1
|
McAnirlin O, Thrift J, Li F, Pope J, Browning M, Moutogiannis P, Thomas G, Farrell E, Evatt M, Fasolino T. The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregivers. Contemp Clin Trials Commun 2024; 40:101318. [PMID: 39045392 PMCID: PMC11263497 DOI: 10.1016/j.conctc.2024.101318] [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: 01/28/2024] [Revised: 05/15/2024] [Accepted: 06/01/2024] [Indexed: 07/25/2024] Open
Abstract
Background Nature-based and other outdoor virtual reality (VR) experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Hospice care services and healthcare need strategies to help patients and informal caregivers with EOL transitions. Methods Our study uses the synchronized Tandem VR TM approach where patient-caregiver dyads experience immersive nature-based and other outdoor VR content. This mixed methods study will recruit 20 patient-caregiver dyads (N = 40) enrolled in home hospice services nearing EOL. Dyads will experience a personalized nature-based and other outdoor VR experience lasting 5-15 min. Self-reported questionnaires and semi-structured interviews will be collected pre/post the VR intervention to identify the impacts of Tandem VR TM experiences on the QOL, pain, and fear of death in patient-caregiver dyads enrolled with hospice services. Additionally, this protocol will determine the acceptance of Tandem VR TM experiences by dyads as a non-pharmacological modality for addressing patient and caregiver needs. Acceptance will be quantified by the number of dyads accepting or declining the VR experience during recruitment. Discussion Using personalized, nature-based and other outdoor VR content, the patient-caregiver dyads can simultaneously engage in an immersive encounter may help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress. Trial registration NCT06186960.
Collapse
Affiliation(s)
- O. McAnirlin
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, 170 Sirrine Hall, 515 Calhoun Dr, Clemson, SC, 29634, USA
| | - J. Thrift
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, 170 Sirrine Hall, 515 Calhoun Dr, Clemson, SC, 29634, USA
- School of Nursing, Clemson University, 605 Grove Road, Greenville, SC, 29605, USA
| | - F. Li
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, 170 Sirrine Hall, 515 Calhoun Dr, Clemson, SC, 29634, USA
| | - J.K. Pope
- Hospice of the Foothills, Prisma Health System, 701 Grove Rd., Greenville, SC, 29605, USA
| | - M.H.E.M. Browning
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, 170 Sirrine Hall, 515 Calhoun Dr, Clemson, SC, 29634, USA
| | - P.P. Moutogiannis
- Palliative Medicine, Prisma Health System, 701 Grove Rd., Greenville, SC, 29605, USA
| | - G. Thomas
- Department of Genetics and Biochemistry, Clemson University, D153 Poole Agricultural Center, Clemson, SC, 29634, USA
| | - E. Farrell
- School of Nursing, Clemson University, 414 Edwards Hall, Epsilon Zeta Dr., Clemson, SC, 29634, USA
| | - M.M. Evatt
- Medical Student (M2), University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - T. Fasolino
- School of Nursing, Clemson University, 414 Edwards Hall, Epsilon Zeta Dr., Clemson, SC, 29634, USA
| |
Collapse
|
2
|
Jang H, Lee K, Kim S, Kim S. Unmet needs in palliative care for patients with common non-cancer diseases: a cross-sectional study. Palliat Care 2022; 21:151. [PMID: 36038840 PMCID: PMC9426270 DOI: 10.1186/s12904-022-01040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Non-cancer patients experience the chronic process of disease that increases the patients’ suffering as well as families’ care burden. Although two-thirds of deaths are caused by non-cancer diseases, there is a lack of studies on palliative care for non-cancer patients. This study identified the palliative care needs and satisfaction, anxiety and depression, and health-related quality of life (HRQOL) of non-cancer patients and identified the factors influencing their HRQOL. Methods A cross-sectional survey design was employed. Participants were 114 non-cancer patients with chronic heart failure, stroke, end-stage renal disease, or end-stage liver disease who were admitted to the general ward of a tertiary hospital in South Korea. Measures included the Palliative Care Needs and Satisfaction Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcome Study 36-items Short Form Health Survey version 2. Data were analysed with descriptive statistics, independent t-tests, analyses of variance, Pearson’s correlations, and multiple linear regression analyses. Results The average score of palliative care needs was 3.66 ± 0.62, which falls between ‘moderate’ and ‘necessary’. Among the four domains, the average score of palliative care needs in the psychosocial domain was the highest: 3.83 ± 0.67. Anxiety was nearly in the normal range (7.48 ± 3.60; normal range = 0–7) but depression was higher than normal (9.17 ± 3.71; normal range = 0–7). Similar to patients with cancer, physical HRQOL (38.89 ± 8.69) and mental HRQOL (40.43 ± 11.19) were about 80% of the general population’s score (50 points). Duration of disease and physical performance were significant factors associated with physical HRQOL, whereas physical performance, anxiety, and depression were significant factors associated with mental HRQOL. Conclusion It is necessary to maintain non-cancer patients’ physical performance and assess and manage their mental health in advance for effective palliative care. This study provides relevant information that can be used to develop a tailored palliative care model for non-cancer patients.
