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Whitlatch CJ, Orsulic-Jeras S, Johnson J. Challenges to and strategies for recruiting chronic care dyads into intervention research. Chronic Illn 2021; 17:232-241. [PMID: 31426659 DOI: 10.1177/1742395319869434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Recruiting and enrolling appropriate participants into research trials for chronic illness populations can be challenging and time intensive. Successful recruitment requires a variety of strategies that may change as the study progresses. This paper reports on the challenges of and actions taken for recruiting and enrolling into research families living with chronic illnesses. METHODS We draw on our experiences from over 20 years of research enrolling older adults and their family caregivers (care dyads) into psychosocial research trials. Barriers and actions taken to challenges of recruiting care dyads are presented that can help future investigators meet their recruitment goals in a timely and efficient manner. RESULTS Despite efforts of an Advisory Committee, numerous community partnerships, and other attempts to boost enrollment, our recruitment goals were not met. Barriers to meeting these goals are described (e.g. partner site staff turnover, lack of site "champion") and potential actions taken. DISCUSSION This paper examines the challenges experienced recruiting appropriate chronic illness dyads into a psychosocial intervention as well as the various recruitment strategies that were used in an attempt to reach recruitment goals.
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Implementing volunteer-navigation for older persons with advanced chronic illness (Nav-CARE): a knowledge to action study. BMC Palliat Care 2020; 19:72. [PMID: 32443979 PMCID: PMC7245025 DOI: 10.1186/s12904-020-00578-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. METHODS This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. RESULTS At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. CONCLUSIONS This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.
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Abstract
Purpose
A growing body of research seeks to include people with dementia as both participants and co-designers. It is also increasingly recognized that dementia research must pay greater attention to informal care, provided by family and friends in non-institutional settings, because this is the situation of most people affected by dementia. Accessing these kinds of naturalistic care sites through meaningfully inclusive studies can be challenging for researchers in many fields. The paper aims to discuss this issue.
Design/methodology/approach
This paper describes a methodology designed to facilitate meaningful inclusion and access to hard-to-reach dementia care networks. It describes the implementation of this methodology in the field, the problems that emerged and the lessons learned.
Findings
A two-step sampling approach was used. People with dementia were sampled through organizations unrelated to dementia. Care networks were sampled through ecomapping with people with dementia. The strategy successfully accessed the desired population, but it was labour-intensive and biased the sample in several respects.
Originality/value
It is hoped that this outline will encourage further reflection and discussion regarding methodological approaches to complex sampling and recruitment issues in dementia research.
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Barclay S, Moran E, Boase S, Johnson M, Lovick R, Graffy J, White PL, Deboys B, Harrison K, Swash B. Primary palliative care research: opportunities and challenges. BMJ Support Palliat Care 2019; 9:468-472. [PMID: 30755396 PMCID: PMC6923936 DOI: 10.1136/bmjspcare-2018-001653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/15/2018] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed. THE STUDY METHODS Using a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs. THE CHALLENGES ADDRESSED Considerable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.
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Affiliation(s)
- Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Emily Moran
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sue Boase
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Johnson
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Roberta Lovick
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Patrick L White
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Brenda Deboys
- Clinical Research Network Eastern; Primary Care, Cambridge, UK
| | - Katy Harrison
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Brooke Swash
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Daamen M, Brunner-la Rocca HP, Tan F, Hamers J, Schols J. Clinical diagnosis of heart failure in nursing home residents based on history, physical exam, BNP and ECG: Is it reliable? Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gardiner C, Brereton L, Frey R, Wilkinson-Meyers L, Gott M. Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:519-531. [PMID: 26099428 DOI: 10.1111/hsc.12253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
The economic burden faced by family caregivers of people at the end of life is well recognised. Financial burden has a significant impact on the provision of family care-giving in the community setting, but has seen limited research attention. A systematic review with realist review synthesis and thematic analysis was undertaken to identify literature relating to the financial costs and impact of family care-giving at the end of life. This paper reports findings relating to previously developed approaches which capture the financial costs and implications of caring for family members receiving palliative/end-of-life care. Seven electronic databases were searched from inception to April 2012, for original research studies relating to the financial impact of care-giving at the end of life. Studies were independently screened to identify those which met the study inclusion criteria, and the methodological quality of included studies was appraised using realist review criteria of relevance and rigour. A descriptive thematic approach was used to synthesise data. Twelve articles met the inclusion criteria for the review. Various approaches to capturing data on the financial costs of care-giving at the end of life were noted; however, no single tool was identified with the sole purpose of exploring these costs. The majority of approaches used structured questionnaires and were administered by personal interview, with most studies using longitudinal designs. Calculation of costs was most often based on recall by patients and family caregivers, in some studies combined with objective measures of resource use. While the studies in this review provide useful data on approaches to capturing costs of care-giving, more work is needed to develop methods which accurately and sensitively capture the financial costs of caring at the end of life. Methodological considerations include study design and method of administration, contextual and cultural relevance, and accuracy of cost estimates.
