1
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Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. PATIENT EDUCATION AND COUNSELING 2023; 114:107811. [PMID: 37244131 PMCID: PMC10526983 DOI: 10.1016/j.pec.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. METHODS We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US. RESULTS Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses. CONCLUSION The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present. PRACTICE IMPLICATIONS Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, United States.
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, United States
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, United States; Department of Population Health Sciences, Duke University School of Medicine, United States
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2
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Farley S, Bansal S, Barks MC, Pollak KI, Kaye EC, Quarles A, Briglia K, Johnson E, Lakis K, Lemmon ME. Role of Social Workers in Family Conferences for Critically Ill Infants. J Palliat Med 2022; 25:1236-1242. [PMID: 35285675 PMCID: PMC9347387 DOI: 10.1089/jpm.2021.0574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Communication challenges in the neonatal intensive care unit include fragmented communication, challenges managing expectations amidst uncertainty, and navigating complex medical information. Social workers are well suited to mitigate these challenges. Objective: In this study, we aimed to characterize the extent and nature of social worker participation in family conferences for critically ill infants. Design: We used a longitudinal observational mixed-methods design, enrolling infants with a neurological condition, their parent(s), and their clinicians. All audio-recorded conferences were transcribed and de-identified. Emergent themes and subthemes were identified using conventional content analysis. Results: We enrolled 40 infants and 61 parents. Sixty-eight conferences were held and audio recorded for 24 infants. Social workers were present for 51 of these conferences (n = 51/68, 75%) across 18 cases (n = 18/24, 75%). We identified four themes, conceptualized as distinct roles played by social workers in family conferences: (1) Translator: social workers served as a communicative bridge between parents and the medical team; (2) Coordinator: social workers simplified logistics and connected parents to community resources, including home health agencies and financial assistance; (3) Expectation manager: social workers provided anticipatory guidance and helped parents conceptualize the remainder of the hospital stay, discharge, and life at home; and (4) Advocate: social workers validated parental values and concerns and provided immediate emotional support. Conclusions: Social workers participated in three-quarters of family conferences for critically ill infants. When they participated, they facilitated communication, coordinated care, managed expectations, and advocated for families. These findings underscore the important, varied, and concurrent roles social workers play in the care of critically ill infants. Future communication and family support interventions should leverage these distinct roles.
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Affiliation(s)
- Sam Farley
- Duke University, Durham, North Carolina, USA
| | | | - Mary Carol Barks
- Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erica C. Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anna Quarles
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathleen Briglia
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erika Johnson
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kristen Lakis
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Palliative Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Monica E. Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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3
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Cahill PJ, Lobb EA, Sanderson CR, Phillips JL. Patients Receiving Palliative Care and Their Families' Experiences of Participating in a "Patient-Centered Family Meeting": A Qualitative Substudy of the Valuing Opinions, Individual Communication, and Experience Feasibility Trial. Palliat Med Rep 2021; 2:305-315. [PMID: 34927156 PMCID: PMC8675095 DOI: 10.1089/pmr.2020.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Family meetings are used in palliative care to facilitate discussion between palliative patients, their families, and the clinical team. However, few studies have undertaken qualitative assessment of the impact of family meetings on patients and their families. Objectives: To explore inpatients receiving palliative care and their families' experiences of participation in a patient-centered family meeting ("Meeting"), where the patient sets the Meeting agenda. Design: This qualitative study used the constant comparative method for thematic content analysis of the data. Setting/Participants: The setting was a specialist palliative care (SPC) inpatient unit in Australia. Nine palliative care inpatients and nine family members were interviewed. Measurements: Semistructured interviews were used evaluate the patients' and their families' experiences and perceptions of the Meeting. Results: Three overarching themes described the experiences of participating in a patient-focused family meeting, namely that the Meeting: (1) provides a forum for inpatients receiving SPC to speak openly about their end-of-life concerns, clarify issues, and is of comfort to patients; (2) provides the family members with a voice, and an opportunity to discuss their concerns and have their needs addressed; and (3) helps to ensure that everyone is "on the same page" and patient care plans can be discussed. Conclusions: These Meetings are a potentially effective means of supporting certain palliative care patients and their families to articulate, confront, and address end-of-life issues in the presence of the interdisciplinary team. It is important to undertake further research to further examine the evidence for this Meeting model and to identify the patients and families who would most benefit from this type of Meeting.
