The Person-Centred Care Guideline: From Principle to Practice

Here for the people: The argument for making clinical ethics more patient-centred

Healthcare organizations aim to provide excellent, patient-centred care. Many departments within a hospital excel in achieving this goal, but clinical ethics service providers would benefit from becoming more patient-centred. This article considers how ethics services can add a patient-facing component to their strategic direction and work portfolio. Through a case example, suggestions to guide ethics service providers in expanding their duties and responsibilities are provided, including consultation with families and education sessions. This reframing would include clarifying the role of ethics within a healthcare organization, making services more accessible to patients, families and the community, as well as engaging with other disciplines to provide well-rounded patient care. While the work currently being done by clinical ethics services is important and ought to be continued, ethics service providers should strive to achieve the goal of improving patient experiences and directly contribute to the excellent care being provided.

The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research

PURPOSE

This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review.

METHODS

The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods.

RESULTS

Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact.

CONCLUSIONS

An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.

Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer

OBJECTIVE

Greater emphasis on patient empowerment has led to a plethora of mobile health applications aimed at empowering patients with cancer. However, the rigor and evidence of these apps are rarely acknowledged. This systematic review of patient empowerment apps describes the characteristics, quality, heuristics, and evidence supporting these apps.

MATERIALS AND METHODS

We identified commercially available apps through the Apple and Google Play stores using patient- and research-derived conceptualizations of patient empowerment. Three authors used the Mobile App Rating Scale, heuristics, readability, user ratings, and evidence to evaluate the apps' foci, features, and quality. App characteristics were summarized with descriptive analyses.

RESULTS

Twelve apps met the eligibility criteria and were analyzed. Apps' content focused on enhancing communication skills (n = 10, 83.3%), social support (n = 8, 66.7%), information about cancer and treatment (n = 8, 66.7%), and peer-to-peer support (n = 5, 41.7%). The mean objective (3.9 ± 0.5 out of 5) and subjective (3.7 ± 1.0 out of 5) quality scores were moderate to high. Most heuristics were not violated, and the mean reading level was 10th grade, which is above the recommended 8th grade level. Four apps had been evaluated in published research articles.

DISCUSSION

The contents of patient empowerment apps varied greatly, and the readability was exclusionary to the average reader. Apps.

CONCLUSION

Patient empowerment apps should be more rigorously designed and tested to ensure the apps are usable and beneficial to diverse groups of cancer survivors.

Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

BACKGROUND

Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care.

METHODS

A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles.

RESULTS

Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority.

CONCLUSION

Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

Incorporating Stakeholder Perspectives on Scarce Resource Allocation: Lessons Learned from Policymaking in a Time of Crisis

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work.

Integrative literature review of evidence-based patient-centred care guidelines

AIM

To summarize what facilitates patient-centred care for adult patients in acute healthcare settings from evidence-based patient-centred care guidelines.

DESIGN

An integrative literature review.

DATA SOURCES

The following data sources were searched between 2002-2020: Citation databases: CINAHL, Medline, Biomed Central, Academic Search Complete, Health Source: Nursing/Academic Edition and Google Scholar. Guideline databases: US National Guideline Clearinghouse, Guidelines International Network, and National Institute for Health and Clinical Excellence (NICE). Websites of guideline developers: Scottish Intercollegiate Guidelines Network, Royal College of Nurses, Registered Nurses Association of Ontario, New Zealand Guidelines Group, National Health and Medical Research Council, and Canadian Medical Association.

GUIDELINES

REVIEW METHODS

Whittemore and Knafl's five-step integrative literature review: (1) identification of research problem; (2) search of the literature; (3) evaluation of data; (4) analysis of data; and (5) presentation of results.

RESULTS

Following critical appraisal, nine guidelines were included for data extraction and synthesis. The following three groups of factors were found to facilitate patient-centred care: 1) Patient care practices: embracing values foundational to patient-centred care, optimal communication in all aspects of care, rendering basic nursing care practices, and family involvement; 2) Educational factors: staff and patient education; and 3) Organizational and policy factors: organizational and managerial support, organizational champions, healthy work environment, and organizational structures promoting interdisciplinary partnership.

CONCLUSION

Evidence from included guidelines can be used by nurses, with the required support and buy-in from management, to promote patient-centred care.

