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Eskola L, Silverman E, Rogers S, Zelenski A. Right-sizing interprofessional team training for serious-illness communication: A strength-based approach. PEC INNOVATION 2024; 4:100267. [PMID: 38414869 PMCID: PMC10897908 DOI: 10.1016/j.pecinn.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Objective Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams. Methods Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice. Results Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team. Conclusions The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings. Innovation We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.
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Affiliation(s)
- Liana Eskola
- Department of Medicine, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, USA
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
| | - Ethan Silverman
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 200 Lothrop St., Suite 933W, Pittsburgh, PA 15213, USA
| | - Sarah Rogers
- Department of Social Work, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
- Department of Mental Health, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
| | - Amy Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
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Mamo N, Tak LM, van de Klundert MAW, Olde Hartman TC, Rosmalen JGM, Hanssen DJC. Quality indicators for collaborative care networks in persistent somatic symptoms and functional disorders: a modified delphi study. BMC Health Serv Res 2024; 24:225. [PMID: 38383395 PMCID: PMC10882926 DOI: 10.1186/s12913-024-10589-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Care for persistent somatic symptoms and functional disorders (PSS/FD) is often fragmented. Collaborative care networks (CCNs) may improve care quality for PSS/FD. Effectiveness likely depends on their functioning, but we lack a straightforward quality evaluation system. We therefore aimed to develop quality indicators to evaluate CCNs for PSS/FD. METHOD Using an online three-round modified Delphi process, an expert panel provided, selected and ranked quality indicators for CCNs in PSS/FD. Recruited experts were diverse healthcare professionals with relevant experience in PSS/FD care in the Netherlands. RESULTS The expert panel consisted of 86 professionals representing 15 disciplines, most commonly physiotherapists, psychologists and medical specialists. 58% had more than 10 years experience in PSS/FD care. Round one resulted in 994 quotations, which resulted in 46 unique quality indicators. These were prioritised in round two and ranked in round three by the panel, resulting in a final top ten. The top three indicators were: "shared vision of care for PSS/FD", "pathways tailored to the individual patient", and "sufficiently-experienced caregivers for PSS/FD". CONCLUSIONS The identified quality indicators to evaluate CCNs in the field of PSS/FD can be implemented in clinical practice and may be useful in improving services and when assessing effectiveness.
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Affiliation(s)
- Nick Mamo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Lineke M Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Manouk A W van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Denise J C Hanssen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Festvåg LE, Sverre BL, Paulsen Ø, Eilertsen G. Advance care planning with older Norwegian adults in their homes: a narrative ethnographic study. BMC Palliat Care 2024; 23:44. [PMID: 38369465 PMCID: PMC10875790 DOI: 10.1186/s12904-024-01378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The aim of advance care planning (ACP) is to enable patients to define and discuss their values and preferences to ensure that the care they receive is consistent with their needs and wishes. Most studies of ACP with older adults focus on conversations conducted in institutions. This study aimed to explore how ACP with older patients is carried out and experienced by healthcare professionals when the conversations occur in their private homes. METHODS The data were obtained from participant observations of ACP conversations in the homes of eight older patients with advanced cancer, which also involved relatives and healthcare professionals. Additionally, ethnographic interviews were conducted with the healthcare professionals. We undertook a narrative analysis of what was said, and how the individuals acted and interacted. RESULTS The home influenced both the substance and form of the ACP conversations. The patients and relatives welcomed the healthcare professionals as guests and were encouraged to share their perceptions of their current situation, joys and worries. Their values were often implicit in their stories about past experiences. The planning mainly focused on life-prolonging treatment and the preferred future place of care. Several patients were not ready to discuss one or more ACP issues. The palliative-care-team physician addressed the patients' readiness for ACP by asking for permission to move on to a different topic, shifting between serious and lighter topics, and using elements from the home as 'door openers' to continue conversations. ACP conversations were an essential basis for future palliative care and cooperation, giving important additional information about the patient and their relatives. CONCLUSION Conducting the ACP conversations in the patients' homes ensured a homely atmosphere that facilitated a caring approach when sensitive issues were discussed, and in turn supported the identification of important personal values. The healthcare professionals expressed that the ACP conversations represented an essential common reference point and provided a shared awareness of the expected disease trajectory and the values, preferences and needs of the patient. These findings are particularly important given that many older patients struggle to verbalize or form an opinion on issues affecting their future.
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Affiliation(s)
- Line Elida Festvåg
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Beate Lie Sverre
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ørnulf Paulsen
- Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
- Dept. of Oncology, European Palliative Care Research Centre (PRC), Oslo University Hospital, Oslo, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Walker W, Jones J, Astley M. In-hospital end-of-life care: an appreciative analysis of bereaved family feedback. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:126-131. [PMID: 38335107 DOI: 10.12968/bjon.2024.33.3.126] [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: 02/12/2024]
Abstract
Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices.
