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Howick J, de Zulueta P, Gray M. Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership. J Eval Clin Pract 2024; 30:548-558. [PMID: 38436621 DOI: 10.1111/jep.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024]
Abstract
Empathic care benefits patients and practitioners, and empathy training for practitioners can enhance empathy. However, practitioners do not operate in a vacuum. For empathy to thrive, healthcare consultations must be situated in a nurturing milieu, guided by empathic, compassionate leaders. Empathy will be suppressed, or even reversed if practitioners are burned out and working in an unpleasant, under-resourced environment with increasingly poorly served and dissatisfied patients. Efforts to enhance empathy must therefore go beyond training practitioners to address system-level factors that foster empathy. These include patient education, cultivating empathic leadership, customer service training for reception staff, valuing cleaning and all ancillary staff, creating healing spaces, and using appropriate, efficiency saving technology to reduce the administrative burden on healthcare practitioners. We divide these elements into environmental factors, organisational factors, job factors, and individual characteristics.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Paquita de Zulueta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Muir Gray
- Director of the Oxford Value and Stewardship Programme, Oxford, UK
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
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Mendoza Martínez MG, Guadarrama Orozco J, Peláez Ballestas I. Pilgrimage in pediatric palliative care: The journey of caregivers. Soc Sci Med 2024; 343:116508. [PMID: 38242031 DOI: 10.1016/j.socscimed.2023.116508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
Admission of terminally ill patients into pediatric palliative care remains a challenge in Mexico and Latin America, despite the multiple benefits of early transfer. In this context the trajectories in search of health care of patients and caregivers have not been documented. Therefore, the objective of this study was to describe and analyze the experiences of primary caregivers and family members of pediatric patients in the palliative care unit of a Children's Hospital in Mexico, between October 19, 2019, and January 19, 2022. We used the framework of health pilgrimage, which comprises the transformative search of healing for patients, focusing on health barriers and the necessary displacement in search of care. With information obtained through interviews, we reconstructed the pilgrimages in search of health care navigating the Mexican healthcare system. Furthermore, we describe the experience of the primary caregiver accompanying the sick child during their journey to palliative care. We recount the adverse factors associated with this pilgrimage, such as the emotional and socioeconomic impact on primary and secondary caregivers.
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Affiliation(s)
| | - Jessica Guadarrama Orozco
- Department of Palliative Care and Quality of Life. Hospital Infantil de México "Federico Gomez", Mexico City, Mexico.
| | - Ingris Peláez Ballestas
- Rheumatology Department. Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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Poncin E, Bovet E, Tamches E, Cantin B, Pralong J, Althaus B, Borasio GD, Bernard M. 'Thank you for loving me': A qualitative study on perceptions of gratitude and their effects in palliative care patients and relatives. Palliat Med 2024; 38:110-120. [PMID: 37942575 PMCID: PMC10798025 DOI: 10.1177/02692163231207495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Empirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits. AIM This paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context. DESIGN We examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis. SETTINGS/PARTICIPANTS Data were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland. RESULTS Participants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation. CONCLUSION Our study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care.