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Affiliation(s)
- Philippa J Cahill
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Elizabeth A Lobb
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Department of Palliative Care Research, Calvary Palliative and End of Life Care Research Institute, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine R Sanderson
- Department of Palliative Care Research, Calvary Palliative and End of Life Care Research Institute, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.,Palliative Care Facility, Territory Palliative Care, Alice Springs Hospital, Central Australia, Northern Territory, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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4
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Taels B, Hermans K, Van Audenhove C, Boesten N, Cohen J, Hermans K, Declercq A. How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice. Palliat Care Soc Pract 2021; 15:26323524211058895. [PMID: 34870204 PMCID: PMC8637690 DOI: 10.1177/26323524211058895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Palliative care is a holistic practice using a multidisciplinary approach in
addressing multidimensional needs. Although the social aspects surrounding the
end-of-life phase suggest a place for social work in it, the profession is often
inadequately involved in daily practice. This contrasts strongly with the
potential meaningful contributions of social workers in this field. To date, no
comprehensive list of prerequisites for meaningful social work involvement in
palliative care exists. This review aims to gain more insight on the
prerequisites for meaningful social work involvement in palliative care and how
to realise them in practice. It could therefore provide pathways for future
intervention development in enhancing the involvement of social workers and
maximising their contributions in palliative care. A scoping review methodology
was used. A systematic selection of peer-reviewed articles ranged from 2000 to
April 2021 – out of the electronic databases Web of Science, Scopus and Pubmed –
was conducted. The 170 articles that met the eligibility criteria were analysed
for relevant content using open and axial coding processes. The findings are
reported according to the PRISMA-ScR checklist. The nine prerequisites listed in
this review concern the level of individual social work capacities and the level
of contextual factors structuring social work practices. A majority of articles
have, however, focused on the level of individual social work capacities in a
rather specialist view on palliative care. Future research should further
address the contextual level of social work involvement in the broader practice
of death, dying and bereavement.
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Affiliation(s)
- Brent Taels
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Kirsten Hermans
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nadine Boesten
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Koen Hermans
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS - Centre for Care Research and Consultancy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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5
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Jonas D, Scanlon C, Schmidt L, Bogetz J. Creating a Seat at the Table: How Family Meetings Elucidate the Palliative Care Social Work Role. J Palliat Med 2020; 23:1688-1691. [PMID: 32326812 DOI: 10.1089/jpm.2019.0645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Palliative care social workers (PCSWs) play a crucial role in optimizing communication and family-centered care for seriously ill patients. However, PCSWs often struggle to demonstrate and receive open acknowledgment of their essential skill set within medical teams. Objective: This case discussion focuses on the care of patients and families surrounding family meetings to highlight the crucial role of the PCSW in (1) preparing the family; (2) participating in the provider meeting; (3) participating in the family meeting; and (4) following up after the meeting. The aim is to illuminate how the PCSWs can demonstrate their unique and essential skill set to medical teams and as a means of furthering the work of psychosocial clinicians throughout medical systems. Conclusion: As the medical model continues to shift toward family-centered care, it is crucial for medical teams to optimize their partnership with patients and families. PCSWs can offer a trauma-informed biopsychosocial-spiritual lens that is instructed by continuity of care and exemplary clinical and rapport-building skills. PCSWs can play a critical role in optimizing communication, support, collaboration, and family-centered whole-person care.