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Affiliation(s)
- Wendy Walker
- Reader in Nursing (End-of-life Care and Bereavement), The Royal Wolverhampton NHS Trust
| | - Jennifer Jones
- Specialist Nurse-Bereavement/Lead Medical Examiner Officer, The Royal Wolverhampton NHS Trust
| | - Melanie Astley
- Clinical Nurse Specialist-Palliative Care, The Royal Wolverhampton NHS Trust
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Andersson S, Granat L, Baxter R, Reimertz H, Modéus C, Pusa S, Sandgren A. Translation, Adaptation, and Validation of the Swedish Serious Illness Conversation Guide. J Palliat Care 2024; 39:21-28. [PMID: 37886797 PMCID: PMC10687820 DOI: 10.1177/08258597231210136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective: To translate and adapt the Serious Illness Conversation Guide for use within the Swedish healthcare setting and examine the validity and acceptability of the Swedish Serious Illness Conversation Guide. Methods: Three rounds of cognitive interviews were conducted (T1-3); patients (T1 n = 11; T2 n = 10; T3 n = 8), family members (T1 n = 5; T2 n = 2; T3 n = 2), and healthcare professionals (T1 n = 6; T2 n = 6; T3 n = 5). The guide was iteratively adapted based on interview feedback, clinical experience, and the literature. The guide was tested on training days with physicians and nurses. Results: The Swedish Serious Illness Conversation Guide was found to be useful in supporting serious illness conversations. Clinicians reported that some questions were emotionally challenging. Explicit questions about prognosis and timing were excluded. Instead, the dual approach of "hoping for the best and preparing for the worst" was used to explore patients' thoughts about the future. Conclusions: Patients, family members, and healthcare professionals found the Swedish Serious Illness Conversation Guide to be appropriate, sensitive, and responsive to their needs. The Swedish Serious Illness Conversation Guide may facilitate a more health-promoting approach to serious illness conversations. Further research is needed to understand the impact of these conversations on person-centered and goal-concordant care.
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Affiliation(s)
- Sofia Andersson
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Sweden
| | - Lisa Granat
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Rebecca Baxter
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Sweden
| | - Helene Reimertz
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Unit of Palliative Care, Region Kronoberg, Växjö, Sweden
| | - Carina Modéus
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Unit of Palliative Care, Region Kronoberg, Växjö, Sweden
| | - Susanna Pusa
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Nursing, Umeå University, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Macharia JM, Raposa BL, Sipos D, Melczer C, Toth Z, Káposztás Z. The Impact of Palliative Care on Mitigating Pain and Its Associated Effects in Determining Quality of Life among Colon Cancer Outpatients. Healthcare (Basel) 2023; 11:2954. [PMID: 37998446 PMCID: PMC10671794 DOI: 10.3390/healthcare11222954] [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: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Pain continues to be a significant problem for cancer patients, and the impact of a population-based strategy on their experiences is not completely understood. Our study aimed to determine the impact of palliative care on mitigating pain and its associated effects in determining the quality of life (QoL) among colon cancer outpatients. Six collection databases were used to perform a structured systematic review of the available literature, considering all papers published between the year 2000 and February 2023. PRISMA guidelines were adopted in our study, and a total of 9792 papers were evaluated. However, only 126 articles met the inclusion criteria. A precise diagnosis of disruptive colorectal cancer (CRC) pain disorders among patients under palliative care is necessary to mitigate it and its associated effects, enhance health, promote life expectancy, increase therapeutic responsiveness, and decrease comorbidity complications. Physical activities, the use of validated pain assessment tools, remote outpatient education and monitoring, chemotherapeutic pain reduction strategies, music and massage therapies, and bridging social isolation gaps are essential in enhancing QoL. We recommend and place a strong emphasis on the adoption of online training/or coaching programs and the integration of formal and informal palliative care systems for maximum QoL benefits among CRC outpatients.
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Affiliation(s)
- John M. Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Bence L. Raposa
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Str 14/B, 7400 Kaposvár, Hungary
| | - Csaba Melczer
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary;
| | - Zoltan Toth
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Zsolt Káposztás
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
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Miller M, Rosa WE, Doerner Rinaldi A, Addicott K, Spence D, Beaussant Y. Applying Key Lessons from the Hospice and Palliative Care Movement to Inform Psychedelic-Assisted Therapy. PSYCHEDELIC MEDICINE (NEW ROCHELLE, N.Y.) 2023; 1:124-129. [PMID: 37753521 PMCID: PMC10518906 DOI: 10.1089/psymed.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Background Psychedelic-assisted therapy (PAT) has re-emerged as a promising intervention for addressing mental health conditions and existential concerns. Despite growing enthusiasm, PAT may be difficult to integrate into mainstream health systems. The rich sacramental traditions of psychedelics, their centering of the human experience, proposed substrates of action, context-dependent outcomes, and highly relational method of therapy all challenge dominant reductionistic approaches of the biomedical model. Hospice and palliative care are well established as holistic evidence-based standards of care, yet they began as a radical grassroots movement. Hospice and palliative care models may offer unique insights to support the growing field of PAT. Purpose The intention of this commentary is to articulate the deep synergies between hospice and palliative care and PAT, with the intention of fostering interdisciplinary dialogue that may aid in implementation of human-centered high-quality PAT. Conclusions Various aspects of hospice and palliative care models were identified and explored, which may support the implementation of human-centered high-quality PAT at scale. These include a focus on truly interdisciplinary care, applying a holistic lens to health and illness, bearing witness to suffering and healing, customized care, centering human relationships, decentralized models of care, generalist/specialist competencies, fostering spirituality, organizing as a social moment around shared goals, and growth from grassroots community organizations to mature care systems. Although hospice and palliative care can offer practical lessons for scaling human-centered experiential therapies, PAT, with its radical centering of meaning-making and relationship in the healing process, may also mutually innovate the fields of hospice and palliative care.