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Affiliation(s)
- Clare Gardiner
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Louise Brereton
- School of Health & Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Rosemary Frey
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | | | - Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Van den Heuvel LAMC, Hoving C, Schols JMGA, Spruit MA, Wouters EFM, Janssen DJA. Barriers and facilitators to end-of-life communication in advanced chronic organ failure. Int J Palliat Nurs 2016; 22:222-9. [DOI: 10.12968/ijpn.2016.22.5.222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ciska Hoving
- Assistant Professor at Department of Health Promotion
| | - Jos MGA Schols
- Professor of Old Age Medicine, Department of General Practice and Department of Health Services Research, Faculty of Health Medicine and Life Sciences/CAPHRI, Maastricht University, Netherlands
| | - Martijn A Spruit
- Scientific Advisor, Department of Research and Education, CIRO, Horn, Netherlands
| | - Emiel FM Wouters
- Professor of Respiratory Medicine, Department of Respiratory Medicine
| | - Daisy JA Janssen
- Elderly Care Physician, Centre of Expertise for Palliative Care; both at Maastricht University Medical Centre+ (MUMC+), the Netherlands, and, Department of Research and Education, CIRO, Horn, the Netherlands
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Preston NJ, Farquhar MC, Walshe CE, Stevinson C, Ewing G, Calman LA, Burden S, Brown Wilson C, Hopkinson JB, Todd C. Strategies designed to help healthcare professionals to recruit participants to research studies. Cochrane Database Syst Rev 2016; 2:MR000036. [PMID: 35658160 PMCID: PMC8190980 DOI: 10.1002/14651858.mr000036.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Identifying and approaching eligible participants for recruitment to research studies usually relies on healthcare professionals. This process is sometimes hampered by deliberate or inadvertent gatekeeping that can introduce bias into patient selection. OBJECTIVES Our primary objective was to identify and assess the effect of strategies designed to help healthcare professionals to recruit participants to research studies. SEARCH METHODS We performed searches on 5 January 2015 in the following electronic databases: Cochrane Methodology Register, CENTRAL, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, ASSIA and Web of Science (SSCI, SCI-EXPANDED) from 1985 onwards. We checked the reference lists of all included studies and relevant review articles and did citation tracking through Web of Science for all included studies. SELECTION CRITERIA We selected all studies that evaluated a strategy to identify and recruit participants for research via healthcare professionals and provided pre-post comparison data on recruitment rates. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results for potential eligibility, read full papers, applied the selection criteria and extracted data. We calculated risk ratios for each study to indicate the effect of each strategy. MAIN RESULTS Eleven studies met our eligibility criteria and all were at medium or high risk of bias. Only five studies gave the total number of participants (totalling 7372 participants). Three studies used a randomised design, with the others using pre-post comparisons. Several different strategies were investigated. Four studies examined the impact of additional visits or information for the study site, with no increases in recruitment demonstrated. Increased recruitment rates were reported in two studies that used a dedicated clinical recruiter, and five studies that introduced an automated alert system for identifying eligible participants. The studies were embedded into trials evaluating care in oncology mainly but also in emergency departments, diabetes and lower back pain. AUTHORS' CONCLUSIONS There is no strong evidence for any single strategy to help healthcare professionals to recruit participants in research studies. Additional visits or information did not appear to increase recruitment by healthcare professionals. The most promising strategies appear to be those with a dedicated resource (e.g. a clinical recruiter or automated alert system) for identifying suitable participants that reduced the demand on healthcare professionals, but these were assessed in studies at high risk of bias.
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Affiliation(s)
- Nancy J Preston
- Lancaster UniversityInternational Observatory on End of Life CareFurness CollegeLancasterUKLA1 4YG
| | - Morag C Farquhar
- University of CambridgePublic Health & Primary CareInstitute of Public HealthForvie Site, Robinson WayCambridgeCambridgeshireUKCB2 0SR
| | - Catherine E Walshe
- Faculty of Health and Medicine, Lancaster UniversityInternational Observatory on End of Life CareBailriggLancasterLancashireUKLA1 4YG
| | - Clare Stevinson
- Loughborough UniversitySchool of Sport, Exercise and Health SciencesLoughboroughLeicesterUKLE11 3TU
| | - Gail Ewing
- University of CambridgeCentre for Family ResearchFree School LaneCambridgeCambridgeshireUKCB2 3RF
| | - Lynn A Calman
- University of SouthamptonMacmillan Survivorship Research GroupHeath Sciences Building 67Highfield Campus, University RoadSouthamptonUKSO17 1BJ
| | - Sorrel Burden
- University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.32, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
| | - Christine Brown Wilson
- The University of QueenslandSchool of Nursing, Midwifery and Social WorkChamberlain BuildingSt. LuciaBrisbane St LuciaAustralia4067
| | - Jane B Hopkinson
- Cardiff UniversitySchool of Healthcare Sciences, College of Bio‐medical and Life SciencesEastgate House35‐43 Newport RoadCardiffWalesUKCF24 0AB
| | - Chris Todd
- University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.32, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
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LeBlanc TW, Kutner JS, Ko D, Wheeler JL, Bull J, Abernethy AP. Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial. Hosp Pract (1995) 2016; 38:137-43. [PMID: 20890063 DOI: 10.3810/hp.2010.06.320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The field of palliative care and hospice has gained accreditation, with a growing cadre of specialists being trained, but there is a dearth of robust research evidence to guide clinical practice. After 2 years of planning, a group of senior investigators convened in January 2010 to explore the possibility of forming a research cooperative group dedicated to advancing the evidence base in palliative care and hospice. The meeting launched the Palliative Care Research Cooperative (PCRC) with an initial national/international membership, and a plan for developing policies and procedures. Proof of the concept for the PCRC is being established through the design, conduct, and dissemination of a multi-site clinical trial targeting a consensually selected, clinically relevant research question: Should patients who are taking statins for primary or secondary prevention, and who have a prognosis of < 6 months, discontinue these medications? A core group of PCRC members have developed the flagship study for the PCRC, evaluating the discontinuation of statin medications in the palliative care setting. Using the proposed trial as a case study, we underscore several approaches to overcoming common research challenges in end-of-life settings, including: 1) study design, to ensure feasibility and timeliness; 2) strategies to overcome barriers to research in this population; 3) data collection and management, to reduce the burden on patients, caregivers, research personnel, and sites while maximizing quality and efficiency; and 4) agenda setting. This article describes the rationale for convening the PCRC and highlights core principles for developing the evidence base in palliative medicine.
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Affiliation(s)
- Thomas W LeBlanc
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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10
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Daamen MAMJ, Hamers JPH, Gorgels APM, Brunner-La Rocca HP, Tan FES, van Dieijen-Visser MP, Schols JMGA. Heart failure in nursing home residents; a cross-sectional study to determine the prevalence and clinical characteristics. BMC Geriatr 2015; 15:167. [PMID: 26675117 PMCID: PMC4681153 DOI: 10.1186/s12877-015-0166-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 12/08/2015] [Indexed: 01/21/2023] Open
Abstract
Background Heart failure (HF) is expected to be highly prevalent in nursing home residents, but precise figures are scarce. The aim of this study was to determine the prevalence of HF in nursing home residents and to get insight in the clinical characteristics of residents with HF. Methods The study followed a multi-centre cross-sectional design. Nursing home residents (n = 501) in the southern part of the Netherlands aged over 65 years and receiving long-term somatic or psychogeriatric care were included in the study. The diagnosis of HF and related characteristics were based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. A panel of two cardiologists and a geriatrician ultimately judged the data to diagnose HF. Results The overall prevalence of HF in nursing home residents was 33 %, of which 52 % had HF with preserved ejection fraction. The symptoms dyspnoea and oedema and a cardiac history were more common in residents with HF. Diabetes mellitus, chronic obstructive pulmonary disease (COPD) were also more prevalent in those with HF. Residents with HF had a higher score on the Mini Mental State Examination. 54 % of those with HF where not known before, and in 31 % with a history of HF, this diagnosis was not confirmed by the expert panel. Conclusion This study shows that HF is highly prevalent in nursing home residents with many unknown or falsely diagnosed with HF. Equal number of HF patients had reduced and preserved left-ventricular ejection fraction. Trial registration The Netherlands National Trial Register NTR2663 (27-12-2010)
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Affiliation(s)
- Mariëlle A M J Daamen
- Department of Health Services Research, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
| | - Anton P M Gorgels
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | - Frans E S Tan
- Department of Methodology and Statistics, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
| | | | - Jos M G A Schols
- Department of Health Services Research, Research School Caphri, Maastricht University, Maastricht, The Netherlands. .,Department of Family Medicine, Research School Caphri, Maastricht University, Maastricht, The Netherlands.