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Affiliation(s)
- Danielle Jonas
- Silver School of Social Work, New York University, New York, New York, USA
| | - Caitlin Scanlon
- Palliative Care Social Work, Pediatric Palliative Care Team, Indiana University Health, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Lauren Schmidt
- Division of Bioethics and Palliative Care, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jori Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
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6
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Farabelli JP, Kimberly SM, Altilio T, Otis-Green S, Dale H, Dombrowski D, Kieffer JR, Leff V, Schott JL, Strouth A, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support. J Palliat Med 2019; 23:280-286. [PMID: 31687876 DOI: 10.1089/jpm.2019.0506] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care (PC) is perhaps the most inherently interdisciplinary specialty within health care. Comprehensive PC is delivered by a core team of physicians, nurses, social workers, spiritual care providers, pharmacists, and others who address the broad range of medical, psychosocial, and spiritual needs of those living with serious illness. While PC clinicians are typically skilled in screening for distress, the best path to follow when patients screen positive for psychosocial distress or exhibit mental health challenges may not always be clear. This article brings together the perspectives of experienced social workers practicing across PC and hospice settings. It seeks to identify opportunities and rationale for the integration of palliative social work (PSW) in the provision of quality, person-centered, family-focused, and culturally congruent care for the seriously ill. Increasing recognition of the impact of social determinants of health highlights the critical importance of including PSW if we are to better understand and ultimately address the broad range of factors that influence people's quality of life.
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Affiliation(s)
- Jill P Farabelli
- Palliative Care Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon M Kimberly
- Palliative Care Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terry Altilio
- Palliative Social Work Consultant, Mount Kisco, New York
| | | | - Heather Dale
- Palliative Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Dana Dombrowski
- Palliative Care (PACT) Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Russell Kieffer
- Providence TrinityCare Palliative Care, Providence St Joseph Health, Los Angeles, California
| | - Victoria Leff
- Duke Palliative Care, Duke University Hospital, Durham, North Carolina
| | - Julia L Schott
- Penn Home Palliative Care, Penn Medicine at Home, Bala Cynwyd, Pennsylvania
| | - Andrea Strouth
- Providence TrinityCare Palliative Care, Providence St Joseph Health, Los Angeles, California
| | - Christopher A Jones
- Department of Medicine, Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Antifaeff K. Social Work Practice with Medical Assistance in Dying: A Case Study. HEALTH & SOCIAL WORK 2019; 44:185-192. [PMID: 30796809 DOI: 10.1093/hsw/hlz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
Medical assistance in dying (MAiD) recently became legal in Canada, and social workers have an integral role providing psychosocial care to those considering this end-of-life care option. Research has found that most requests for assisted dying have a psychosocial dimension. Social workers are uniquely equipped to understand the personal and contextual factors informing the choice for MAiD and offer supports. A case example highlights practice opportunities for social workers throughout the MAiD process.
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Affiliation(s)
- Kelsey Antifaeff
- Vancouver General Hospital, Vancouver Coastal Health, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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8
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Agllias K. A snapshot of Australian social workers in palliative care and their work with estranged clients. SOCIAL WORK IN HEALTH CARE 2018; 57:620-636. [PMID: 29757106 DOI: 10.1080/00981389.2018.1474163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper describes a mixed method survey that was administered to a group of Australian palliative care social workers (n = 27). Specifically, it aimed to investigate the ways that social workers understood and worked with clients who were estranged from family at the end of life. Respondents suggested that estrangement potentially impacted clients emotionally, practically, and existentially. They were challenged to make clear assessments, provide emotional support, encourage news ways of thinking about estrangement, to manage practical issues, work with the client's family, and monitor their own professional role. Theories and models of intervention and levels of training are also discussed.