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Affiliation(s)
- Megan Miller
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alden Doerner Rinaldi
- Care Dimensions Hospice, Danvers, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Katie Addicott
- Department of Palliative Medicine, Maine Medical Center, Portland, Maine, USA
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Yvan Beaussant
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana–Farber Cancer Institute, Boston, Massachusetts, USA
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Levoy K, Sullivan SS, Chittams J, Myers RL, Hickman SE, Meghani SH. Don't Throw the Baby Out With the Bathwater: Meta-Analysis of Advance Care Planning and End-of-life Cancer Care. J Pain Symptom Manage 2023; 65:e715-e743. [PMID: 36764411 PMCID: PMC10192153 DOI: 10.1016/j.jpainsymman.2023.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
CONTEXT There is ongoing discourse about the impact of advance care planning (ACP) on end-of-life (EOL) care. No meta-analysis exists to clarify ACP's impact on patients with cancer. OBJECTIVE To investigate the association between, and moderators of, ACP and aggressive vs. comfort-focused EOL care outcomes among patients with cancer. METHODS Five databases were searched for peer-reviewed observational/experimental ACP-specific studies that were published between 1990-2022 that focused on samples of patients with cancer. Odds ratios were pooled to estimate overall effects using inverse variance weighting. RESULTS Of 8,673 articles, 21 met criteria, representing 33,541 participants and 68 effect sizes (54 aggressive, 14 comfort-focused). ACP was associated with significantly lower odds of chemotherapy, intensive care, hospital admissions, hospice use fewer than seven days, hospital death, and aggressive care composite measures. ACP was associated with 1.51 times greater odds of do-not-resuscitate orders. Other outcomes-cardiopulmonary resuscitation, emergency department admissions, mechanical ventilation, and hospice use-were not impacted. Tests of moderation revealed that the communication components of ACP produced greater reductions in the odds of hospital admissions compared to other components of ACP (e.g., documents); and, observational studies, not experimental, produced greater odds of hospice use. CONCLUSION This meta-analysis demonstrated mixed evidence of the association between ACP and EOL cancer care, where tests of moderation suggested that the communication components of ACP carry more weight in influencing outcomes. Further disease-specific efforts to clarify models and components of ACP that work and matter to patients and caregivers will advance the field.
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Affiliation(s)
- Kristin Levoy
- Department of Community and Health Systems (K.L., R.L.M., S.E.H.), Indiana University School of Nursing, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute (K.L., S.E.H.), Indianapolis, Indiana; Indiana University Melvin and Bren Simon Comprehensive Cancer Center (K.L., S.E.H.), Indianapolis, Indiana.
| | - Suzanne S Sullivan
- School of Nursing (S.S.S.), University at Buffalo, State University of New York, Buffalo, New York
| | - Jesse Chittams
- BECCA (Biostatistics, Evaluation, Collaboration, Consultation & Analysis) Lab, Office of Nursing Research (J.C.), University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Ruth L Myers
- Department of Community and Health Systems (K.L., R.L.M., S.E.H.), Indiana University School of Nursing, Indianapolis, Indiana
| | - Susan E Hickman
- Department of Community and Health Systems (K.L., R.L.M., S.E.H.), Indiana University School of Nursing, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute (K.L., S.E.H.), Indianapolis, Indiana; Indiana University Melvin and Bren Simon Comprehensive Cancer Center (K.L., S.E.H.), Indianapolis, Indiana
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences (S.H.M.), University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics (S.H.M.), University of Pennsylvania, Philadelphia, Pennsylvania
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Librada-Flores S, Pérez-Solano Vázquez MJ, Lucas-Díaz MÁ, Rodríguez Álvarez-Ossorio Z, Herrera-Molina E, Nabal-Vicuña M, Guerra-Martín MD. "Compassionate City" in Patients with Advanced Illnesses and at the End of Life: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2234. [PMID: 36767601 PMCID: PMC9914945 DOI: 10.3390/ijerph20032234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To evaluate, in a Compassionate City pilot experience (Sevilla), the impact results on health in a population of people with advanced illness and at the end of life. METHODS The project was undertaken in Sevilla, Spain, between January 2019 and June 2020. A longitudinal, descriptive study was conducted using a longitudinal cohort design with two cross-sectional measurements, pre and post intervention. All patients who entered the program on the start date were included. The networks of care around people with advanced illness and at the end of life, palliative care needs, quality of life, loneliness, anxiety, depression, caregivers' burden and family satisfaction were evaluated. The interventions were conducted by community promoters assigned to the "Sevilla Contigo, Compassionate City" program. RESULTS A total of 83 people were included in the program. The average number of people involved in care at the beginning of the evaluations was 3.6, increasing to 6.1 at the end of the interventions. The average number of needs detected at the beginning was 15.58, and at the end of interventions, it was 16.56 out of 25. The unmet needs were those related to last wishes (40.7%), emotional relief (18.5%), entertainment (16%), help to walk up and down stairs (8.6%) and help to walk (6.2%). A total of 54.2% showed improved loneliness in the final evaluation. Out of 26 people evaluated for pre and post quality of life, 7 (26.9%) improved their quality of life in the general evaluation and 5 (19.2%) displayed improved anxiety/depression. A total of 6 people (28.6%) improved their quality-of-life thermometer scores. A total of 57.7% of caregivers improved their burden with a mean score of 17.8.