IMPACT

Patient-centred care is essential for quality care. No other literature review has been conducted in the English language to summarize evidence-based patient-centred care guidelines. Patient care practices and educational, organizational, and policy factors promote patient-centred care to improve quality of care and raise levels of awareness of patient-centred care among nursing staff and patients.

Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi

Resilience as a strength-based notion, measured across cultures, age groups, and sub-populations, contributes to understanding health and well-being. Yet, there is limited evidence of how the construct performs in resource-limited countries. We explored the psychometric properties of the CYRM-28 and validated the scale with adolescents living with HIV (ALHIV), a key sub-population. The participants included members of an advisory panel and 406 ALHIV, aged 15–19 years, attending an antiretroviral therapy and teen-club clinic in Blantyre, Malawi. This study employed a mixed-method study using an exploratory sequential design. The advisory panel discussed the CYRM-28, and select ALHIV then translated it into Chichewa, pilot-tested it using cognitive interviews, and back-translated it for clarity and appropriateness. The resultant CYRM-28 was tested using a survey with purposefully selected ALHIV. The overall median score was 123, with an interquartile range of 110–130. Minimum and maximum scores were 53 and 140. Cronbach’s alpha of 0.863 and Kaiser–Meyer–Olkin measure (0.866) confirmed internal consistency and the sample size adequacy, respectively. Bartlett’s tests of sphericity (p < 0.001) informed factor analysis. Exploratory factor analysis determined possible dimensions of resilience and the sub-scales. The confirmatory factor analysis (CFA) confirmed the construct validity and supported a three-factor model consistent with the conceptualization of resilience as a multi-dimensional construct. Structural equation modeling was applied to perform CFA to measure model of resilience. Multiple fit indices showed a good fit for the model. The CYRM-28 has good internal consistency, test and re-test reliability, and moderate convergent validity which render it useful as a self-report resilience measure to inform and evaluate interventions for the health and well-being of adolescents in Malawi.

Patients' perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews

OBJECTIVES

Previous studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of this study was to analyse patients' perspectives of facilitators and barriers towards implementing PCC.

DESIGN

We conducted semistructured individual interviews with chronically ill patients. The interviewees were encouraged to share positive and negative experiences of care and the related facilitators and barriers in all settings including preventive, acute and chronic health issues. Interview data were analysed based on the concept of content analysis.

SETTING

Interviews took place at the University Hospital Cologne, nursing homes, at participants' homes or by telephone.

PARTICIPANTS

Any person with at least one chronic illness living in the region of Cologne was eligible for participation. 25 persons with an average age of 60 years participated in the interviews. The participants suffered from various chronic conditions including mental health problems, oncological, metabolic, neurological diseases, but also shared experiences related to acute health issues.

RESULTS

Participants described facilitators and barriers of PCC on the microlevel (eg, patient-provider interaction), mesolevel (eg, health and social care organisation, HSCO) and macrolevel (eg, laws, financing). In addition to previous concepts, interviewees illustrated the importance of being an active patient by taking individual responsibility for health. Interviewees considered functioning teams and healthy staff members a facilitator of PCC as this can compensate stressful situations or lack of staff to some degree. A lack of transparency in financing and reimbursement was identified as barrier to PCC.

CONCLUSION

Individual providers and HSCOs can address many facilitators and barriers of PCC as perceived by patients. Large-scale changes such as reduction of administrative barriers, the expansion of care networks or higher mandatory nurse to patient ratios require political action and incentives.

TRIAL REGISTRATION NUMBER

DRKS00011925.

Forms of trust and polypharmacy among older adults

This article examines how older adults make decisions about their medications through interconnected axes of trust that operate across social networks. Trust is negotiated by older adults enrolled in a deprescribing programme which guides them through the process of reducing medications to mitigate risks associated with polypharmacy. Habermas’ work on the significance of communicative action in negotiating trust within social relationships informs our analysis, specifically in-depth semi-structured interviews with older adults about their medication use and the role of social networks in managing their health. Participants were age 70+ and experiencing polypharmacy. Our analysis discusses the social nature of medication practices and the importance of social networks for older adults’ decision-making. Their perspective reflects the critique of late-modern society put forward by Habermas. Negotiating trust in pharmaceutical decision-making requires navigating tensions across and between system networks (health-care professionals) and life-world networks (family and friends). This study contributes to our knowledge of how distinct forms of trust operate in different social spheres, setting the context for the way health-care decisions are made across social networks. Our analysis reinforces the need for older adults to engage meaningfully in health-care decision-making such that a convergence between system-world and life-world structures is encouraged. This would improve deprescribing programmes’ efficacy as older adults optimise their medication use and improve overall quality of life.