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Noble HR, Agus A, Brazil K, Burns A, Goodfellow NA, Guiney M, McCourt F, McDowell C, Normand C, Roderick P, Thompson C, Maxwell AP, Yaqoob MM. PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis. BMC Nephrol 2015; 16:104. [PMID: 26163382 PMCID: PMC4499188 DOI: 10.1186/s12882-015-0084-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022] Open
Abstract
Background The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. Methods In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. Discussion The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.
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Affiliation(s)
- Helen Rose Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK.
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK
| | - Aine Burns
- Royal Free Hospital, Pond Street, London, NW3 2QN, UK.
| | - Nicola A Goodfellow
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Mary Guiney
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Fiona McCourt
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Charles Normand
- Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Paul Roderick
- University of Southampton, Mailpoint 805, C floor, South Academic Block, Southampton General Hospital, Southampton, SO166YD, UK.
| | | | - A P Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast & Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK.
| | - M M Yaqoob
- William Harvey Research Institute, Queen Mary University of London, London & Renal Unit, The Royal London Hospital, London, E1 1BB, UK.
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Campbell RT, Jackson CE, Wright A, Gardner RS, Ford I, Davidson PM, Denvir MA, Hogg KJ, Johnson MJ, Petrie MC, McMurray JJV. Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design. ESC Heart Fail 2015; 2:25-36. [PMID: 27347426 PMCID: PMC4864752 DOI: 10.1002/ehf2.12027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 01/29/2023] Open
Abstract
Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near‐consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2‐year period. All potential participants will be screened using B‐type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease‐specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.
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Affiliation(s)
- Ross T Campbell
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ann Wright
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow UK
| | | | | | | | | | - Mark C Petrie
- Robertson Centre for Biostatistics University of Glasgow UK
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
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Theander K, Hasselgren M, Luhr K, Eckerblad J, Unosson M, Karlsson I. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. Int J Chron Obstruct Pulmon Dis 2014; 9:785-94. [PMID: 25071370 PMCID: PMC4111648 DOI: 10.2147/copd.s62563] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare. Aim Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC). Method The study is cross sectional, including patients with COPD (n=437) and CHF (n=388), registered in the patient administrative systems of PHC. The patients received specific questionnaires – the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale – by mail and additional questions about psychological and physical health. Results The mean age was 70±10 years and 78±10 years for patients with COPD and CHF respectively (P=0.001). Patients with COPD (n=273) experienced more symptoms (11±7.5) than the CHF patients (n=211) (10±7.6). The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background characteristics, there were no differences regarding feeling irritable, worrying, and sexual problems. There were no differences in impact of symptoms or health. Conclusion Patients with COPD and CHF seem to experience similar symptoms. There were no differences in how the patients perceived their functioning according to their cardinal symptoms; dyspnea and fatigue, and health. An intervention for both groups of patients to optimize the management of symptoms and improve function is probably more relevant in PHC than focusing on separate diagnosis groups.
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Affiliation(s)
- Kersti Theander
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden ; Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden
| | - Mikael Hasselgren
- Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden ; Department of Medicine, Örebro University, Örebro, Sweden
| | - Kristina Luhr
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Karlsson
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
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McLean C, Kerse N, Moyes SA, Ng T, Lin SYS, Peri K. Recruiting older people for research through general practice: the Brief Risk Identification Geriatric Health Tool trial. Australas J Ageing 2013; 33:257-63. [PMID: 24520915 DOI: 10.1111/ajag.12058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe successful methods of recruitment and identify practice characteristics related to increased recruitment of older people for a randomised controlled trial. METHODS General practices in three regions of New Zealand and community-dwelling patients aged 75+ were recruited for the Brief Risk Identification Geriatric Health Tool trial. General practitioners (GPs) were faxed invitations with telephone follow-up. Reply-paid cards with telephone follow-up were used to invite older people. GP and practice characteristics were examined in relationship to recruitment rate. RESULTS During 2007-2008, 158 of 438 GPs (36%) in 60 of 116 practices approached (52%) were recruited. Regional variation was marked and 3893 of 8308 invited (49%) older people were recruited. The GP's length of time at the practice and training in New Zealand was associated with recruitment success. CONCLUSIONS Despite variability in practice recruitment, a reasonably large and representative sample of older people was recruited through general practices.
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Affiliation(s)
- Christine McLean
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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15
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16
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Barnes S, Wasielewska A, Raiswell C, Drummond B. Exploring the mealtime experience in residential care settings for older people: an observational study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:442-450. [PMID: 23638872 DOI: 10.1111/hsc.12033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 06/02/2023]
Abstract
Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research.
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Affiliation(s)
- Sarah Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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17
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18
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Wilke S, Janssen DJA, Wouters EFM, Schols JMGA, Franssen FME, Spruit MA. Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study. Health Qual Life Outcomes 2012; 10:98. [PMID: 22909154 PMCID: PMC3493349 DOI: 10.1186/1477-7525-10-98] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/16/2012] [Indexed: 11/24/2022] Open
Abstract
Background Longitudinal studies analyzing the correlations between disease-specific and generic health status questionnaires at different time points in patients with advanced COPD are lacking. The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George’s Respiratory Questionnaire, SGRQ) correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36) at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. Methods Demographic and clinical characteristics were assessed in 105 outpatients with advanced COPD at baseline. Disease-specific health status (SGRQ) and generic health status (EQ-5D, AQoL, SF-36) were assessed at baseline, four, eight, and 12 months. Correlations were determined between SGRQ and EQ-5D, AQoL, and SF-36 scores and changes in these scores. Agreement in direction of change was assessed. Results Eighty-four patients (80%) completed one-year follow-up and were included for analysis. SGRQ total score and EQ-5D index score, AQoL total score and SF-36 Physical Component Summary measure (SF-36 PCS) score were moderately to strongly correlated. The correlation of the changes between the SGRQ total score and EQ-5D index score, AQoL total score, SF-36 PCS, and SF-36 Mental Component Summary measure (SF-36 MCS) score were weak or absent. The direction of changes in SGRQ total scores agreed slightly with the direction of changes in EQ-5D index score, AQoL total score, and SF-36 PCS score. Conclusions At four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores. The correlations between changes over time were weak or even absent. Disease-specific health status questionnaires and generic health status questionnaires should be used together to gain complete insight in health status and changes in health status over time in patients with advanced COPD.