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Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
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Delphi-endorsed Communication Skills Clinicians Need to Care for Hospitalized Incapacitated Patients. ATS Sch 2022; 3:285-300. [PMID: 35924204 PMCID: PMC9341473 DOI: 10.34197/ats-scholar.2021-0136oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Objective Methods Results Conclusion
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12
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A Randomized, Controlled Trial Exploring Collaborative Nursing Intervention on Self-Care Ability and Blood Glucose of Patients with Type 2 Diabetes Mellitus. DISEASE MARKERS 2022; 2022:7829454. [PMID: 35359881 PMCID: PMC8964215 DOI: 10.1155/2022/7829454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/20/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Objective For determining the impacts of collaborative nursing intervention (CNI) on self-care ability and blood glucose (BG) of patients with type 2 diabetes mellitus (T2DM). Methods The study enrolled 72 T2DM patients, who are referred to our hospital between April 2017 and September 2019. Of them, 35 cases given routine nursing were set as the control group (CG) and 37 cases given CNI were set as the research group (RG). The Exercise of Self-Care Agency (ESCA) scale scores and the levels of fasting plasma glucose (FPG) as well as glycosylated hemoglobin (HbAlc) were observed pre- and postintervention. The scores of SAS and HAMD and Morisky pre- and postnursing intervention as well as postnursing SF-36 scores and patients' satisfaction toward the nursing content were recorded. Results After intervention, RG presented notably lower serum HbAlc and FPG levels than CG (P < 0.05); RG presented evidently lower SAS and HAMD scores while distinctly higher Morisky, SF-36, and ESCA scores than CG (P < 0.05); the nursing satisfaction in RG and CG was 97.30% and 51.43%, respectively. Conclusions In view of the fact that CNI can decrease HbAlc and FPG levels in patients with T2DM and enhance their self-care ability, it is worth popularizing in the clinic.
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Matthys O, Dierickx S, Deliens L, Lapeire L, Hudson P, Van Audenhove C, De Vleminck A, Cohen J. How are family caregivers of people with a serious illness supported by healthcare professionals in their caregiving tasks? A cross-sectional survey of bereaved family caregivers. Palliat Med 2022; 36:529-539. [PMID: 35090372 DOI: 10.1177/02692163211070228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to medical advances and an increasingly ageing population, the number of people living with a serious illness is rising. This has major implications for the burden on family members of assisting with care. Support of family caregivers by healthcare professionals is needed to ensure they can provide quality care for people with serious illness. AIM To investigate how family caregivers of people with serious illness are supported by healthcare professionals in their caregiving tasks. DESIGN/PARTICIPANTS Population-based cross-sectional survey of bereaved family caregivers of people with serious illness (N = 3000) who cared for a person who had died 2-6 months before the sample was drawn (November 2019), as identified through three sickness funds in Flanders, Belgium. The survey explored support from healthcare professionals for family caregivers 3 months prior to bereavement. RESULTS Response rate was 55.0%. Most family caregivers received support from one or more healthcare professionals for family caregiving tasks, ranging from 71% for promoting social interaction to 95% for managing symptoms. The type of support mostly involved providing information. Use of palliative care services was the strongest predictor of such support across physical, psychosocial and practical tasks. CONCLUSION Most family caregivers of those with serious illness get some form of support from healthcare professionals for their tasks. However, an empowering support strategy for example one aimed at increasing self-efficacy of the family caregiver is rare and end-of-life communication between healthcare professionals and family caregivers needs improvement.
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Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Centre for Palliative Care, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
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Ghafourifard M, Zamanzadeh V, Valizadeh L, Rahmani A. Compassionate Nursing Care Model: Results from a grounded theory study. Nurs Ethics 2022; 29:621-635. [PMID: 35100909 DOI: 10.1177/09697330211051005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.