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Affiliation(s)
- Kylie Agllias
- a School of Humanities and Social Sciences , University of Newcastle , Callaghan , Australia
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9
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Powazki RD, Walsh D, Aktas A, Hauser K. Palliative Medicine Family Conferences Reduce Spokesperson Distress and Enhance Communication in Advanced Cancer. J Palliat Med 2018; 21:1086-1093. [DOI: 10.1089/jpm.2018.0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruth D. Powazki
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Declan Walsh
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Aynur Aktas
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Hauser
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, Ohio
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10
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Stein GL, Cagle JG, Christ GH. Social Work Involvement in Advance Care Planning: Findings from a Large Survey of Social Workers in Hospice and Palliative Care Settings. J Palliat Med 2017; 20:253-259. [DOI: 10.1089/jpm.2016.0352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary L. Stein
- Wurzweiler School of Social Work–Yeshiva University, Vice Chair, Social Work Hospice and Palliative Care Network, New York, New York
| | - John G. Cagle
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Grace H. Christ
- Chair, Social Work Hospice and Palliative Care Network, Columbia University School of Social Work, Seattle, Washington
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11
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Cahill PJ, Lobb EA, Sanderson C, Phillips JL. What is the evidence for conducting palliative care family meetings? A systematic review. Palliat Med 2017; 31:197-211. [PMID: 27492159 DOI: 10.1177/0269216316658833] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Structured family meeting procedures and guidelines suggest that these forums enhance family-patient-team communication in the palliative care inpatient setting. However, the vulnerability of palliative patients and the resources required to implement family meetings in accordance with recommended guidelines make better understanding about the effectiveness of this type of intervention an important priority. Aim and design: This systematic review examines the evidence supporting family meetings as a strategy to address the needs of palliative patients and their families. The review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. DATA SOURCES Six medical and psychosocial databases and "CareSearch," a palliative care-specific database, were used to identify studies reporting empirical data, published in English in peer-reviewed journals from 1980 to March 2015. Book chapters, expert opinion, and gray literature were excluded. The Cochrane Collaboration Tool assessed risk of bias. RESULTS Of the 5051 articles identified, 13 met the inclusion criteria: 10 quantitative and 3 qualitative studies. There was low-level evidence to support family meetings. Only two quantitative pre- and post-studies used a validated palliative care family outcome measure with both studies reporting significant results post-family meetings. Four other quantitative studies reported significant results using non-validated measures. CONCLUSION Despite the existence of consensus-based family meeting guidelines, there is a paucity of evidence to support family meetings in the inpatient palliative care setting. Further research using more robust designs, validated outcome measures, and an economic analysis are required to build the family meeting evidence before they are routinely adopted into clinical practice.
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Affiliation(s)
- Philippa J Cahill
- 1 School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Elizabeth A Lobb
- 1 School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,2 Calvary Health Care Sydney, Kogarah, NSW, Australia
| | - Christine Sanderson
- 1 School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,2 Calvary Health Care Sydney, Kogarah, NSW, Australia.,3 CareSearch Palliative Care Knowledge Network, Department of Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia
| | - Jane L Phillips
- 4 Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Ultimo, NSW, Australia.,5 School of Nursing, The University of Notre Dame Australia, Sydney, NSW Australia.,6 School of Medicine, The University of Sydney, Sydney, NSW, Australia
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12
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Wallace CL. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model. SOCIAL WORK IN HEALTH CARE 2016; 55:503-517. [PMID: 27332743 DOI: 10.1080/00981389.2016.1183552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.
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Affiliation(s)
- Cara L Wallace
- a School of Social Work , Saint Louis University , St. Louis , Missouri , USA
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13
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Otis-Green S, Jones B, Zebrack B, Kilburn L, Altilio TA, Ferrell B. ExCEL in Social Work: Excellence in Cancer Education & Leadership: An Oncology Social Work Response to the 2008 Institute of Medicine Report. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:503-513. [PMID: 25146345 PMCID: PMC4339672 DOI: 10.1007/s13187-014-0717-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
ExCEL in Social Work: Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program's curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers--the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers.
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Affiliation(s)
- Shirley Otis-Green
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA,
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14
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Lundberg T, Olsson M, Fürst CJ. The perspectives of bereaved family members on their experiences of support in palliative care. Int J Palliat Nurs 2013; 19:282-8. [PMID: 24151739 DOI: 10.12968/ijpn.2013.19.6.282] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore family members' supportive interactions in palliative care and the emotional experiences that they associate with these interactions. METHODS Qualitative individual interviews were performed with bereaved family members recruited from an urban palliative care service in Sweden. The interviews were analysed using inductive qualitative content analysis. RESULTS Five categories of supportive interactions with staff members were linked with emotional consequences: informational support, supportive encounters, professional focus of staff, a supportive environment, and bereavement support. Having a dialogue with family members nurtured certainty and security, supportive encounters gave a warm and comforting feeling, and bereavement support contributed to feelings of strength. Environmental factors contributed to dignity. CONCLUSION Supportive interactions with staff and within a home-like environment help to build resilience if tailored to the family member's own needs.