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Affiliation(s)
- Sarah Wilke
- Program Development Centre, CIRO+, centre of expertise for chronic organ failure, Hornerheide 1, Horn, NM 6085, The Netherlands.
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Dale B, Saevareid HI, Söderhamn O. Testing reliability and validity of Lorensen's Self-care Capability Scale (LSCS) among older home-living, care-dependent individuals in Norway. Int J Older People Nurs 2012; 8:166-73. [PMID: 22883140 DOI: 10.1111/j.1748-3743.2012.00339.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to test reliability and validity of the Lorensen's Self-Care Capability Scale (LSCS). BACKGROUND The assessment of self-care capability among older people living at home is essential for maintaining independence for as long as possible. METHOD The study sample consisted of 242 home nursing patients who were 75 + years old and living at home. The responsible home nurses documented their answers. In addition to the LSCS, help dependency, subjective health and demographic characteristics were recorded. Various statistical analyses were used to assess reliability and validity of the LSCS. RESULTS Reliability of the LSCS was supported by a Cronbach's alpha coefficient of 0.97. Regarding validity, six factors extracted in the factor analysis explained 69.8% of the variance in the group. The extracted factors supported the underlying theoretical assumptions of the instrument. Construct validity was supported by significant differences between groups with expected low and expected high LSCS scores, respectively. Concurrent validity was established by a significant correlation between LSCS and Barthel's ADL Index. CONCLUSION AND IMPLICATIONS FOR PRACTICE This study has shown that LSCS is a reliable and valid instrument for assessing self-care capability in older people living at home.
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Affiliation(s)
- Bjørg Dale
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Ruijs CD, Kerkhof AJ, van der Wal G, Onwuteaka-Philipsen BD. The broad spectrum of unbearable suffering in end-of-life cancer studied in dutch primary care. BMC Palliat Care 2012; 11:12. [PMID: 22853448 PMCID: PMC3453495 DOI: 10.1186/1472-684x-11-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unbearable suffering most frequently is reported in end-of-life cancer patients in primary care. However, research seldom addresses unbearable suffering. The aim of this study was to comprehensively investigate the various aspects of unbearable suffering in end-of-life cancer patients cared for in primary care. METHODS Forty four general practitioners recruited end-of-life cancer patients with an estimated life expectancy of half a year or shorter. The inclusion period was three years, follow-up lasted one additional year. Practices were monitored bimonthly to identify new cases. Unbearable aspects in five domains and overall unbearable suffering were quantitatively assessed (5-point scale) through patient interviews every two months with a comprehensive instrument. Scores of 4 (serious) or 5 (hardly can be worse) were defined unbearable. The last interviews before death were analyzed. Sources providing strength to bear suffering were identified through additional open-ended questions. RESULTS Seventy six out of 148 patients (51%) requested to participate consented; the attrition rate was 8%, while 8% were alive at the end of follow-up. Sixty four patients were followed up until death; in 60 patients interviews were complete. Overall unbearable suffering occurred in 28%. A mean of 18 unbearable aspects was present in patients with serious (score 4) overall unbearable suffering. Overall, half of the unbearable aspects involved the domain of traditional medical symptoms. The most frequent unbearable aspects were weakness, general discomfort, tiredness, pain, loss of appetite and not sleeping well (25%-57%). The other half of the unbearable aspects involved the domains of function, personhood, environment, and nature and prognosis of disease. The most frequent unbearable aspects were impaired activities, feeling dependent, help needed with housekeeping, not being able to do important things, trouble accepting the situation, being bedridden and loss of control (27%-55%). The combination of love and support was the most frequent source (67%) providing strength to bear suffering. CONCLUSIONS Overall unbearable suffering occurred in one in every four end-of-life cancer patients. Half of the unbearable aspects involved medical symptoms, the other half concerned psychological, social and existential dimensions. Physicians need to comprehensively assess suffering and provide psychosocial interventions alongside physical symptom management.
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Affiliation(s)
- Cees Dm Ruijs
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands.
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21
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Daamen MA, Hamers JPH, Gorgels APM, Brunner-la Rocca HP, Tan FES, van Dieijen-Visser MP, Schols JMGA. The prevalence and management of heart failure in Dutch nursing homes; design of a multi-centre cross-sectional study. BMC Geriatr 2012; 12:29. [PMID: 22686685 PMCID: PMC3462700 DOI: 10.1186/1471-2318-12-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure is likely to be particularly prevalent in the nursing home population, but reliable data about the prevalence of heart failure in nursing homes are lacking. Therefore the aims of this study are to investigate (a) the prevalence and management of heart failure in nursing home residents and (b) the relation between heart failure and care dependency as well as heart failure and quality of life in nursing home residents. METHODS/DESIGN Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care will be included in the study. A panel of two cardiologists and a geriatrician will diagnose heart failure based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. Care dependency will be measured using the Care Dependency Scale. To measure the quality of life of the participating residents, the Qualidem will be used for psychogeriatric residents and the SF-12 and VAS for somatic residents. CONCLUSION The study will provide an insight into the actual prevalence and management of heart failure in nursing home residents as well as their quality of life and care dependency. TRIAL REGISTRATION Dutch trial register NTR2663.