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Affiliation(s)
- Mansour Ghafourifard
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, 48432Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Liu CJ, Huang SJ, Wang SSC. Implementation of Compassionate Communities: The Taipei Experience. Healthcare (Basel) 2022; 10:healthcare10010177. [PMID: 35052340 PMCID: PMC8776212 DOI: 10.3390/healthcare10010177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities (CC) in Taipei City. Using the guidance of the Charter and international experiences, we have developed and multiplied a culturally sensitive, sustainable, and holistic CC program that composes municipal hospital, social, and other services, partnering with community leaders, non-governmental organizations, university students, and volunteers. Innovative campaigns, such as workshops, conferences, and the Life Issue Café, have been delivered to facilitate engagement, public education, and leadership with reverence to folk beliefs and the use of existing social networks. We have identified a model with strong collaborative leadership, high participation rates, and ongoing commitment. The gaps between asking/accepting and providing help were bridged when social connectedness was strengthened. We also integrated home-based medical care, home-based palliative care, and advance care planning to help the vulnerable who live alone, with poor status, or with limited resource access, and continue to support the community throughout the COVID-19 pandemic.
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Affiliation(s)
- Chia-Jen Liu
- Taipei City Hospital, Taipei City 10341, Taiwan; (C.-J.L.); (S.-J.H.)
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei City 111036, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei City 10341, Taiwan; (C.-J.L.); (S.-J.H.)
| | - Samuel Shih-Chih Wang
- Department of Health and Welfare, Tian-Mu Campus, College of City Management, University of Taipei, Taipei City 111036, Taiwan
- Correspondence: ; Tel.: +886-979-311255
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16
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Hatefimoadab N, Cheraghi MA, Benton DC, Pashaeypoor S. Ethical advocacy in the end-of-life nursing care: A concept analysis. Nurs Forum 2022; 57:127-135. [PMID: 34549431 DOI: 10.1111/nuf.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
AIM This concept analysis was conducted to identify and define the features and functions of ethical advocacy in the end-of-life nursing care. BACKGROUND Ethical advocacy is key to the role of the nurse in delivering quality and competent care. Despite this, the dimensions of this concept are poorly understood. DESIGN/DATA SOURCE Databases such as Google Scholar, Scopus, Web of Science, Science Direct, and PubMed were searched systematically. To search these databases, the following keywords were used: "patient advocacy," "nursing," "ethics," "end-of-life care," and their combinations. REVIEW METHODS Walker and Avant's method was utilized as a comprehensive review of the literature to explore how ethical advocacy in nursing can be used to improve the quality of care. RESULTS The defining attributes of the concept of ethical advocacy included adhering to ethical principles of nursing, championing social justice in the provision of healthcare, safeguarding and defending patient's rights by applying collective wisdom, and involving hospital ethics committees. Antecedents are organizational and personal power and ethical leadership. The optimal consequence of ethical advocacy can be getting the best ethical governance. CONCLUSION Based on this analysis, the concept of ethical advocacy is one of the most important roles for nurses which requires their awareness of this concept.
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Affiliation(s)
- Nasim Hatefimoadab
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad A Cheraghi
- Department of Critical Care and Nursing Management, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
| | - David C Benton
- National Council of State Boards of Nursing, Chicago, Illinois, USA
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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17
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Al Mani TYA, Sallam AMA, Aldosary RA, AlGhamdi JA, Ghulam BMI, Shamah WF. Impact of Palliative Care for Dementia Patients in Tertiary Hospitals among Saudi Arabia: A Systemic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/2gfzkuzb1m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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18
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Goto R, Haruta J, Ozone S. Verification of a Sense of Community Scale for Hospitals in Japan. J Prim Care Community Health 2022; 13:21501319221107317. [PMID: 35726750 PMCID: PMC9218502 DOI: 10.1177/21501319221107317] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction/Objectives: We aimed to verify whether a sense of community scale developed for hospital wards can be applied to hospitals. Methods: A cross-sectional study was conducted using a self-administered questionnaire between July and October 2018 in 3 hospitals in Japan. The subjects were staff members working in these hospitals who provide direct medical or administrative services to patients and their families. The questionnaire inquired about the participants’ basic attributes and workplace satisfaction, and included the sense of community scale and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II. We evaluated the scale’s structural validity, internal consistency, and hypothesis testing for construct validity. Results: Of 826 eligible staff members, 539 were included in the analysis. Mean age was 40.4 years and 77.4% were female. Exploratory factor analysis showed that 24 of the 28 items in the sense of community scale could be categorized under 3 factors. Confirmatory factor analysis demonstrated a goodness of fit index of 0.794, adjusted goodness of fit index of 0.752, comparative fit index of 0.885 and root mean square error of approximation of 0.092. Cronbach’s α for score in the sense of community scale was high (.96). Participants who reported high workplace satisfaction had significantly higher scores in the sense of community scale than those who indicated low workplace satisfaction (P < .001). Conclusions: We verified the reliability and validity of the Japanese version of the sense of community scale, which was originally developed for hospital wards, for the community in hospitals. With further verification, we hope the scale will be useful for evaluating the sense of community in hospitals.