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Affiliation(s)
- Emmanuelle Poncin
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland
- La Source School of Nursing, HES-SO, Lausanne, Switzerland
| | - Emilie Bovet
- Haute École de Santé Vaud (HESAV), Haute école spécialisée de Suisse occidentale (HES-SO), Lausanne, Switzerland
| | - Emmanuel Tamches
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Boris Cantin
- Palliative Care Center, Fribourg Hospital, Fribourg, Switzerland
| | | | - Betty Althaus
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Vaud, Switzerland
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Arantzamendi M, Aparicio M, Centeno C, Sánchez-Migallón S, Riojas M, De Julián V, Crespo M. A reflection on the essence of gratitude in palliative care: healing in severe disease and professional affirmation through accompanying patients until the end. Palliat Care Soc Pract 2023; 17:26323524221147538. [PMID: 36654664 PMCID: PMC9841837 DOI: 10.1177/26323524221147538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Abstract
Background Gratitude has sparked interest in the world of health. It is considered as a personality characteristic or as an emotion. However, little has been explored in the context of the interpersonal relationship of caring. An exploration in the context of end of life is ground-breaking. Objectives This study analyses and reflects on the object of gratitude from the perspective of both the persons being cared for and the professionals providing health care. What are patients and their family members grateful for in palliative care? What is the reason for gratitude? What do these health professionals perceive when there is gratitude? These questions were answered considering the gratitude generated in health care encounters, not gratitude as personality trait. Methods The phenomenological approach was used starting from lived clinical experiences. In the light of the dialogue between clinical experiences and philosophy, this study proposes an explanation of the 'real' or essential object of gratitude in palliative care. It was conducted within the context of palliative care. The study materials were manifestations of gratitude expressed or felt in clinical encounters and published in newspapers or shared in daily encounters. These were the basis for analysis and reflection and interdisciplinary dialogue. Findings The analyses performed indicated healing or deep relief in serious diseases as objects of gratitude according to patients' perspective, and professional self-affirmation until the end according to the professionals' perspective. Conclusion The two perspectives shared an important common fact, namely, the need to consider the persons in their entirety, and the importance of not losing sight of the value they have. This concept would characterize the nature of gratitude, its object being the 'objective good' for patients, family members, and palliative care professionals.
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Affiliation(s)
| | - Maria Aparicio
- St Christopher’s Hospice, London, UK,ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain,Clínica Universidad de Navarra, Departamento de Medicina Paliativa, Pamplona, Spain,IdISNA-Instituto de Investigación Sanitaria de Navarra, Medicina Paliativa, Pamplona, Spain
| | - Sergio Sánchez-Migallón
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain,Facultad Eclesiástica de Filosofía, Universidad de Navarra, Pamplona, Spain
| | - Mariana Riojas
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain,Tecnológico de Monterrey, Monterrey, México
| | - Victoria De Julián
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain
| | - Mariano Crespo
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, Universidad de Navarra, Pamplona, Spain,Departamento de Filosofía, Universidad de Navarra, Pamplona, Spain
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Borelli E, Bigi S, Potenza L, Gilioli F, Artioli F, Porzio G, Porro CA, Efficace F, Bruera E, Luppi M, Bandieri E. Gratitude among advanced cancer patients and their caregivers: The role of early palliative care. Front Oncol 2022; 12:991250. [PMID: 36353529 PMCID: PMC9639866 DOI: 10.3389/fonc.2022.991250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE A cancer diagnosis represents a unique trauma, given its life-threatening, multidimensional, and uncertain nature. Gratitude is a construct representing the emotional state that arises when individuals recognize that a benefit has been received as a result of someone else's action or a spiritual entity's intervention. Based on the positive psychological wellbeing, gratitude has been associated with improved health outcomes even in the disease setting. Thus, the models of care that foster gratitude should be adopted in the clinical context. This study aims to explore whether and how gratitude may originate in patients with advanced cancer and their caregivers undergoing early palliative care (EPC). METHODS We analyzed 251 reports from 133 patients and 118 caregivers describing their clinical experience in two EPC units. The sources of gratitude were identified and ranked based on their frequencies. Words expressing gratitude and words referring to communication and spirituality were collected by means of the Linguistic Inquiry and Word Count software and correlated. RESULTS In total, 123 (92.5%) of 133 patients' and 97 (82.2%) of 118 caregivers' reports, respectively, included explicit or implicit expressions of gratitude. Gratitude was associated specifically with successful physical symptom management, emotional support, improved attitude toward death, better information, humanity, and the familiar environment. The use of words of gratitude in patients' reports was positively correlated with the use of words referring to communication (r = .215, p = .026) and spirituality (r = .612, p <.001). CONCLUSION Our results suggest that interventions within the EPC model based on doctor-patient-caregiver communication may allow patients and caregivers to experience a feeling of gratitude, and this may represent a resource to be exploited to improve their physical and psychosocial wellbeing.
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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, Unitá Sanitaria Locale (USL), Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unitá Sanitaria Locale (USL), Carpi, 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
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, TX, United States
| | - 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, Unitá Sanitaria Locale (USL), Carpi, Italy
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