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Affiliation(s)
- Mariëlle Amj Daamen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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22
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Family Caregiving in Advanced Chronic Organ Failure. J Am Med Dir Assoc 2012; 13:394-9. [DOI: 10.1016/j.jamda.2011.04.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 11/20/2022]
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Janssen DJA, Spruit MA, Wouters EFM, Schols JMGA. Symptom distress in advanced chronic organ failure: disagreement among patients and family caregivers. J Palliat Med 2012; 15:447-56. [PMID: 22475192 DOI: 10.1089/jpm.2011.0394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Proxy reporting is frequently used to assess symptom distress of patients with advanced chronic organ failure. The aim of the present cross-sectional study was to examine agreement in severity of symptom distress, presence of symptom-related interventions, and satisfaction with medical treatment among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) and their family caregivers. METHODS Outpatients with advanced COPD (n=73), CHF (n=45) and CRF (n=41) and their family caregivers rated severity of physical and psychological symptoms experienced by the patient using Visual Analogue Scales (VAS). The presence of symptom-related interventions was recorded by patients and family caregivers. Finally, patients and family caregivers rated satisfaction with medical treatment of the patient using VAS. Agreement was determined using intraclass correlation coefficients (ICC) for continuous variables and Cohen's kappa for categorical variables. RESULTS Family caregivers reported a higher number of symptoms than patients (mean [standard deviation; SD]: 8.2 [3.5] versus 7.3 [3.6], respectively [p<0.0005]). For most symptoms, agreement about severity between patients and family caregivers was moderate (ICC: 0.41-0.60). Agreement about satisfaction with medical treatment was fair (ICC [95% confidence interval; CI]: 0.21 [0.05-0.35]). Agreement was poor to moderate for presence of symptom-related interventions (kappa: -0.03-0.54). CONCLUSIONS Studies using proxy reporting reflect the views of proxies and do not accurately represent the patients' experience. For clinical care, it's important to pay attention to the perception from the patient as well as the perception from the family caregiver of symptom distress, presence of symptom-related interventions, and satisfaction with treatment.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
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Janssen DJA, Franssen FME, Wouters EFM, Schols JMGA, Spruit MA. Impaired health status and care dependency in patients with advanced COPD or chronic heart failure. Qual Life Res 2011; 20:1679-88. [PMID: 21442430 PMCID: PMC3220822 DOI: 10.1007/s11136-011-9892-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status. METHODS The following outcomes were assessed in outpatients with advanced COPD (n = 105) or CHF (n = 80): clinical characteristics; general health status (EuroQol-5 Dimensions (EQ-5D); Assessment of Quality of Life instrument (AQoL); Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)); disease-specific health status (St. Georges Respiratory Questionnaire (SGRQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ)); physical mobility (timed 'Up and Go' test); and care dependency (Care Dependency Scale). RESULTS Patients with advanced COPD or CHF have an impaired health status and may be confronted with care dependency. Multiple regression analyses have shown that physical and psychological symptoms, care dependency and number of drugs were correlated with impaired health status in advanced COPD or CHF, while demographic and clinical characteristics like age, gender, disease severity and co-morbidities were not correlated. CONCLUSIONS Clinical care should regularly assess symptom burden and care dependency to identify patients with advanced COPD or CHF at risk for an impaired health status.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO +, centre of expertise for chronic organ failure, Hornerheide 1, 6085 NM Horn, The Netherlands.
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25
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Wohleber AM, McKitrick DS, Davis SE. Designing Research With Hospice and Palliative Care Populations. Am J Hosp Palliat Care 2011; 29:335-45. [DOI: 10.1177/1049909111427139] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research in palliative care and hospice populations is important for improving quality of care, quality of life, and provider understanding of individuals at the end of life. However, this research involves many potential challenges. This review seeks to inform and assist researchers targeting to design studies targeting hospice and palliative care patients by presenting a thorough review of the published literature. This review covers English-language articles published from 1990 through 2009 listed in the PsycInfo, Medline, or CINAHL research databases under relevant keywords. Articles on pediatric hospice were not included. Issues discussed include study design, informed consent, and recruitment for participants. Synthesized recommendations for researchers in these populations are presented.
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Affiliation(s)
- Ashley M. Wohleber
- School of Professional Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Shawn E. Davis
- School of Professional Psychology, Pacific University, Hillsboro, OR, USA
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Janssen DJA, Spruit MA, Schols JMGA, Cox B, Nawrot TS, Curtis JR, Wouters EFM. Predicting changes in preferences for life-sustaining treatment among patients with advanced chronic organ failure. Chest 2011; 141:1251-1259. [PMID: 22016488 DOI: 10.1378/chest.11-1472] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND For physicians discussing advance care planning with patients with life-limiting illness, it is important to understand the stability of the patients' preferences for life-sustaining treatments and the factors that predict a change in preferences. Our objectives were to investigate 1-year stability of preferences regarding CPR and mechanical ventilation (MV) for outpatients with advanced COPD, chronic heart failure (CHF), or chronic renal failure (CRF) and to identify predictors of changes in preferences. METHODS In this study, 265 clinically stable outpatients with advanced COPD, CHF, or CRF were visited at baseline and every 4 months for 1 year to assess preferences regarding CPR and MV in their current health status. Generalized estimating equations were used to examine the association between change in life-sustaining treatment preferences and several potential predictors, including changes in comorbidities, hospital admissions, generic health status, care dependency, mobility, and symptoms of anxiety or depression. RESULTS The 1-year follow-up period was completed by 77.7% of the patients. Preferences regarding CPR or MV changed in 38.3% of the patients during the follow-up period. Changes over time in generic health status, mobility, symptoms of anxiety and depression, and marital status were associated with changes in life-sustaining treatment preferences. CONCLUSIONS More than one-third of outpatients with advanced COPD, CHF, or CRF change their preferences regarding CPR and/or MV at least once during 1 year. Regular reevaluation of advance care planning is necessary, in particular when patients experience a change in health status, mobility, symptoms of anxiety or depression, or marital status. TRIAL REGISTRY Netherlands National Trial Register; No.: NTR 1552; URL: http://www.trialregister.nl.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands.
| | - Martijn A Spruit
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands
| | - Jos M G A Schols
- Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life Sciences/CAPHRI, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Bianca Cox
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, Seattle, WA
| | - Emiel F M Wouters
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
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McLennon SM, Habermann B. Accruing the sample: strategies for recruiting older adult and African Americans caregivers for persons with Alzheimer's disease. Appl Nurs Res 2011; 25:e1-6. [PMID: 21945377 DOI: 10.1016/j.apnr.2011.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/26/2011] [Accepted: 06/24/2011] [Indexed: 11/17/2022]
Abstract
The challenges and barriers associated with recruiting a representative sample of community-residing older adult caregivers for persons with Alzheimer's disease (AD) may limit efficient accrual in a reasonable period. These limitations may inhibit study completion, result in underpowered samples, or overextend research budgets. With the use of both grassroots recruiting and local community resources, successful recruitment methods and experiences obtained during two studies, the first in older adults caring for a spouse with AD and the second in family caregivers for African Americans with AD, are described. Strategies used to accrue the samples are discussed within the framework of knowledge, planning, and creativity.