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Affiliation(s)
- Tina Lundberg
- Palliative Research Centre, PO Box 11189, SE-100 61 Stockholm, Sweden.
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15
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Doorenbos A, Lindhorst T, Starks H, Aisenberg E, Curtis JR, Hays R. Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2012; 8:297-315. [PMID: 23194167 PMCID: PMC3647033 DOI: 10.1080/15524256.2012.732461] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The culture of pediatric intensive care units (PICUs) is focused on curative or life-prolonging treatments for seriously ill children. We present empirically-based approaches to family-centered palliative care that can be applied in PICUs. Palliative care in these settings is framed by larger issues related to the context of care in PICUs, the stressors experienced by families, and challenges to palliative care philosophy within this environment. Innovations from research on family-centered communication practices in adult ICU settings provide a framework for development of palliative care in PICUs and suggest avenues for social work support of critically ill children and their families.
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Affiliation(s)
- Ardith Doorenbos
- Department of Biobehavioral Nursing & Health Systems, School of Nursing, University of Washington, Seattle, Washington, USA.
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16
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Abstract
The family conference (FC) is a forum for communication with both the patient and family to discuss essential information about medical, educational, and psychosocial needs. It ensures appropriate decision-making, which is integral to comprehensive cancer care. Inclusion of the family creates opportunities and challenges. The main opportunities are for the family to share support for the patient and collaborate with the medical team. This can ease adaptation throughout the illness course with better adherence to recommended treatment plans and greater satisfaction with medical care. The challenge is to manage communication to evolve understanding when treatment outcomes are not curative, and to meet the medical information and psychosocial needs of the patient and family. The FC aim is to give the family confidence by: (1) providing a calm discussion and understanding the illness and treatment; (2) offering a sense of safety that patient's goals will be balanced by the impact on the family caregivers; (3) affording the opportunity to connect and sustain each other; (4) sharing hope and mutual empathy; and (5) maintaining self-efficacy to manage their needs. Using the FC to discuss the plan of care and at the same time assisting the family to process the impact of the illness optimizes benefit for the patient, family, and physician.
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Affiliation(s)
- Ruth D Powazki
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
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Fineberg IC, Kawashima M, Asch SM. Communication with families facing life-threatening illness: a research-based model for family conferences. J Palliat Med 2011; 14:421-7. [PMID: 21385083 DOI: 10.1089/jpm.2010.0436] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Communication is an ongoing challenge for clinicians working with people facing life-threatening illnesses and end of life. Family conferences offer patient-focused, family-oriented care that brings together patients, family members, and health care providers. OBJECTIVE The aim of this study was to develop a research-based model for family conferences to help physicians and other health care providers conduct such conferences effectively and improve communication with patients and families. DESIGN We prospectively studied family conferences for patients facing life-threatening illness in two inpatient medical centers. We videotape and audiotape recorded real-life conferences and postconference interviews with participants. PARTICIPANTS Twenty-four family conferences were included in the study. Participants consisted of 24 patients, 10 of whom took part in the family conferences, 49 family members, and 85 health care providers. APPROACH A multidisciplinary team conducted a qualitative analysis of the videotaped and audiotaped materials using thematic analysis. The team used a multistage approach to independently and collectively analyze and integrate three data sources. MAIN RESULTS The resulting theoretical model for family conferences has 4 main components. These include the underlying structural context of conference organization and the key process components of negotiation and personal stance. Emotional engagement by health care providers, emotion work, appears central to the impact of these components on the successful outcome of the conference. In addition to the theoretical model, the authors found that family conference participants place specific value on the "simultaneous presence" of conference attendees that leads to being on the "same page." CONCLUSIONS Physicians and other health care professionals can use the model as a guide for conducting family conferences and strengthening communication with patients, families and colleagues.
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Affiliation(s)
- Iris Cohen Fineberg
- International Observatory on End of Life Care, School of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, United Kingdom.
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