L'infirmière pivot associée à une expérience de soins oncologiques positive et à une satisfaction accrue des patients

Contexte et objectifs

Un nombre croissant de résultats probants indique que l'infirmière pivot en oncologie (IPO) joue un rôle de premier plan dans l'optimisation des processus et des résultats de soins. Il faudra toutefois mener des études d'envergure pour comparer les perceptions de l'expérience de soins liés au cancer des patients traités par des infirmières pivots et de ceux qui n'ont pas bénéficié de ce type de suivi.

Méthodologie

Des participants (N = 2 858) traités au cours des six derniers mois dans un centre de traitement du cancer situé à Montréal, au Québec, et affilié à une université ont répondu au sondage sur la satisfaction des patients en traitement anticancéreux ambulatoire, c'est-à-dire le Ambulatory Oncology Patient Satisfaction Survey (AOPSS).

Résultats

L'expérience des soins oncologiques était significativement plus positives et la satisfaction plus élevée dans le groupe suivi par une infirmière pivot (n = 2 003) pour les six domaines de soins (différences moyennes de 3,32 à 8,95) et les quatre fonctions infirmières (différences moyennes de 5,64 à 10,39), comparativement au groupe sans IPO (n = 855).

Discussion

L'infirmière pivot joue un rôle important dans l'amélioration de l'expérience de soins et la satisfaction des patients. Les recherches futures devront explorer les potentielles relations de cause à effet entre les infirmières pivots, les processus de soins et les résultats des patients.

The nurse pivot-navigator associated with more positive cancer care experiences and higher patient satisfaction

Background and objectives

Growing evidence indicates that the nurse navigator-pivot (NN), is key to optimizing care processes and outcomes. However, large scale studies are needed to examine how patients exposed to NNs (as opposed to non-NN) differentially perceived their cancer care experiences.

Method

Participants (N = 2,858) treated for cancer in the last six months at university-affiliated cancer centres in Montréal, Québec, completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS).

Results

Cancer care experiences and satisfaction were significantly higher in the NN group (n = 2,003) for all six care domains (Ds from 3.32 to 8.95) and all four nursing functions (Ds from 5.64 to 10.39) when compared to the non-NN group (n = 855).

Discussion

The NN role is significantly related to enhanced cancer care experiences and higher patient satisfaction. Future research should explore potential causal effects between NNs and care processes, as well as patient outcomes.

Oncology health care professionals' perspectives on the causes of mental health distress in cancer patients

OBJECTIVE

To explore oncologists, social workers, and nurses' perceptions about the causes of their cancer patient's mental health distress.

METHODS

The grounded theory (GT) method of data collection and analysis was used. Sixty-one oncology health care professionals were interviewed about what they perceived to be the causes of mental health distress in their patients. Analysis involved line-by-line coding and was inductive, with codes and categories emerging from participants' narratives.

RESULTS

Oncology health care professionals were sensitive in their perceptions of their patients' distress. The findings were organized into three categories, namely, disease-related factors, social factors, and existential factors. Disease-related themes included side effects of the disease and treatment, loss of bodily functions, and body image concerns as causing patient's mental health distress. Social-related themes included socio-economic stress, loneliness/lack of social support, and family-related distress. Existential themes included dependence/fear of being a burden, death anxiety, and grief and loss.

CONCLUSIONS

Oncology health care professionals were able to name a wide range of causes of mental health distress in their patients. These findings highlight the need to have explicit conversations with patients about their mental status and to explore their understanding of their suffering. A patient-centered approach that values the patient's conceptualization of their problem and their narrative to understanding their illness can improve the patient-provider relationship and facilitate discussions about patient-centered treatments.