Exline JJ. Personal Relationships and Communication Messages at the End of Life. Nurs Clin North Am 2010; 45:449-63. [DOI: 10.1016/j.cnur.2010.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Williams AM. Evaluating Canada's Compassionate Care Benefit using a utilization-focused evaluation framework: successful strategies and prerequisite conditions. EVALUATION AND PROGRAM PLANNING 2010; 33:91-97. [PMID: 19709748 DOI: 10.1016/j.evalprogplan.2009.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 07/15/2009] [Accepted: 07/28/2009] [Indexed: 05/28/2023]
Abstract
A utilization-focused evaluation (Patton, 1997) framework was used in 2004-2005 to conduct a pilot evaluation of Canada's newly unveiled Compassionate Care Benefit from a family caregivers' perspective. This paper presents a description of the successful utilization-focused evaluation process. Successful strategies are summarized in three main categories: (1) motivated leadership; (2) regular, planned communication; and (3) consistent and continued commitment of all parties involved. Three main prerequisite conditions for success were found to include: (a) have in place a widely representative Evaluation Taskforce with as many, if not all, key stakeholders represented; (b) have the program of concern and the focus of the evaluation flexible enough to actually accommodate change; and (c) adhere to a pre-determined timeline.
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Affiliation(s)
- Allison M Williams
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
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Gardner DS, Kramer BJ. End-of-life concerns and care preferences: congruence among terminally ill elders and their family caregivers. OMEGA-JOURNAL OF DEATH AND DYING 2010; 60:273-97. [PMID: 20361726 DOI: 10.2190/om.60.3.e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the end-of-life challenges, concerns, and care preferences of terminally ill elders and their family caregivers, with a focus on areas of congruence and incongruence. Ten elders and 10 family caregivers participated in separate, semi-structured, face-to-face interviews. Data analysis included team coding and thematic analysis, guided by an a priori set of categories based on the study questions. Shared challenges and concerns included experiencing decline, managing pain and discomfort, and living with uncertainty. There was also congruence regarding end-of-life care preferences, specifically the importance of quality care, treatment with dignity and respect, and avoiding unnecessary life-sustaining treatment. Areas of incongruence included the elders' difficulties in accepting dependence, their fears of becoming a burden, and desire to be prepared for death. Family caregivers were most concerned with providing adequate care to meet the elders' physical and spiritual care needs. Open family communication was associated with greater congruence. The authors discuss implications of these findings for research and intervention.
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Affiliation(s)
- Daniel S Gardner
- New York University, Silver School of Social Work, New York, NY 10003, USA.
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Devlin M, McIlfatrick S. Providing palliative and end-of-life care in the community: the role of the home-care worker. Int J Palliat Nurs 2010; 16:195-203. [DOI: 10.12968/ijpn.2010.16.4.47786] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Margaret Devlin
- Northern Health and Social Care Trust, Diamond Medical Centre, Magherafelt
| | - Sonja McIlfatrick
- Northern Health and Social Care Trust/Reader, Institute of Nursing Research, University of Ulster, Shore Road, Newtownabbey, Northen Ireland
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Wilson DM, Birch S, Sheps S, Thomas R, Justice C, MacLeod R. Researching a Best-Practice End-of-Life Care Model for Canada. Can J Aging 2010; 27:319-30. [DOI: 10.3138/cja.27.4.319] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RÉSUMÉDe nos jours, la majorité des 220 000 Canadiens qui meurent chaque année, principalement de vieillesse ou des suites de problèmes de santé dégénératifs, n'ont pas accès à des centres de soins palliatifs ou spécialisés en fin de vie. Les programmes de soins palliatifs et d'hospices sont inégalement répartis au Canada, la plupart n'ont qu'une faible capacité de services, et ces services varient considérablement d'un programme à l'autre. Les services de fin de vie sont « les services qui permettent aux familles et aux amis d'aider une personne en phase terminale à vivre ses dernières semaines, ainsi que des services de soutien aux personnes en deuil. » Bien que des services de santé et des services sociaux soient disponibles, la plupart des Canadiens en phase terminale n'ont pas facilement accès à un ensemble complet de services qui pourraient les aider à traverser cette période difficile. La plupart risquent donc d'être soumis en fin de vie à des soins non coordonnés et potentiellement inadéquats. Les personnes en phase terminale sont les plus vulnérables de toutes. Le passage de la vie à la mort est souvent difficile en raison des défis émotionnels et physiques que cela engendre. Bien que le soutien des parents et des amis soit irremplaçable, les soins de fin de vie constituent une obligation publique importante.Un projet de recherche de synthèse a été mené dans le but de déterminer un modèle des meilleures pratiques de prestation de soins de fin de vie qui favoriserait la coordination et l'intégration de ces soins au Canada. Par le truchement de visites, d'analyses documentaires, de sondages sur le web, et d'une analyse des données sur les soins à domicile, quatre éléments essentiels d'un modèle intégrant les meilleures pratiques en matière de soins en fin de vie au Canada ont été dégagés: 1) universalité, 2) coordination des soins, 3) accès assuré à un vaste éventail de soins de vie de base et spécialisés, et 4) assurance de services de fin de vie peu importe où les soins sont prodigués. Le présent modèle est proposé comme guide pour l'établissement de soins intégrés de fin de vie au Canada.
