Palliative care for those with heart failure: nurses' knowledge, attitude, and preparedness to practice

Attitude of nurses towards palliative care and its associated factors in Ethiopia, systematic review and meta-analysis

INTRODUCTION

Palliative care significantly improves the distressing symptoms of patients, especially those with cancer, heart disease, renal disease, and liver disease. The need for palliative care is increasing worldwide due to the growing burden of chronic disease. Nurses with an unfavorable attitude towards palliative care cannot skillfully assess the patient's needs, do not communicate effectively, and do not address the patient's problems adequately. Therefore, this study was aimed to assess the nurse's level of attitude towards palliative care in Ethiopia.

METHODS

Several databases were searched to find available articles. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I2 statistics were used to assess heterogeneity and publication bias, respectively. Subgroup analysis was carried out to identify the source of heterogeneity. A log-odds ratio was employed to show the relationship between nurses' level of attitude towards palliative care and its related factors. P-value less than 0.05 was considered statistically significant.

RESULT

In Ethiopia, the pooled prevalence of favorable attitudes of nurses towards palliative care was 66.13% (95% CI: 54.00-78.27). The highest percentage of favorable attitudes towards palliative care among nurses was found in research studies done in Addis Ababa (80.31%; 95% CI: 72.00-88.63). Training on palliative care was significantly associated with the level of a nurse's attitude towards palliative care. Therefore, nurses who received palliative care training had a 2.5 times higher chance of having a favorable attitude towards palliative care than nurses who did not receive training on palliative care (AOR = 2.55; 95% CI: 2.28-2.82).

CONCLUSION

One-third of nurses had unfavorable attitude towards palliative care. Nurses who took palliative care training had a more favorable attitude than nurses who did not take palliative care training. Routine palliative care training is needed for nurses to improve their level of attitude towards palliative care.

Do spirituality and emotional intelligence improve the perception of the ability to provide care at the end of life? The role of knowledge and self-efficacy

OBJECTIVES

Spirituality, emotional intelligence, and palliative care (PC) knowledge have a positive and direct influence on self-efficacy and on perception of preparation and ability to provide end-of-life (EOL) care. The aim of this work is to propose a conceptual model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the preparation and ability to provide EOL care by doctors and nurses.

METHODS

Quantitative, exploratory, descriptive, and inferential study applied to doctors and nurses in a hospital in the north of Portugal, between May and July 2022. The data collection instrument includes a questionnaire. The relationships between latent variables were evaluated using structural equation models by the partial least squares method using the Smart PLS 3.0 software. It was obtained the previous authorization of the ethics committee.

RESULTS

The results (n = 380) indicate that self-efficacy, spirituality, and PC knowledge have a positive influence on the ability to provide EOL care. Emotional intelligence and spirituality have a direct and positive effect on self-efficacy. There is no direct influence of emotional intelligence on the ability to provide EOL care, but emotional intelligence has an indirect effect mediated by self-efficacy.

SIGNIFICANCE OF RESULTS

Spirituality, self-efficacy, and emotional intelligence are very important for the ability of doctors and nurses to provide EOL care. The identification of predictive factors of the ability to provide EOL care and the determination of the relationship between them can improve the provision of EOL care, reduction of health costs, timely and early referral of people to PC, and increase life quality.

Assessment of Knowledge on Palliative Care among the Community Health Officers in Rural Area of Purba Medinipur District, West Bengal, India

Objectives

Palliative care deals with patients who are facing problems of life-threatening diseases. Under the Ayushman Bharat programme, a new cadre of Community Health Officers (CHOs) is provisioned at Health and Wellness Centres (HWCs) who are nursing graduates. Being the team leader at the HWC level, having a low level of knowledge of palliative care would compromise their service. The study assessed the knowledge of CHOs about palliative care services in a rural district of Purba Medinipur, West Bengal, India.