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Affiliation(s)
- Ryohei Goto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Shinanomachi, Shinjuku ku, Tokyo, Japan
| | - Sachiko Ozone
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Implementing compassion in pediatric healthcare: A qualitative study of Canadian patients', parents', and healthcare providers' perspectives. J Pediatr Nurs 2022; 62:e103-e112. [PMID: 34412933 DOI: 10.1016/j.pedn.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Compassion has received significant scholarly attention over the past decade. Research has been largely theoretical, with interventions focused on self-care practices of healthcare providers (HCPs), rather than implementation at a systems level. This study aimed to identify how compassion can be operationalized within pediatric healthcare. DESIGN AND METHODS Data was analyzed from a secondary dataset of a larger Straussian grounded theory study of perspectives and experiences of compassion in pediatric healthcare. Patients (n = 33); parents (n = 16); and HCPs (n = 17) were asked specifically how compassion could be implemented within the clinical culture and healthcare system. RESULTS 66 participants generated an operational model of compassion indicating how compassion could be implemented across the organization and larger healthcare system. The data revealed four themes and associated subthemes: teach and train; recognize and reward; measure and report; and embed compassion across the healthcare system. CONCLUSIONS Improving compassion in pediatric healthcare needs to extend beyond the efforts of individual HCPs. Compassion is the responsibility of the entire healthcare system and needs to traverse the patient and family experience. In addition to embedding compassion in policy, procedures, practice, and education, compassion should be considered a performance indicator that is measured and reported. PRACTICE IMPLICATIONS This study provides a preliminary framework for organizational leaders to operationalize compassion across the services, structures, polices, procedures and practices of pediatric healthcare. This includes ongoing compassion training across the organization; assessing compassion, recognizing compassion as a performance indicator, and ensuring that the infrastructure and ancillary services of the organization reflect compassion.
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20
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Buller H, Ferrell BR, Paice JA, Glajchen M, Haythorn T. Advancing interprofessional education in communication. Palliat Support Care 2021; 19:727-732. [PMID: 34154688 PMCID: PMC10685389 DOI: 10.1017/s1478951521000663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this training project is to develop and host Interprofessional Communication courses to improve interdisciplinary communication in oncology care. The initial national course was held in a virtual format and included pre- and post-course participant data. The curriculum was developed with support from the National Cancer Institute. METHODS A virtual two-day course was held to equip nurses, social workers, and chaplains with vital communication skills in oncology practice, so that they could return to their home institutions and teach communication skills to other healthcare professionals, with the intention of making improved communication a quality improvement goal. Fifty-two participants were selected through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and chaplain, or social worker and nurse). The Interprofessional Communication Curriculum was based on the National Consensus Project for Quality Palliative Care's eight domains of quality palliative care. The six online modules developed by the investigators were presented in lectures, supplemented by discussion groups, role plays, and other methods of experiential learning. RESULTS Pre- and post-course results identified areas of communication, which are a priority for improvement by oncology clinicians. Participant goals identified specific strategies to be implemented by participants in their settings. SIGNIFICANCE OF RESULTS The need for communication training was clearly demonstrated across professions in this national training course. Participants were able to apply course content to their goals for quality improvement in cancer settings.
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Affiliation(s)
- Haley Buller
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA 91010
| | - Betty R. Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA 91010
| | - Judith A. Paice
- Feinberg School of Medicine, Division of Hematology-Oncology, Northwestern University, Chicago, IL
| | - Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, New York, NY
| | - Trace Haythorn
- Association for Clinical Pastoral Education (ACPE), Atlanta, GA 30308
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21
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Moran S, Bailey M, Doody O. An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing. BMC Palliat Care 2021; 20:111. [PMID: 34271889 PMCID: PMC8285858 DOI: 10.1186/s12904-021-00810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Caring for individuals and their families with a life-limiting, symptomatic illness and those who are dying has long been an integral role of palliative care nurses. Yet, over the last two decades, the specialty of palliative care has undergone significant changes in technology and medical treatments which have altered both the disease trajectory and the delivery of palliative care. To date, there is little evidence as to the impact of these medical and nursing advancements on the role of nurses working in palliative care and how in clinical practice these nurses continue to uphold their nursing values and the philosophy of palliative care. Methods An integrative review was conducted searching seven academic databases from the time period of January 2010 – December 2019 for studies identifying research relating to the role of the palliative care nurse working in specialist palliative care units and hospices. Research articles identified were screened against the inclusion criteria. Data extraction was completed on all included studies and the Crowe Critical Appraisal Tool was utilized to appraise the methodological quality and thematic analysis was performed guided by Braun and Clarke’s framework. The review was conducted and reported in lines with PRISMA guidelines. Results The search yielded 22,828 articles of which 7 were included for appraisal and review. Four themes were identified: (1) enhancing patient-centred care (2) being there (3) exposure to suffering and death (4) nursing values seen but not heard. The findings highlight that while palliative care nurses do not articulate their nurse values, their actions and behaviors evident within the literature demonstrate care, compassion, and commitment. Conclusion These findings suggest that there is a need for nurses working in specialist palliative care units to articulate, document, and audit how they incorporate the values of nursing into their practice. This is pivotal not only for the future of palliative nursing within hospice and specialist palliative care units but also to the future of palliative care itself. To make visible the values of nursing further practice-based education and research is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00810-6.