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Waterworth S, Gott M, Raphael D, Barnes S. Older people with heart failure and general practitioners: temporal reference frameworks and implications for practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:412-419. [PMID: 21324024 DOI: 10.1111/j.1365-2524.2010.00984.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of the study was to identify the time experiences of older patients and general practitioners (GPs). Secondary analysis of qualitative data collected from two longitudinal studies, one in the United Kingdom (UK) and the other in New Zealand (NZ), was carried out. The UK study involved interviews with 44 older people with heart failure and nine focus group discussions with primary health professionals during 2004-2005. The NZ study involved 79 interviews with 25 older people with heart failure and 30 telephone interviews with GPs during 2008-2009. Temporal reference frameworks function as background expectations and influence how patients and GPs experienced time and act as time controls. The key themes identified were: clock time was evident in how it structured the consultations; both patients and GPs valued needing time and for some GPs this involved creating space for emotional time. There were also tensions between needing time and wasting time; being known over time was important to both patients and GPs. For older people with heart failure improving their quality of care is essential and time is integral to this, not only the clock time and length of consultations. Identifying temporal reference frameworks provides an understanding that there are multiple times and exposes the influence of these in the lives of both the older people and GPs.
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Janssen DJ, Spruit MA, Uszko-Lencer NH, Schols JM, Wouters EF. Symptoms, Comorbidities, and Health Care in Advanced Chronic Obstructive Pulmonary Disease or Chronic Heart Failure. J Palliat Med 2011; 14:735-43. [DOI: 10.1089/jpm.2010.0479] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daisy J.A. Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- CAPHRI, Nursing Home Medicine, Faculty of Health Medicine and Life Sciences/CAPHRI Maastricht University, Maastricht, The Netherlands
- Proteion Thuis, Horn, The Netherlands
| | - Martijn A. Spruit
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Nicole H. Uszko-Lencer
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Jos M.G.A. Schols
- Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life Sciences/CAPHRI Maastricht University, Maastricht, The Netherlands
| | - Emiel F.M. Wouters
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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30
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Janssen DJA, Spruit MA, Schols JMGA, Wouters EFM. A call for high-quality advance care planning in outpatients with severe COPD or chronic heart failure. Chest 2010; 139:1081-1088. [PMID: 20829337 DOI: 10.1378/chest.10-1753] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with severe COPD or chronic heart failure (CHF) are often confronted with decisions concerning life-sustaining treatments. The aim of this prospective, observational study was to assess life-sustaining treatment preferences, advance care planning, and the quality of end-of-life care communication in Dutch outpatients with clinically stable but severe COPD or CHF. METHODS The following outcomes were assessed in outpatients with severe COPD (n = 105) or CHF (n = 80): life-sustaining treatment preferences (CPR and mechanical ventilation; Willingness to Accept Life-sustaining Treatment instrument), advance care planning, and quality of end-of-life care communication (Quality of Communication questionnaire). RESULTS Most patients asserted that in their current health status, they would prefer CPR (COPD, 70.5%; CHF, 62.5%) and/or mechanical ventilation (COPD, 70.5%; CHF, 66.3%). Patients' treatment preferences were influenced by burden of treatment, outcome of treatment, and likelihood of outcome. Advance directives were discussed with the physician specialist by 5.9% of patients with COPD and 3.9% of patients with CHF. Patients rated quality of patient-physician end-of-life care communication as poor. Physicians rarely discussed prognosis, dying, and palliative care. CONCLUSIONS Despite the fact that patients are able to indicate their preferences regarding life-sustaining treatments, based on burden of treatment, outcome of treatment, and likelihood of outcome, these preferences are rarely discussed with their physician specialist. This study shows a need for advance care planning, taking into account the burden of treatment, outcome of treatment, and likelihood of outcome, in patients with severe COPD or CHF. Finally, the quality of patient-physician end-of-life care communication needs to improve.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - Martijn A Spruit
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Jos M G A Schols
- Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Ingleton C, Gardiner C. Commentary on Tang W-R (2009) Hospice family caregivers' quality of life. Journal of Clinical Nursing 18, 2563-2572. J Clin Nurs 2010; 18:3516-9. [PMID: 20487496 DOI: 10.1111/j.1365-2702.2009.02824.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forster SE, Jones L, Saxton JM, Flower DJ, Foulds G, Powers HJ, Parker SG, Pockley AG, Williams EA. Recruiting older people to a randomised controlled dietary intervention trial--how hard can it be? BMC Med Res Methodol 2010; 10:17. [PMID: 20175903 PMCID: PMC2843618 DOI: 10.1186/1471-2288-10-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 02/22/2010] [Indexed: 11/28/2022] Open
Abstract
Background The success of a human intervention trial depends upon the ability to recruit eligible volunteers. Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies. In order to predict recruitment rates accurately, researchers need information on the relative success of various recruitment strategies. Few published trials include such information and the number of participants screened or approached is not always cited. Methods This paper will describe in detail the recruitment strategies employed to identify older adults for recruitment to a 6-month randomised controlled dietary intervention trial which aimed to explore the relationship between diet and immune function (The FIT study). The number of people approached and recruited, and the reasons for exclusion, will be discussed. Results Two hundred and seventeen participants were recruited to the trial. A total of 7,482 letters were sent to potential recruits using names and addresses that had been supplied by local Family (General) Practices. Eight hundred and forty three potential recruits replied to all methods of recruitment (528 from GP letters and 315 from other methods). The eligibility of those who replied was determined using a screening telephone interview, 217 of whom were found to be suitable and agreed to take part in the study. Conclusion The study demonstrates the application of multiple recruitment methods to successfully recruit older people to a randomised controlled trial. The most successful recruitment method was by contacting potential recruits by letter on NHS headed note paper using contacts provided from General Practices. Ninety percent of recruitment was achieved using this method. Adequate recruitment is fundamental to the success of a research project, and appropriate strategies must therefore be adopted in order to identify eligible individuals and achieve recruitment targets. Trial registration number ISRCTN45031464.
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Affiliation(s)
- Sarah E Forster
- Department of oncology, Faculty of Medicine and Dentistry and Health, The University of Sheffield, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, UK.