Collapse
Affiliation(s)
- Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Kyunghwa Lee
- College of Nursing, Konyang University, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, Republic of Korea
| | - Sookyung Kim
- School of Nursing, Soonchunhyang University, 50, Suncheonhyang 4-gil, Dongnam-gu, Chungcheongnam-do, 31151, Cheonan-si, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
Patel HV, Kim S, Srivastava A, Shinder BM, Sterling J, Saraiya B, Mayer TM, Ghodoussipour S, Jang TL, Singer EA. Factors associated with palliative intervention utilization for metastatic renal cell carcinoma. Clin Genitourin Cancer 2022; 20:296-296.e9. [DOI: 10.1016/j.clgc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/19/2021] [Accepted: 01/02/2022] [Indexed: 12/25/2022]
|
5
|
Shepherd C, Cookson M, Shore N. The Growth of Integrated Care Models in Urology. Urol Clin North Am 2021; 48:223-232. [PMID: 33795056 DOI: 10.1016/j.ucl.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With heightened awareness of health care outcomes and efficiencies and reimbursement-based metrics, it is ever more important that urologists consider the effects of integrated care models on physicians/staff/clinics fulfillment and patient outcomes, and whether and how to optimally implement these models within their unique practice settings. Despite growing evidence that integrating care improves outcomes, uncertainty persists regarding which approach is most efficient and achievable in terms of specialty considerations and financial resources. In this article, we discuss strategies for integrating urologic care and its impact on current and future health care delivery.
Collapse
Affiliation(s)
- Caitlin Shepherd
- University of Oklahoma, 920 Stanton L. Young Boulevard, WP 2140, Oklahoma City, OK 73104, USA.
| | - Michael Cookson
- Department of Urology, University of Oklahoma, 920 Stanton L. Young Boulevard, WP 2140, Oklahoma City, OK, USA
| | - Neal Shore
- CPI, Carolina Research Center, 823 82nd Parkway, Myrtle Beach, SC 29572, USA
| |
Collapse
|
6
|
Hugar LA, Wulff-Burchfield EM, Winzelberg GS, Jacobs BL, Davies BJ. Incorporating palliative care principles to improve patient care and quality of life in urologic oncology. Nat Rev Urol 2021; 18:623-635. [PMID: 34312530 PMCID: PMC8312356 DOI: 10.1038/s41585-021-00491-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
Palliative care - specialized healthcare focused on improving quality of life for patients with serious illnesses - can help urologists to care for patients with unmet symptom, coping and communication needs. Society guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend incorporating palliative care into standard oncological care, based on multiple randomized trials demonstrating that it significantly improves physical well-being, patient satisfaction and goal concordant care. Misconceptions regarding the objective and ideal timing of palliative care are common; a key concept is that palliative care and treatments seeking to cure or prolong life are not mutually exclusive. Urologists are well positioned to champion the integration of palliative care into surgical urologic oncology and should be aware of palliative care guidelines, indications for palliative care use and how the field of urologic oncology can adopt best practices.
Collapse
Affiliation(s)
- Lee A. Hugar
- grid.468198.a0000 0000 9891 5233Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL USA
| | - Elizabeth M. Wulff-Burchfield
- grid.412016.00000 0001 2177 6375Medical Oncology Division and Palliative Care Division, Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS USA
| | - Gary S. Winzelberg
- grid.10698.360000000122483208UNC Palliative Care Program, Division of Geriatric Medicine, Department of Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Bruce L. Jacobs
- grid.21925.3d0000 0004 1936 9000Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Benjamin J. Davies
- grid.21925.3d0000 0004 1936 9000Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| |
Collapse
|
7
|
Fliedner M, Willener R. A case study: Concurrent palliative care based on
SENS
‐structure for patients with advanced prostate cancer. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Monica Fliedner
- University Centre for Palliative Care, Department of Oncology University Hospital Berne Bern Switzerland
- Department of Health Services Research CAPHRI, Maastricht University Maastricht The Netherlands
| | - Rita Willener
- Department of Urology University Hospital Berne Bern Switzerland
| |
Collapse
|
8
|
Lec PM, Lenis AT, Brisbane W, Sharma V, Golla V, Gollapudi K, Blumberg J, Drakaki A, Bergman J, Chamie K. Trends in palliative care interventions among patients with advanced bladder, prostate, or kidney cancer: A retrospective cohort study. Urol Oncol 2020; 38:854.e1-854.e9. [PMID: 32430252 DOI: 10.1016/j.urolonc.2020.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Palliative care has an established role in improving the quality of life in patients with advanced cancer, but little is known regarding its delivery among patients with urologic malignancies. OBJECTIVE To determine trends in the utilization of palliative interventions among patients with advanced bladder, prostate, and kidney cancer. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study of patients from years 2004 to 2013 in the National Cancer Database diagnosed with stage IV bladder (n = 17,997), prostate (n = 23,322), and kidney (n = 34,697) cancer, after excluding those with missing disease stage, treatment, and outcomes data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics and logistic regression were performed to evaluate utilization of palliative care intervention. Utilization was analyzed by cancer type and by overall survival strata (<6, 6-24, and >24 months). Kaplan-Meier and Cox proportional hazards models analyzed overall survival. RESULTS AND LIMITATIONS Palliative interventions were utilized in 12.5% (2,257/17,997), 14.7% (3,442/23,322), and 19.9% (6,935/34,697) of advanced bladder, prostate, and kidney cancer patients, respectively. Older age and longer survival were associated with lower odds of palliative intervention utilization in each malignancy, as was minority race in kidney and bladder cancer patients. Palliative radiation was used most commonly, and utilization of any palliative intervention was associated with poorer overall survival. Limitations largely stem from imperfect data abstraction, and the analysis of interventions' incomplete reflection of palliative care. CONCLUSIONS Palliative interventions were seldom used among patients with advanced urologic malignancies. Palliative interventions were less frequently used in older patients and minority races. Further study is warranted to define the role of palliative interventions in advanced urologic malignancies and guide their utilization.
Collapse
Affiliation(s)
- Patrick M Lec
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Andrew T Lenis
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Wayne Brisbane
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vidit Sharma
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vishnukamal Golla
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Alexandra Drakaki
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA; Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jonathan Bergman
- Los Angeles County Department of Health Services, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| |
Collapse
|