Materials and Methods

A descriptive study with a cross-sectional design was carried out among 314 CHOs posted in different HWCs of Purba Medinipur, West Bengal, during July-August' 2022. We used to collect data based on questionnaires of 'Palliative-Care-Knowledge Questionnaire-Basic' comprising items related to palliative care, the requirement of palliative care, pain management, communication, and dealing with psychosocial issues. A chi-square test was performed to check the association with educational- and experience-related variables and knowledge.

Results

Overall, adequate knowledge was present in 216 (68.8%) and inadequate knowledge in 98 (31.2%) of CHOs. Improper knowledge was present regarding the role of oxygen supplementation in dying patients, the need for palliative care in human immunodeficiency virus/acquired immunodeficiency syndrome, chronic non-malignant diseases, pain management, and communication about the prognosis of disease. The proportion of CHOs who had adequate knowledge who were highly educated (70%) and those who had previous job as CHO (73.3%). Almost similar knowledge scores were found among those who ever cared for or never cared for either terminally ill patients (P = 0.89) or cancer patients (P = 0.853).

Conclusion

In-depth knowledge was lacking among the CHOs. Training and re-training of CHOs to develop technical and communication skills will help them deliver proper palliative care.

The Role of Palliative Care in Heart Failure, Part 3: Facilitators and Barriers to Cardiac Palliative Care Clinic Development

Background: Patients with heart failure frequently have significant disease burden and complex psychosocial needs. The integration of palliative care into the management of these patients can decrease symptom burden throughout their course of illness. Therefore, in 2009, we established a cardiac palliative care clinic colocated with heart failure providers in a large academic heart hospital. Objective: To better understand the facilitators and barriers to integrating palliative care into our heart failure management service. Design: Qualitative study using a semistructured interview guide. Setting, Subjects: Between October 2020 and January 2021, we invited all 25 primary cardiac providers at our academic medical center in the midwestern United States to participate in semistructured qualitative interviews to discuss their experiences with the cardiac palliative care clinic. Measurements: Interview transcripts were analyzed using a deductive-dominant thematic analysis approach to reveal emerging themes. Results: Providers noted that the integration of palliative care into the treatment of patients with heart failure was helped and hindered primarily by issues related to operations and communications. Operational themes about clinic proximity and the use of telehealth as well as communication themes around provider-provider communication and the understanding of palliative care were particularly salient. Conclusions: The facilitators and barriers identified have broad applicability that are independent of the etiological nature (e.g., cancer, pulmonary, neurological) of any specialty or palliative care clinic. Moreover, the strategies we used to implement improvements in our clinic may be of benefit to other practice models such as independent and embedded clinics.

Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis

BACKGROUND

The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care.

OBJECTIVE

This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care.

DESIGN

The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria.

RESULTS

The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures.

CONCLUSION

Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.

Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses' Knowledge, Training Needs, and Related-Barriers

Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff's needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals' knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues.

A Systematic Review and Meta-analysis of Attitudes of Iranian Nurses and Related Factors Towards End-Of-Life Care

This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53-86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.

Knowledge and associated factors towards palliative care among nurses in Ethiopia: A systematic review and meta-analysis

Palliative care is a holistic care that emphasises on relieving pain and other symptoms of a critical illness, irrespective of age, diagnosis, or stage of illness. It improves the quality of life of the individual. Since nurses spend the longest time with patients, they are the heart of the palliative care team who deliver high standards of care. This study was intended to assess the pooled prevalence of knowledge and associated factors towards palliative care among nurses in Ethiopia. During this study, a comprehensive search was performed by using different databases. A funnel plot and Egger’s test were used to evaluate a publication bias. I² statistic was used to check the heterogeneity between the studies. The subgroup analysis was also conducted for this study. A total of 11 studies with 3330 study participants were included in this systematic review and meta-analysis. The systematic review and meta-analysis showed that the pooled prevalence of knowledge towards palliative care among nurses in Ethiopia was 42.31% (95% confidence interval = [32.41, 52.21]). Educational status (adjusted odds ratio = 2.69, 95% confidence interval = [1.11, 4.25]), experience of caring for a dying patient (adjusted odds ratio = 3.15, 95% confidence interval = [1.17, 5.13]), and training on palliative care (adjusted odds ratio = 2.53, 95% confidence interval = [1.42, 3.64]) were factors significantly associated with the knowledge of nurses towards palliative care. This study indicated that the pooled prevalence of knowledge towards palliative care among nurses in Ethiopia was low. Educational status, experience of caring for a dying patient, and training on palliative care were factors significantly associated with the knowledge of nurses towards palliative care. Thus, training on palliative care and education is suggested for nurses to improve their knowledge towards palliative care.