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Dying, death and bereavement: a qualitative study of the views of carers of people with heart failure in the UK. BMC Palliat Care 2009; 8:6. [PMID: 19531240 PMCID: PMC2702327 DOI: 10.1186/1472-684x-8-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 06/16/2009] [Indexed: 01/15/2023] Open
Abstract
Background This paper explores carers' views of dying, death and bereavement for family members who had recently died with heart failure adding to a growing literature on end of life experiences for people with conditions other than cancer. Methods Twenty interviews were conducted with bereaved carers of older people with heart failure (HF) who had been participating in a longitudinal study. Carers were approached in writing 3 months after the death. Interviews were transcribed verbatim and analysed thematically with the assistance of NUD*IST. Results Findings were grouped into three time periods: prior to death; the death itself and bereavement. Most carers found discussions about end of life with their family member prior to death difficult. Dissatisfaction with the manner of the death was focused around hospital care, particularly what they believed to be futile treatments. In contrast deaths in the home were considered 'good'. Carers adopted a range of coping strategies to deal with grief including 'using their faith' and 'busying themselves' with practicalities. There was some satisfaction with services accessed during the bereavement period although only a small number had taken up counselling. Discussion Our findings suggest that an absence of discussion about end of life care wishes with family members or health professionals is a barrier to advance care planning. Carers' perceptions about prioritising making the dying person comfortable can be in conflict with doctors' decisions to treat. Whilst carers report a range of strategies adopted in response to bereavement there is a need for continued support for vulnerable carers after the death of the person with HF.
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Gott M, Small N, Barnes S, Payne S, Seamark D. Older people's views of a good death in heart failure: implications for palliative care provision. Soc Sci Med 2008; 67:1113-21. [PMID: 18585838 DOI: 10.1016/j.socscimed.2008.05.024] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Indexed: 11/25/2022]
Abstract
Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. That prevalent model is identified as the "revivalist" good death. Our findings indicate that older people's views of a 'good death' often conflict with the values upon which palliative care is predicated. For example, in line with previous research, many participants did not want an open awareness of death preceded by acknowledgement of the potential imminence of dying. Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.
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Affiliation(s)
- M Gott
- Sheffield Insitute for Studies on Ageing, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S Yorks, UK.
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Janssen DJA, Wouters EFM, Schols JMGA, Spruit MA. Self-perceived symptoms and care needs of patients with severe to very severe chronic obstructive pulmonary disease, congestive heart failure or chronic renal failure and its consequences for their closest relatives: the research protocol. BMC Palliat Care 2008; 7:5. [PMID: 18460203 PMCID: PMC2391145 DOI: 10.1186/1472-684x-7-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 05/06/2008] [Indexed: 11/30/2022] Open
Abstract
Background Recent research shows that the prevalence of patients with very severe chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and chronic renal failure (CRF) continues to rise over the next years. Scientific studies concerning self-perceived symptoms and care needs in patients with severe to very severe COPD, CHF and CRF are scarce. Consequently, it will be difficult to develop an optimal patient-centred palliative care program for patients with end-stage COPD, CHF or CRF. The present study has been designed to assess the symptoms, care needs, end-of-life care treatment preferences and communication needs of patients with severe to very severe COPD, CHF or CRF. Additionally, family distress and care giving burden of relatives of these patients will be assessed. Methods/design A cross-sectional comparative and prospective longitudinal study in patients with end-stage COPD, CHF or CRF has been designed. Patients will be recruited by their treating physician specialist. Patients and their closest relatives will be visited at baseline and every 4 months after baseline for a period of 12 months. The following outcomes will be assessed during home visits: self-perceived symptoms and care needs; daily physical functioning; general health status; end-of-life care treatment preferences; end-of-life care communication and care-giver burden of family caregivers. Additionally, end-of-life care communication and prognosis of survival will be assessed with the physician primarily responsible for the management of the chronic organ failure. Finally, if patients decease during the study period, the baseline preferences with regard to life-sustaining treatments will be compared with the real end-of-life care. Discussion To date, the symptoms, care needs, caregiver burden, end-of-life care treatment preferences and communication needs of patients with very severe COPD, CHF or CRF remain unknown. The present study will increase the knowledge about the self-perceived symptoms, care-needs, caregiver burden, end-of-life care treatment preferences and communication needs from the views of patients, their loved ones and their treating physician. This knowledge is necessary to optimize palliative care for patients with COPD, CHF or CRF. Here, the design of the present study has been described. A preliminary analysis of the possible strengths, weaknesses and clinical consequences is outlined.
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Affiliation(s)
- Daisy J A Janssen
- Central Department of Treatment and Care, Proteion Thuis, Horn, The Netherlands.
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Janssen DJA, Wouters EFM, Schols JMGA, Spruit MA. Self-perceived symptoms and care needs of patients with severe to very severe chronic obstructive pulmonary disease, congestive heart failure or chronic renal failure and its consequences for their closest relatives: the research protocol. BMC Palliat Care 2008. [PMID: 18460203 DOI: 10.1186/1472–684x-7-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent research shows that the prevalence of patients with very severe chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and chronic renal failure (CRF) continues to rise over the next years. Scientific studies concerning self-perceived symptoms and care needs in patients with severe to very severe COPD, CHF and CRF are scarce.Consequently, it will be difficult to develop an optimal patient-centred palliative care program for patients with end-stage COPD, CHF or CRF. The present study has been designed to assess the symptoms, care needs, end-of-life care treatment preferences and communication needs of patients with severe to very severe COPD, CHF or CRF. Additionally, family distress and care giving burden of relatives of these patients will be assessed. METHODS/DESIGN A cross-sectional comparative and prospective longitudinal study in patients with end-stage COPD, CHF or CRF has been designed. Patients will be recruited by their treating physician specialist. Patients and their closest relatives will be visited at baseline and every 4 months after baseline for a period of 12 months. The following outcomes will be assessed during home visits: self-perceived symptoms and care needs; daily physical functioning; general health status; end-of-life care treatment preferences; end-of-life care communication and care-giver burden of family caregivers. Additionally, end-of-life care communication and prognosis of survival will be assessed with the physician primarily responsible for the management of the chronic organ failure. Finally, if patients decease during the study period, the baseline preferences with regard to life-sustaining treatments will be compared with the real end-of-life care. DISCUSSION To date, the symptoms, care needs, caregiver burden, end-of-life care treatment preferences and communication needs of patients with very severe COPD, CHF or CRF remain unknown. The present study will increase the knowledge about the self-perceived symptoms, care-needs, caregiver burden, end-of-life care treatment preferences and communication needs from the views of patients, their loved ones and their treating physician. This knowledge is necessary to optimize palliative care for patients with COPD, CHF or CRF. Here, the design of the present study has been described. A preliminary analysis of the possible strengths, weaknesses and clinical consequences is outlined.
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Affiliation(s)
- Daisy J A Janssen
- Central Department of Treatment and Care, Proteion Thuis, Horn, The Netherlands.