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Affiliation(s)
- Sue Moran
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Maria Bailey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Dokmai P, Meemon N, Paek SC, Tayjasanant S. Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand. BMC Health Serv Res 2021; 21:616. [PMID: 34183000 PMCID: PMC8240380 DOI: 10.1186/s12913-021-06623-w] [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] [Received: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication. Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.
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Affiliation(s)
- Parichat Dokmai
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
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Anderson RJ, Stone PC, Low JTS, Bloch S. Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study. PATIENT EDUCATION AND COUNSELING 2021; 104:1075-1085. [PMID: 33199091 DOI: 10.1016/j.pec.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients. METHODS Conversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice. RESULTS Following the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort. CONCLUSION In conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care. PRACTICE IMPLICATIONS In a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.
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Affiliation(s)
- Rebecca J Anderson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
| | - Patrick C Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Steven Bloch
- Department of Language and Cognition, Division of Psychology and Language Sciences, UCL, London, UK
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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Vermorgen M, Vandenbogaerde I, Van Audenhove C, Hudson P, Deliens L, Cohen J, De Vleminck A. Are family carers part of the care team providing end-of-life care? A qualitative interview study on the collaboration between family and professional carers. Palliat Med 2021; 35:109-119. [PMID: 32928056 DOI: 10.1177/0269216320954342] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context. AIM This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life. DESIGN Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data. SETTING/PARTICIPANTS A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness. RESULTS Five main themes emerged from interpretative phenomenological analysis that describe the quality of the collaboration between family carers and professionals: respecting family carers both as someone with care needs and as a member of the care team; the continuous availability and accessibility of healthcare professionals; the provision of information and communication including family carer issues; the coordination of care between all parties and contextual factors. The dominant experience by family carers was one of missed opportunities across these themes. CONCLUSIONS This qualitative study about the experiences and perceptions of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care.
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Affiliation(s)
- Maarten Vermorgen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Isabel Vandenbogaerde
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | | | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Centre for Palliative Care, St Vincent's Hospital Melbourne and University of Melbourne, Melbourne, Australia
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Heino L, Stolt M, Haavisto E. The practices and attitudes of nurses regarding palliative sedation: A scoping review. Int J Nurs Stud 2020; 117:103859. [PMID: 33545642 DOI: 10.1016/j.ijnurstu.2020.103859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/12/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Palliative sedation is used as a last-resort option to treat refractory symptoms of dying patients. Nurses are important participants in the process of sedation. However, little is known about palliative sedation from a nursing perspective. OBJECTIVES To analyze the practices and attitudes of nurses concerning palliative sedation. DATA SOURCES AND REVIEW METHODS A scoping review guided by Arksey and O`Malley`s methodological framework was used to analyze existing peer-reviewed empirical research on the topic of the practices and attitudes of nurses related to the palliative sedation of patients aged 18 years and older. Of the 316 publications identified from the PubMed, CINAHL and Cochrane Library, 17 full-text articles were included in this review. The data of the included articles were charted (author(s), year of publication, country, objectives, study design, data collection, setting, respondents, definition of palliative sedation, focus of the study and key findings), and the results were summarized with inductive content analysis. The PRISMA-ScR checklist was used as a guideline for the reporting in this review. RESULTS During the decision-making concerning the start of palliative sedation, nurses usually have an advocatory and supportive role, although the role varies between different countries. This role then changes to a relatively independent performance of sedation; including administration of the medication, monitoring the effectiveness of sedation, and in some cases taking decisions concerning the medication and dosage policy. Further, nurses provide information and compassionate care to both the patient and the family during the process of palliative sedation. Most nurses view palliative sedation as a positive and sometimes necessary last resort therapy to relieve refractory suffering of dying patients. However, sedation poses ethical problems for many nurses. These problems especially concern the essential elements of deciding to use palliative sedation, the depth of sedation, the potential for shortening life, and the loss of social interaction. CONCLUSIONS Nurses play a key role in palliative sedation, as they often perform sedation independently and have important information about the needs and wishes of both patients and their families due to their unique position at the bedside of the patient. Although nurses generally see palliative sedation as a positive practice for selected patients, many of them feel it is ethically controversial. This scoping review reveals a great need for further research and discussion on the practices and attitudes of nurses regarding palliative sedation.
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Affiliation(s)
- Linda Heino
- Bachelor of Health Sciences, Department of Nursing Science, University of Turku, Turku, Finland.