Systematic review registration: PROSPERO CRD42021247590

Knowledge on Palliative Care and Associated Factors among Nurses in Ethiopia: A Systematic Review and Meta-Analysis

Background

Palliative care is a multidisciplinary team-based care for patients facing life-threatening illness and their families which addresses their physical, psychological, social, and spiritual needs to improve the quality of care. There is a strategy for an increase in palliative care services by integrating with the healthcare system. Therefore, this systematic review and meta-analysis was aimed to assess the overall pooled prevalence of nurses' knowledge towards palliative care in Ethiopia.

Method

PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar, and African Journals OnLine (AJOL) were the databases used to search for articles. Cochrane I 2 statistics and Egger's test were done to check heterogeneity and publication bias, respectively. Subgroup analysis by region, study period, and sample size was done due to the presence of heterogeneity. Sensitivity analysis was also done to detect the presence or absence of an influential study.

Result

Nine studies with a total of 2709 study participants were included in the final analysis. The overall pooled prevalence of nurses' knowledge towards palliative care was 45.57% (95% CI: 35.27-55.87). Educational status and palliative care training were significantly associated factors with the level of nurses' knowledge towards palliative care. B.S. degree holder nurses (AOR = 3.01; 95% CI: 1.50-6.02) and nurses who had palliative care training (AOR = 4.64; 95% CI: 2.37-9.08) were found to be significantly associated factors with the nurses' level of knowledge.

Conclusion

More than half of nurses had poor knowledge of palliative care. Educational status of nurses and palliative care training were significantly associated factors with the nurses' level of knowledge about palliative care. Therefore, palliative care training and improving nurses' careers through continuous professional development should be focused on regularly to improve nurses' knowledge about palliative care.

Undergraduate nursing students' knowledge, attitudes and self-efficacy regarding palliative care in China: A descriptive correlational study

Aim

To describe nursing students' knowledge, attitudes and self-efficacy about palliative care and to examine the associations between these variables in China.

Design

A descriptive correlational study.

Methods

Undergraduate nursing students (N = 187) at the end of third year of education from a university were surveyed. Measurements included the Chinese versions of the Palliative Care Quiz for Nursing, the Death Attitude Profile-Revised, the Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Self-Efficacy Scale. Descriptive and correlational analyses were performed.

Results

Although most nursing students had favourable attitudes towards death and caring for the dying, students had low level of knowledge and self-efficacy regarding palliative care, suggesting the need for integrating palliative care education into nursing curriculum in China. Moreover, special attention should be paid to psychosocial and spiritual care teaching and preparing students to psychologically deal with the challenges in the process of patient's dying.

Nurses' knowledge about palliative care and attitude towards end- of-life care in public hospitals in Wollega zones: A multicenter cross-sectional study

BACKGROUND

Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in the final stages of their life. Lack of knowledge of and negative attitude palliative care among nurses is one of the most common barriers to quality palliative care. This study, therefore, aimed to assess nurses' knowledge about palliative care and attitude toward end-of-life care in public hospitals in Wollega zones, Ethiopia.

METHODS

A multicenter institutional-based cross-sectional study design was employed to collect data from 372 nurses working in public hospitals in Wollega zones from October 02-22, 2019. A self-administered questionnaire with three different parts: Demographic characteristics of nurses, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD). SPSS version 21 was used for analysis used for data analysis. The binary logistic regression test was used for analysis at p < 0.05.

