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Tang JMS, Cher BXBB, Lim SF, Siah CJR. A meta-synthesis on the older adults' perspective of advance care planning. J Clin Nurs 2023. [PMID: 36710379 DOI: 10.1111/jocn.16629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
AIM To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end-of-life care. BACKGROUND Advance care planning involves continuous communication of end-of-life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. DESIGN The meta-synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. DATA SOURCE A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. REVIEW METHOD The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE-CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. RESULTS Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. DISCUSSION These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end-of-life preparedness. CONCLUSION This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end-of-life preparedness. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision-making to enhance readiness and confidence among older adults and their families.
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Affiliation(s)
| | | | - Su-Fee Lim
- National University of Singapore, Singapore, Singapore
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2
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Glajchen M, Goehring A, Johns H, Portenoy RK. Family Meetings in Palliative Care: Benefits and Barriers. Curr Treat Options Oncol 2022; 23:658-667. [PMID: 35316479 PMCID: PMC8938578 DOI: 10.1007/s11864-022-00957-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
OPINION STATEMENT Specialists in palliative care view the family meeting as a means to engage patients and their families in a serious illness discussion that may clarify the values of patients and caregivers, provide information, determine care preferences, and identify sources of illness-related distress and burden. The family meeting is considered the best practice for achieving patient- and family-centered care in palliative care. Although studies of the family meeting are limited, those extant suggest that these interventions may reduce caregiver distress, mitigate the perception of unmet needs, prepare family members for caregiving, and improve bereavement outcomes. The experience of palliative care specialists further suggests that the family meeting may reinforce the therapeutic alliance with families, promote consensus, and reduce the need for ad hoc meetings. Physician satisfaction may be enhanced when the treatment plan includes the opportunity to show empathy and see the family's perspective-core elements of the clinical approach to the family meeting. In the oncology setting, the potential to achieve these positive outcomes supports the integration of the family meeting into practice. Clinical skills for the planning and running of family meetings should be promoted with consideration of a standardized protocol for routine family meetings at critical points during the illness and its treatment using an interdisciplinary team. Further research is needed to refine understanding of the indications for the family meeting and determine the optimal timing, structure, and staffing models. Outcome studies employing validated measures are needed to better characterize the impact of family meetings on patient and family distress and on treatment outcomes. Although better evidence is needed to guide the future integration of the family meeting into oncology practice, current best practices can be recommended based on available data and the extensive observations of palliative care specialists.
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Affiliation(s)
- Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Hannah Johns
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
| | - Russell K. Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY USA
- MJHS Hospice and Palliative Care, New York, NY USA
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Donnelly S, Ó Coimín D, O'Donnell D, Ní Shé É, Davies C, Christophers L, Mc Donald S, Kroll T. Assisted decision-making and interprofessional collaboration in the care of older people: a qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting. J Interprof Care 2021; 35:852-862. [PMID: 33588668 DOI: 10.1080/13561820.2020.1863342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In recent years, there has been a move toward a more human rights-based approach to the issue of supported and assisted decision-making (ADM) with legislative changes strengthening the formal right for older people to participate in care planning and decision-making. Ireland's Assisted Decision-Making (Capacity) Act, 2015 breaks from traditional views of capacity to consider the uniqueness of each decision in relation to topic, time and place for those with impaired or fluctuating capacity. This study set out to explore experiences of assisted decision making (ADM) in acute care hospitals in Ireland and to identify the barriers and enablers to ADM for older people and people with dementia from the perspective of different Health and Social Care Professionals (HSCPs) involved in their care. We carried out 26 semi-structured audio-recorded interviews with a convenience sample of HSCPs working in two acute hospitals and subsequently confirmed the results. HSCPs identified several barriers to, and enablers of, ADM in acute hospitals that were categorized into three key themes: Building meaningful engagement with older people and their family carers; barriers and enablers associated with interprofessional collaboration and barriers and enablers associated with the environment. Our findings suggest that despite concrete policy and legislative underpinnings to ADM, this was not always evident in practice and suggests the need for specialized education and training on ADM in practice settings.
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Affiliation(s)
- Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Diarmuid Ó Coimín
- End of Life Care Coordinator, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lauren Christophers
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Steve Mc Donald
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Hudson P, Girgis A, Thomas K, Philip J, Currow DC, Mitchell G, Parker D, Liew D, Brand C, Le B, Moran J. Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial. Palliat Med 2021; 35:188-199. [PMID: 33135552 DOI: 10.1177/0269216320967282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. AIMS To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. DESIGN Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. RESULTS 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. CONCLUSIONS Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12615000200583.