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A survey of the views of palliative care healthcare professionals towards referring cancer patients to participate in randomized controlled trials in palliative care. Support Care Cancer 2008; 16:1397-405. [PMID: 18449574 DOI: 10.1007/s00520-008-0441-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 03/06/2008] [Indexed: 10/22/2022]
Abstract
GOALS OF WORK Clinical trials in palliative care (PC), especially randomised controlled trials (RCTs), are notoriously difficult to complete. One perceived challenge is gatekeeping, the reluctance of some healthcare professionals (HCPs) to refer patients for research studies. This study aimed to identify the extent of gatekeeping from palliative RCTs. MATERIALS AND METHODS An anonymous questionnaire was sent to 597 HCPs with an interest in PC in Australia and New Zealand to assess their willingness to refer patients for RCTs. Respondents considered key issues that might affect their decision, documented willingness to refer to RCTs of increasing complexity in a hypothetical pain situation and documented the degree of patient inconvenience considered acceptable. Demographic data were collected. MAIN RESULTS One hundred ninety-eight questionnaires were returned (33%), 122 from doctors and 76 from other HCPs. Very few were willing to refer to complicated studies involving many extra tests and/or hospital visits. Non-medical HCPs were less interested than doctors in studies that involved randomisation, placebo controls or double-blind methodology. The majority would refer patients for non-pharmacological studies, but were less willing to refer for pharmacological studies with possible side effects. Non-medical HCPs were less willing than doctors to refer to trials that involved patient inconvenience. Two factors predicted for greater willingness to refer: previous research experience and male gender. CONCLUSION The survey revealed an unwillingness on the part of many HCPs to refer patients for RCTs in PC. It identifies trial-related factors that may encourage or discourage referral. Gatekeeping has the potential block recruitment and introduce a selection bias.
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Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, Small N. Predicting mortality among a general practice-based sample of older people with heart failure. Chronic Illn 2008; 4:5-12. [PMID: 18322025 DOI: 10.1177/1742395307083783] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify factors available to general practitioners (GPs) that are predictive of mortality within a general practice-based population of heart failure patients, and to report the sensitivity and specificity of prognostic information from GPs. METHODS Five hundred and forty-two heart failure patients aged >60 years were recruited from 16 UK GP surgeries. Patients completed quality-of-life and services use questionnaires every 3 months for 24 months or until death. Factors with independent significant association with survival were identified using Cox proportional hazards regression analysis. RESULTS Women had a 58% lower risk of death. Patients self-reporting New York Heart Association Classification III or IV had an 81% higher risk of death. Patients aged 85+ years had over a five-fold risk of death as compared with those aged <65 years. Patients with a co-morbidity of cancer had a 78% higher risk of death. Of the 14 patients who died in a 12-month period, the GPs identified 11 (sensitivity 79%). They identified 133 of the 217 who did not die (specificity 61%). DISCUSSION Predictors readily available to GPs, such as patient characteristics, are easy to adapt to use in general practice, where most heart failure patients are diagnosed and treated. Identifying factors likely to influence death is useful in primary care, as this can initiate discussion about end-of-life care.
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Affiliation(s)
- Sarah Barnes
- Section of Public Health, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
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Gott M, Barnes S, Payne S, Parker C, Seamark D, Gariballa S, Small N. Patient views of social service provision for older people with advanced heart failure. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:333-42. [PMID: 17578394 DOI: 10.1111/j.1365-2524.2007.00689.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The objective of the present paper is to explore levels of social service provision, the barriers to receiving these services and the experiences of social service provision amongst older people with heart failure. Five hundred and forty-two people aged over 60 years with heart failure were recruited from UK general practices in four areas of the UK, and these subjects completed quality-of-life and service-use questionnaires every 3 months for 24 months, or until death. Forty patients participated in in-depth interviews. Data collection was conducted between September 2003 and March 2006. Only 24% (n = 127) of the 460 participants who had provided information about social services contact reported having received social services during the past 24 months. Significant associations between the level of social services contact and participant characteristics were identified, with women, participants over 75 years of age, participants living alone, and those with two or more comorbidities being more likely to report receipt of social services. The qualitative data identified key barriers to using social services, including: access problems; not wanting additional help; the negative experiences of friends; and carers substituting for statutory services. The few participants interviewed who had received social services reported mixed experiences, including problems with inappropriate and insufficient services. This study indicates that only a minority of older people with heart failure have contact with social services. Improving provision for this group involves tackling the barriers to access identified above, as well as ensuring that their views influence service planning and delivery.
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Affiliation(s)
- Merryn Gott
- Sheffield Institute for Studies on Ageing, University of Sheffield, Sheffield, UK
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Abstract
OBJECTIVES To explore dying trajectories in heart failure. DESIGN Prospective, longitudinal study. SETTING Sixteen GP surgeries in four demographically contrasting areas of the UK. PARTICIPANTS A total of 27 heart failure patients, >60 years of age, who completed questionnaires for at least five time-points before death. MAIN OUTCOME MEASURES Kansas City Cardiomyopathy Questionnaire Physical Limitation Scale. RESULTS No 'typical' dying trajectory could be identified, and only a minority of patients conformed to the theoretical trajectory of dying in heart failure. CONCLUSIONS This study provides the first prospective data regarding physical decline prior to death in heart failure. Findings challenge current efforts to plan and deliver palliative care services on the basis of the theoretical heart failure dying trajectory.
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Affiliation(s)
- Merryn Gott
- Sheffield Institute for Studies on Ageing, University of Sheffield, Sheffield
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Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, Small N. Prevalence of symptoms in a community-based sample of heart failure patients. J Pain Symptom Manage 2006; 32:208-16. [PMID: 16939845 DOI: 10.1016/j.jpainsymman.2006.04.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2006] [Indexed: 10/24/2022]
Abstract
This study explored the prevalence and burden of symptoms in a community-based sample of patients aged >60 with symptomatic heart failure. Five hundred forty-two patients were recruited from UK general practices. Participants completed the Kansas City Cardiomyopathy Questionnaire every 3 months for 2 years. Data are presented at baseline alongside findings from in-depth interviews with patients and focus groups with primary care professionals. Over half the participants experienced breathlessness and/or fatigue daily. Factors identified as predictive of symptom prevalence and burden were as follows: being female; being staged at New York Heart Association Class III or IV; having symptoms of depression; and having two or more comorbidities. Interviews identified other symptoms, including chest pain, nausea, sleep disruption, and confusion. Participants felt that symptoms restricted activities of daily living. Health professionals reported symptom control as being a concern of patients and identified their own educational needs in this area. Findings suggest that symptom prevalence and burden for this population is high. Primary care professionals should offer comprehensive assessment and treatment of symptoms.
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Affiliation(s)
- Sarah Barnes
- Sheffield Institute for Studies on Ageing, University of Sheffield, Sheffield, United Kingdom.
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