FINDINGS

Our final sample size was 422 nurses (response rate = 88%). With the mean total PCQN scores (9.34), the majority of them showed an inadequate level of knowledge about palliative care. The mean total FATCOD scores (79.58) displayed a positive attitude toward end-of-life care, with 52% of respondents eager to care for a dying person and their family. Nurses who had PC service experience [AOR = 1.94 CI (1.10-3.42), p = 0.02] and had ever attended training/lecture on PC [AOR = 1.87 CI (1.01-3.46), p = 0.04] were independently associated with nurses' knowledge about PC. Similarly, nurses who had no PC service experience [AOR = 0.41, CI (0.21-0.79), p = 0.008], who read articles/brochures about PC [AOR = 1.94, CI (1.11-3.39), p = 0.01] and had provided care for a smaller number of terminally ill patients [AOR = 1.74, CI (1.01-2.97), p = 0.04] were significantly associated with nurses' attitude towards end-of-life care.

CONCLUSION

The study highlighted that nurses' knowledge about palliative care is inadequate, and showed a less favorable attitude toward end-of-life care. The findings also provide evidence for greater attentions and resources should be directed towards educating and supporting nurses caring for patients with palliative care needs in Wollega Zones.

Spiritual Dimension at the End of Life: A Phenomenological Study from the Caregiver's Perspective

The lives of healthy and sick people are structured according to a variety of conceptual matrices. One of these matrixes consists of philosophical, spiritual, and religious convictions, being this especially relevant in the process of the end of life. The objective of the study is to understand the meaning that individuals at the end of life and the relatives of such individuals award spiritual and/or religious beliefs through an examination of caregiver narratives. Multicentric study was developed that used a qualitative design and a phenomenological approach. The study was conducted in the autonomous community of Andalusia, specifically in the provinces of Almeria, Malaga, Seville, Granada, and Huelva. The selection method was purposive sampling. Caregivers who had lost a relative in a period between 2 months and 2 years previously and who were not in a process of pathological grieving were selected for inclusion in the study. The method involved five discussion groups and 41 in-depth interviews, with a total of 87 participants. A change of paradigms is necessary in which, among other elements, the focus of palliative care is centered on the ability to address these spiritual needs, and healthcare professionals are trained to assist in the provision of such care. Another important consideration is the inequality of spiritual supported provided by clergy from various religions. At least in the cultural context of the research, Catholic chaplains were the only institutional figures whose presence was assumed necessary by health organizations. However, the cultural and/or religious diversity in the autonomous community in which the study was conducted is increasingly broad and complex. It appears necessary to incorporate a variety of clergies in health units so that all patients may find support, whether in terms of companionship or celebration.

Healthcare Providers' Perceived Communication Barriers to Offering Palliative Care to Patients With Heart Failure: An Integrative Review

CONTEXT

Heart failure is a chronic complex syndrome that is common and burdensome. International clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients with heart failure.

OBJECTIVES

The aim of this study was to conduct an integrative review to evaluate how healthcare providers perceived communication barriers to offering information to individuals in the palliative phase of heart failure.

METHODS

Four databases and the gray literature were searched from January 1987 to February 2017. Inclusion and exclusion criteria were applied. Studies were graded for strength and quality using a critical appraisal tool, and key themes were extracted and synthesized.

RESULTS

Ten articles met the full inclusion criteria. Most studies were qualitative or nonexperimental studies of good quality. Authors of several studies found that healthcare providers lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach.

CONCLUSIONS

The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Healthcare providers caring for individuals with heart failure need palliative care knowledge, skills, and competencies to ensure that this vulnerable population receives holistic patient-centered care.

Life and priorities before death: A narrative inquiry of uncertainty and end of life in people with heart failure and their family members

BACKGROUND

Most patients with advanced heart failure are ill-prepared and poorly supported during the end of life. To date, research has focused primarily on generalized patient accounts of the management or self-care phase of the syndrome. Little research has examined the end of life in depth or from the perspectives of family members.