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Development of a computer-administered mobility questionnaire. Support Care Cancer 2010; 19:745-55. [DOI: 10.1007/s00520-010-0867-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
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Taminiau-Bloem EF, Visser MRM, Tishelman C, Koeneman MA, van Zuuren FJ, Sprangers MAG. Somatically ill persons' self-nominated quality of life domains: review of the literature and guidelines for future studies. Qual Life Res 2010; 19:253-91. [PMID: 20047087 PMCID: PMC2816248 DOI: 10.1007/s11136-009-9569-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review which domains somatically ill persons nominate as constituting their QoL. Specific objective is to examine whether the method of enquiry affect these domains. METHODS We conducted two literature searches in the databases PubMed/Medline, CINAHL and Psychinfo for qualitative studies examining patients' self-defined QoL domains using (1) SEIQoL and (2) study-specific questions. For each database, two researchers independently assessed the eligibility of the retrieved abstracts and three researchers subsequently classified all QoL domains. RESULTS Thirty-six eligible papers were identified: 27 studies using the SEIQoL, and nine presenting data derived from study-specific questions. The influence of the method of enquiry on patients' self-nominated QoL domains appears limited: most domains were presented in both types of studies, albeit with different frequencies. CONCLUSIONS This review provides a comprehensive overview of somatically ill persons' self-nominated QoL domains. However, limitations inherent to reviewing qualitative studies (e.g., the varying level of abstraction of patients' self-defined QoL domains), limitations of the included studies and limitations inherent to the review process, hinder cross-study comparisons. Therefore, we provide guidelines to address shortcomings of qualitative reports amenable to improvement and to stimulate further improvement of conducting and reporting qualitative research aimed at exploring respondents' self-nominated QoL domains.
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Affiliation(s)
- Elsbeth F Taminiau-Bloem
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Downey L, Curtis JR, Lafferty WE, Herting JR, Engelberg RA. The Quality of Dying and Death Questionnaire (QODD): empirical domains and theoretical perspectives. J Pain Symptom Manage 2010; 39:9-22. [PMID: 19782530 PMCID: PMC2815047 DOI: 10.1016/j.jpainsymman.2009.05.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 05/07/2009] [Accepted: 05/14/2009] [Indexed: 11/18/2022]
Abstract
We used exploratory factor analysis within the confirmatory analysis framework, and data provided by family members and friends of 205 decedents in Missoula, Montana, to construct a model of latent-variable domains underlying the Quality of Dying and Death questionnaire (QODD). We then used data from 182 surrogate respondents, who were survivors of Seattle decedents, to verify the latent-variable structure. Results from the two samples suggested that survivors' retrospective ratings of 13 specific aspects of decedents' end-of-life experience served as indicators of four correlated, but distinct, latent-variable domains: Symptom Control, Preparation, Connectedness, and Transcendence. A model testing a unidimensional domain structure exhibited unsatisfactory fit to the data, implying that a single global quality measure of dying and death may provide insufficient evidence for guiding clinical practice, evaluating interventions to improve quality of care or assessing the status or trajectory of individual patients. In anticipation of possible future research tying the quality of dying and death to theoretical constructs, we linked the inferred domains to concepts from identity theory and existential psychology. We conclude that research based on the current version of the QODD might benefit from the use of composite measures representing the four identified domains, but that future expansion and modification of the questionnaire are in order.
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Affiliation(s)
- Lois Downey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
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Abstract
AbstractObjective:Tending to the spiritual needs of patients has begun to be formally recognized by professional spiritual care providers, health care councils, and health delivery systems over the last 30 years. Recognition of these programs has coincided with evidence-based research on the effect of spirituality on health. Palliative care has served as a forerunner to an integrated professional spiritual care approach, recognizing the importance of addressing the spiritual needs of the dying from its inauguration within Western medicine almost 50 years ago. Oncology programs have also begun to recognize the importance of spirituality to patients along the cancer continuum, especially those who are approaching the end of life. Although standards and best practice guidelines have been established and incorporated into practice, little is known about the actual factors affecting the practice of spiritual care programs or professional chaplains working within an oncology setting.Methods:Participant observation and interactive interviews occurred at five cancer programs after we conducted a literature search.Results:This study identified underlying organizational challenges, cultural and professional issues, academic program development challenges, administrative duties, and therapeutic interventions that determined the success of oncology spiritual care programs in practice.Significance of results:Although spiritual care services have developed as a profession and become recognized as a service within oncology and palliative care, organizational and operational issues were underrecognized yet significant factors in the success of oncology spiritual care programs. Spiritual care programs that were centrally located within the cancer care center, reported and provided guidance to senior leaders, reflected a multifaith approach, and had an academic role were better resourced, utilized more frequently, and seen to be integral members of an interdisciplinary care team than those services who did not reflect these characteristics.
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