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Affiliation(s)
- Peter Hudson
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia.,Vrije University Brussels, Belgium
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales (UNSW Sydney), NSW, Australia
| | | | - Jennifer Philip
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Australia
| | | | | | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Brian Le
- Melbourne Health, Parkville, Victoria, Australia
| | - Juli Moran
- Austin Health, Heidelberg, Victoria, Australia
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Wang A, Thomas K, Weil J, Hudson P. Characteristics of family meetings for patients with advanced disease in an Australian metropolitan tertiary hospital. BMJ Support Palliat Care 2020:bmjspcare-2020-002250. [PMID: 32718937 DOI: 10.1136/bmjspcare-2020-002250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Family meetings (FMs) between clinicians, patients and family are recommended as a valuable communication and care planning method in the delivery of palliative care. However, there is a dearth of knowledge regarding FM characteristics, with few studies describing the prevalence, circumstances and content of FMs. The aims of this study were to: (1) measure the prevalence of FMs, (2) examine circumstance and timing of FMs, and (3) explore the content of FMs. METHODS A retrospective medical record audit was conducted of 200 patients who died in an Australian hospital of an expected death from advanced disease. Details of FMs were collected using an audit tool, along with patient demographics and admission data. RESULTS 33 patients (16.5%) had at least one FM during their inpatient stay. The majority of FMs occurred for patients admitted to an inpatient palliative care unit (59.5%) and were most commonly facilitated by doctors (81.0%). Patient attendance was frequent (40.5%). FM content fell into six categories: medical information, supportive communication behaviours of clinicians, psychosocial support for patients and families, end-of-life discussions, discharge planning and administrative arrangements. CONCLUSIONS Despite the benefits FMs confer, FMs appear to be infrequently used at the end of life. When FMs are used, there is a strong medical focus on both facilitation and content. Available FM documentation tools also appear to be underused. Clinicians are encouraged to have a greater understanding of FMs to optimise their use and adopt a proactive and structured approach to the conduct and documentation of FMs.
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Affiliation(s)
- Amy Wang
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jennifer Weil
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Vrije University Brussels, Brussels, Belgium
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Waller A, Sanson-Fisher R, Nair BR, Evans T. Preferences for End-of-Life Care and Decision Making Among Older and Seriously Ill Inpatients: A Cross-Sectional Study. J Pain Symptom Manage 2020; 59:187-196. [PMID: 31539600 DOI: 10.1016/j.jpainsymman.2019.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Older and seriously ill Australians are often admitted to hospital in the last year of their life. The extent to which these individuals have considered important aspects of end-of-life (EOL) care, including location in which care is provided, goals of care, and involvement of others in decision making, is unclear. OBJECTIVES To determine, in a sample of older and seriously ill Australian inpatients, preferences regarding location in which they receive EOL care and reasons for their choice; who is involved in EOL decisions; disclosure of life expectancy; goals of care; and voluntary-assisted dying. METHODS Cross-sectional face-to-face survey interviews conducted with 186 (80% consent) inpatients in a tertiary referral center aged 80 years and older; or aged 55 years and older with progressive chronic disease(s); or with physician-estimated life expectancy of less than 12 months. RESULTS Home care was preferred (69%), given the perceived availability of family/friends, familiarity of environment, and likelihood of having wishes respected. If unable to make decisions themselves, inpatients wanted family to decide care alone (31%) or with a doctor (49%). Of those who had not discussed life expectancy, 23% wished to. Most (76%) preferred care that maintained quality of life and relieved symptoms. There was some agreement for being sedated at the EOL (63%) and able to access medication to end life (43%). CONCLUSION Most inpatients would prefer EOL care that maintains quality and relieves suffering compared with life extension and to receive this care at home. Family involvement in resolution and documentation of EOL decisions should be prioritized.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Balakrishnan R Nair
- John Hunter Hospital, New Lambton Heights, New South Wales, and the University of Newcastle, Callaghan, New South Wales, Australia
| | - Tiffany Evans
- Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Forbat L, François K, O'Callaghan L, Kulikowski J. Family Meetings in Inpatient Specialist Palliative Care: A Mechanism to Convey Empathy. J Pain Symptom Manage 2018; 55:1253-1259. [PMID: 29425882 DOI: 10.1016/j.jpainsymman.2018.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/30/2022]
Abstract
CONTEXT Family meetings are increasingly used in palliative care, yet have little empirical evidence of their impact in inpatient settings. OBJECTIVES To examine whether relatives report more empathy after a family meeting in a specialist palliative care inpatient ward. METHODS Pre/post self-complete questionnaires measuring relational empathy and information needs were administered. Qualitative interviews were also conducted. Data were collected during nine months from one inpatient specialist palliative care unit. Participants from 52 family meetings completed pre/post questionnaires, and 13 relatives participated in an interview that was analyzed thematically. RESULTS Families reported more empathy from staff after a family meeting (Wilcoxon test: n = 47; P > 0.001; Z score -4.17). Some families with relatives who do not speak with each other reported that meeting facilitators were unable to manage the pre-existing dynamics. CONCLUSION Family meetings improve reported empathy. It would be beneficial to have more specific preparation and planning by the clinical team for meetings with people who have a history of familial conflict, and those where the staff's agenda is around discharge planning. Published guidelines could be adapted to better support staff to run meetings where there are complex family dynamics. Adoption of family meetings in outpatient settings has the potential to improve perceptions of empathy with a larger patient group.