AIMS

The purpose of this study is to describe how people diagnosed with heart failure and their family members describe uncertainty related to impending death.

METHODS AND RESULTS

A narrative inquiry was undertaken using a social constructionist perspective. Twenty participants took part in over 60 interviews: 12 participants with heart failure (eight male and four female; mean = 67.3 years) and eight family members (mean = 61.6 years) engaged in two in-depth interviews, approximately 3-4 months apart, followed by a telephone follow-up 2-3 months later. Six key themes/storylines were identified. These included: prognosis messages received from physicians; whenever I die, I die; loss isn't new to me but … ; carrying on amidst the fragility of life; ultimately living not knowing; and the need to prepare.

CONCLUSION

The six key storylines of death and dying with advanced heart failure were consistent for both patients and family members. There was a desire for better communication with physicians. Many participants were critical of how the prognosis of advanced heart failure was communicated to them, even if they anticipated the news. Participants wanted frank, open conversations with their healthcare providers that both acknowledged that they were at end of life but did not remove all hope.

An Integrative Review on Knowledge and Attitudes of Nurses Toward Palliative Care: Implications for Practice

To effectively participate in provision of palliative care, nurses need to possess a combination of knowledge, skills, and positive attitudes in equal measure in a way that is sensitive and meaningful and in a dynamic manner. The aim of this review was to examine nurses' knowledge and attitudes about palliative care, to identify gaps to improve care of patients and families facing death. An integrative review method guided this review. After implementation of a search strategy, data from 26 studies were analyzed and synthesized. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. Data were extracted using a common table, and themes were generated from the available peer-reviewed studies using narrative synthesis. Findings revealed knowledge deficit but favorable attitudes toward palliative care among nurses. Education and the clinical experience of nurses in palliative care influenced their knowledge and attitudes toward palliative care. There is a need for mandatory inclusion of basic palliative care content in nursing school curricula and more in-depth postgraduate curricula. In clinical practice, there is a need to reinforce palliative care education by creating expert nurse support networks to model excellence in palliative care.

Associations among knowledge, attitudes, and practices toward palliative care consultation service in healthcare staffs: A cross-sectional study

Background

The palliative care consultation service (PCCS) of the National Health Insurance payments has been promoted in Taiwan since 2011, although few studies have been conducted on healthcare staffs’ knowledge, attitudes, and practices regarding PCCS in Taiwan; consequently, the main objective of this study was to explore any correlations regarding the above by cross-sectional design using convenience sampling.

Methods

A total of 210 healthcare staff members were enrolled from a regional hospital from June 1, 2018, to September 30, 2018. Questionnaire items on the Palliative Care Consultation Service Inventory (KAP-PCCSI) were used to measure healthcare staff’s knowledge, attitudes, and practices of PCCS. The collected data were analyzed by using descriptive statistics, independent samples t-test, Pearson’s correlation coefficient analysis, and multiple linear regression analysis.

Results

The results revealed that the mean scores for knowledge of and attitudes of KAP-PCCSI were 58.7 ± 8.9 (perfect score: 75) and 42.7 ± 4.7 (perfect score: 50) respectively, while the mean score for practices of KAP-PCCSI was 36.3 ± 8.1 (perfect score: 50); moreover, the healthcare staff’s knowledge and attitudes were positively correlated with their practices (p < 0.01). The results also showed that knowledge, attitudes, experience of having a family member(s) or friend(s) passing away, and being a medical personnel constituted the major predictors of practices (p < 0.001). These factors explained 43.2% of the overall variance for practices of KAP-PCCSI.

Conclusions

The findings can help healthcare staff understand factors influencing practices of KAP-PCCSI and can serve as a reference for the development of strategies for palliative care education and training while improving the care quality of patients undergoing such palliative care with terminal life considerations in the hospitals, thereby fulfilling the goal of achieving holistic care.

Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play?

Objective

Understanding factors that are associated with more adaptive death attitudes and competencies can inspire future health-promoting palliative care strategies and inform approaches to training and development for health professionals. The potential importance of meaning, purpose, quality, and values in life for promoting adaptive death attitudes has been highlighted, but there is limited research in this area, particularly in relation to death competence. The purpose of this cross-sectional study was to develop an understanding of demographic and life-related factors associated with perceived death competence, such as meaning in life and quality of life.

Method

During the course enrollment period of a Massive-Online-Open-Course about death and dying, 277 participants completed questionnaires on death competence, meaning in life, quality of life, and sociodemographic background.

Result

Findings indicated that greater presence of meaning in life, quality of life, age, death experience, and carer experience were each statistically significant unique predictors of death competence scores. Life-related variables were more strongly associated with death competence than demographic variables. Bereavement experience and experience caring for the dying was associated with greater death competence, but there were no differences on death competence between health professionals and the general community. Above all other factors, the presence of meaning in life was the strongest predictor of higher perceived competence in coping with death.

Significance of results

The findings demonstrate important interconnections between our attitudes about life and death. Knowledge of factors associated with poorer death competence may help identify those at risk of greater distress when facing death, and might prove useful additions to bereavement risk assessments. Understanding factors associated with greater death competence in health professionals and volunteers may help predict or prevent burnout and compassion fatigue, and help identify who would benefit from additional training and support. Future longitudinal studies including both health professionals and the general community are needed to determine the effect adaptive attitudes toward meaning in life can potentially have on bolstering subsequent adaptive coping and competence regarding death and dying.

'I did try and point out about his dignity': a qualitative narrative study of patients and carers' experiences and expectations of junior doctors

OBJECTIVES

For many years, the voice of patients has been understood as a critical element for the improvement of care quality in healthcare settings. How well medical graduates are prepared for clinical practice is an important question, but one that has rarely been considered from patient and public perspectives. We aimed to fill this gap by exploring patients and carers' experiences and expectations of junior doctors.

DESIGN

This comprises part of a wider study on UK medical graduates' preparedness for practice. A qualitative narrative methodology was used, comprising four individual and six group interviews.

PARTICIPANTS

25 patients and carers from three UK countries.

ANALYSIS

Data were transcribed, anonymised and analysed using framework analysis.

MAIN RESULTS

We identified three themes pertinent to answering our research question: (1) sources of knowledge (sources of information contributing to patients and carers' perceptions of junior doctors' impacting on expectations); (2) desires for student/trainee learning (experiences and expectations of medical training); and (3) future doctors (experiences and expectations of junior doctors). We also highlight metaphorical talk and humour, where relevant, in the quotes presented to give deeper insights into participants' perspectives of the issues. Participants focused on personal and interpersonal aspects of being a doctor, such as respect and communication. There was a strong assertion that medical graduates needed to gain direct experience with a diverse range of patients to encourage individualised care. Participants narrated their experiences of having symptoms ignored and attributed to an existing diagnosis ('diagnostic overshadowing') and problems relating to confidentiality.

CONCLUSIONS

Our findings support the view that patients and carers have clear expectations about junior doctors, and that patient views are important for preparing junior doctors for practice. There is a necessity for greater dialogue between patients, doctors and educators to clarify expectations and confidentiality issues around patient care.

Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study

Background

The Taiwanese government has promoted palliative care consultation services (PCCS) to support terminally ill patients in acute ward settings to receive palliative care since 2005. Such an intervention can enhance the quality of life and dignity of terminally ill patients. However, research focusing on the relationship between the knowledge, attitude and practice of a PCCS using path modelling in nursing staff is limited. Therefore, the aim of this study was to elucidate the effect of path modeling on the knowledge, attitude and practice toward PCCS in Taiwanese nursing staff.