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Affiliation(s)
- Liz Forbat
- Calvary Centre for Palliative Care Research, Calvary Public Hospital, Canberra, Australia; School of Health Sciences, Australian Catholic University, Canberra, Australia.
| | - Karemah François
- Calvary Centre for Palliative Care Research, Calvary Public Hospital, Canberra, Australia; School of Health Sciences, Australian Catholic University, Canberra, Australia
| | - Lynne O'Callaghan
- Calvary Centre for Palliative Care Research, Calvary Public Hospital, Canberra, Australia
| | - Julie Kulikowski
- Calvary Centre for Palliative Care Research, Calvary Public Hospital, Canberra, Australia
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9
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Family care conferences in long-term care: Exploring content and processes in end-of-life communication. Palliat Support Care 2017; 16:590-601. [PMID: 29284551 DOI: 10.1017/s1478951517000773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjective:End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation. METHOD A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. RESULTS The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. SIGNIFICANCE OF RESULTS Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians.
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Braz MS, Franco MHP. Profissionais Paliativistas e suas Contribuições na Prevenção de Luto Complicado. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2017. [DOI: 10.1590/1982-3703001702016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Os cuidados paliativos buscam qualidade de vida baseada principalmente na prevenção e alívio do sofrimento de pacientes que possuem doenças ameaçadoras de vida, englobando as esferas de ordem física, psicossocial e espiritual. Além disso, estende-se ao pós-morte do paciente, oferecendo suporte à família no processo de luto. Esta pesquisa qualitativa teve como objetivo compreender e analisar a formação dos profissionais em relação ao processo de morrer do paciente e as percepções daqueles em relação às suas contribuições para a prevenção de luto complicado da unidade de cuidado. A Teoria do Apego fundamentou teoricamente este estudo. Participaram voluntariamente profissionais de saúde que integram formalmente equipes de cuidados paliativos. Foi utilizado um questionário autoaplicativo para obtenção de dados acadêmicos, profissionais e de cursos realizados, e uma entrevista semiestruturada. A análise das informações colhidas nas entrevistas foi realizada através de transcrição e categorização das mesmas, seguida de análise de conteúdo. Os resultados confirmaram que a formação dos profissionais em relação ao processo de morrer é escassa. Ademais, observou-se que os profissionais de saúde que trabalham em cuidados paliativos possuem comportamentos de apego, os quais são identificados como naturais nesse contexto, o que acaba por dificultar a percepção de que são importantes contribuições para a prevenção de luto complicado da unidade de cuidado. Diante desses resultados, a presente pesquisa trouxe a relevância sobre a necessidade da inserção das temáticas morte e morrer na educação dos profissionais de saúde, o que pode contribuir para melhor assistência à unidade de cuidado nos seus processos de luto.
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Laursen J, Broholm M, Rosenberg J. Health professionals perceive teamwork with relatives as an obstacle in their daily work - a focus group interview. Scand J Caring Sci 2016; 31:547-553. [DOI: 10.1111/scs.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jannie Laursen
- Department of surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
| | - Malene Broholm
- Department of surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
| | - Jacob Rosenberg
- Department of surgery; Herlev Hospital; University of Copenhagen; Herlev Denmark
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