Methods

This was a cross-sectional, descriptive study design using convenience sampling. Data collected included demographics, knowledge, attitude and practice as measured by the PCCS inventory (KAP-PCCSI). Two hundred and eighty-four nursing staff from a medical center in northern Taiwan participated in the study in 2013. We performed descriptive statistics, regression analysis, and path modeling using SPSS 19.0 and set p < 0.05 as the statistical significance threshold.

Results

The results showed that the identical factor significantly associated with knowledge, attitude, and practice toward PCCS among nurses was the frequency of contact with PCCS. In addition, higher level of knowledge toward PCCS was associated with working in haematology and oncology wards, and participation in education related to palliative care. A more positive attitude toward PCCS was associated with working in a haematology and oncology ward, and experience of friends or relatives dying. Higher level of practice toward PCCS was associated with nurses who participated in education related to palliative care. In the path modeling, we found that holders of a master’s degree indirectly positive affected practice toward PCCS. Possession of a bachelor degree or above, being single, working within a haematology and oncology ward, and frequency of contact with PCCS positively affected practice toward PCCS.

Conclusions

Based on this study, it is proposed that consultation with PCCS has a positive impact on the care of terminally ill patients. Encouragement of staff to undertake further education can improve the practice of ward staff providing palliative care.

Heart failure patients' future expectations and their association with disease severity, quality of life, depressive symptoms and clinical outcomes

BACKGROUND

Although treatment of heart failure (HF) patients has improved, prognosis still remains poor. Current HF Guidelines recommend communication about prognosis with all patients. Little is known about HF patients' awareness of their shortened life expectancy.

AIM

To explore HF patients' future expectations and to examine whether these expectations are associated with disease severity, quality of life, depressive symptoms and clinical outcomes.

METHOD

Patients randomised to the intervention groups of the COACH study, who were at the end of HF hospitalisation, were asked about their future expectations. Patients were divided into three groups: patients expecting improvement/stabilisation, patients expecting deterioration and those not knowing what to expect. Depressive symptoms were measured by CES-D and quality of life with the Ladder of Life and RAND-36.

RESULTS

Six hundred and seventy eight patients (age 70 ± 12; 41% female patients; LVEF 33% ± 15) participated in the study. Most patients (56%, N = 380) expected improvement or stabilisation, 8% (N = 55) expected deterioration and 21% (N = 144) did not know what to expect for the future. Patients who expected to deteriorate were significantly older, experienced a lower quality of life and more depressive symptoms compared with patients in the other two groups. They also had a higher mortality rate, both after 18 and 36 months, and had more HF admissions. No association with severity of the disease (NYHA-class, LVEF, BNP levels) was found.

CONCLUSION

Many hospitalised HF patients are not aware of their poor prognosis. Depressive symptoms, poor quality of life, increased mortality and rehospitalisation were related to expected deterioration. Improvement of communication about prognosis with HF patients is needed in the future.

Heart failure and palliative care: training needs assessment to guide priority learning of multiprofessionals working across different care settings

PURPOSE OF REVIEW

International bodies acknowledge that palliative care principles and access to palliative care services should be offered to persons living with and dying from advanced illness such as heart failure. Without an appropriately trained workforce, however, appropriate goals of care and associated reductions in hospital utilizations may not be feasible.Marie Curie Cancer Care, British Heart Foundation Scotland and NHS Greater Glasgow and Clyde are working in partnership to improve the quality and access to palliative care for patients and their caregivers living with and dying from advanced heart failure. A training needs assessment has been undertaken as part of this programme in order to inform the development of training specific to heart failure and palliative care.

RECENT FINDINGS

The results of the training needs assessment showed that the majority of respondents had some level of training needs to underpin their existing knowledge and skills in relation to palliative care, heart failure or both.

SUMMARY

Well trained professionals will improve the coordination, earlier identification, quality of care provision and communication between all stakeholders. In doing so, the opportunity to facilitate preferred care wishes and preferred place of care for patients and families is optimised. Without this aligning, clinical practice with national guidance is not feasible.