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku and Turku University Hospital, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku and Satakunta Central Hospital, Pori, Finland
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Skorpen Tarberg A, Landstad BJ, Hole T, Thronaes M, Kvangarsnes M. Nurses' experiences of compassionate care in the palliative pathway. J Clin Nurs 2020; 29:4818-4826. [PMID: 33031582 PMCID: PMC7756377 DOI: 10.1111/jocn.15528] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023]
Abstract
Aims and objectives The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway. Background Compassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway. Design This study employed a qualitative design using focus groups and a hermeneutic approach. Methods Four focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28–60 years (mean age = 45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines. Results Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) creating a space for dying and (c) family caregivers’ acceptance of death. Conclusions This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief and the absence of noise and conflict. Relevance to clinical practice The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.
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Affiliation(s)
- Anett Skorpen Tarberg
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torstein Hole
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
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Mills J, Ramachenderan J, Chapman M, Greenland R, Agar M. Prioritising workforce wellbeing and resilience: What COVID-19 is reminding us about self-care and staff support. Palliat Med 2020; 34:1137-1139. [PMID: 32736490 DOI: 10.1177/0269216320947966] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Mills
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, QLD, Australia
| | - Jonathan Ramachenderan
- Great Southern Regional Palliative Care Service, Albany Health Campus, Western Australia Country Health Service, WA, Australia
| | - Michael Chapman
- Department of Palliative Care, ANU Medical School, Canberra Health Services, Australian National University, ACT, Australia
| | | | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation) Centre, University of Technology Sydney, NSW, Australia
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30
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Ferrell B, Buller H, Paice JA. Communication Skills: Use of the Interprofessional Communication Curriculum to Address Physical Aspects of Care. Clin J Oncol Nurs 2020; 24:547-553. [PMID: 32945793 DOI: 10.1188/20.cjon.547-553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The literature has emphasized the importance of effective communication regarding psychosocial needs; however, other aspects of patient care, including attention to physical needs, are equally important. OBJECTIVES The aims of this article are to (a) describe an Interprofessional Communication Curriculum (ICC) in oncology, (b) detail the curriculum content specifically focused on physical aspects of care, and (c) illustrate the importance of interprofessional care in oncology. METHODS The ICC is organized by the 8 domains of the National Consensus Project for Quality Palliative Care and centers on communication skills needed in oncology clinical practice. FINDINGS Based on initial pilot data, oncology clinicians indicate a high level of satisfaction with the ICC. Additional future training courses supported by the National Cancer Institute will prepare oncology teams to enhance communication with patients and families.
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31
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Librada-Flores S, Nabal-Vicuña M, Forero-Vega D, Muñoz-Mayorga I, Guerra-Martín MD. Implementation Models of Compassionate Communities and Compassionate Cities at the End of Life: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6271. [PMID: 32872244 PMCID: PMC7504622 DOI: 10.3390/ijerph17176271] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022]
Abstract
In the last decade, we have seen a growth of Compassionate Communities and Cities (CCC) at the end of life. There has been an evolution of organizations that help construct Community-Based Palliative Care programs. The objective is to analyze the implementation, methodology and effectiveness of the CCC models at the end of life. We conducted a systematic review following PRISMA ScR Guideline. The protocol was registered on PROSPERO (CRD42017068501). Five databases (MEDLINE, EMBASE, Web of Science, CINAHL and Google Scholar) were searched for studies (from 2000 to 2018) using set eligibility criteria. Three reviewers screened full-texts articles and extracted study data. Outcomes were filled in a registration form which included a narrative synthesis of each article. We screened 1975 records. We retrieved 112 articles and included 31 articles for the final analysis: 17 descriptive studies, 4 interventions studies, 4 reviews and 6 qualitative studies. A total of 11 studies regard the development models of CCC at the end of life, 15 studies were about evaluation of compassionate communities' programs and 5 studies were about protocols for the development of CCC programs. There is poor evidence of the implementation and evaluation models of CCC at the end of life. There is little and low-/very low-quality evidence about CCC development and assessment models. We found no data published on care intervention in advance disease and end of life. A global model for the development and evaluation of CCC at the end of life seems to be necessary.
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Affiliation(s)
| | - María Nabal-Vicuña
- Palliative Care Team, Arnau de Villanova Hospital, 25198 Lleida, Spain; (M.N.-V.); (D.F.-V.)
| | - Diana Forero-Vega
- Palliative Care Team, Arnau de Villanova Hospital, 25198 Lleida, Spain; (M.N.-V.); (D.F.-V.)
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Safety in Pediatric Hospice and Palliative Care: A Qualitative Study. Pediatr Qual Saf 2020; 5:e328. [PMID: 32766499 PMCID: PMC7365704 DOI: 10.1097/pq9.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/13/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Patient safety is extensively studied in both adults and pediatric medicine; however, knowledge is limited regarding particular safety events in pediatric hospice and palliative care (HPC). Additionally, pediatric HPC lacks a unified definition of safe care. This qualitative study sought to explore caregiver views regarding safe care in pediatric HPC. Methods This is a secondary analysis of qualitative data from a multisite study utilizing semistructured interview data to evaluate parental perspectives of quality in pediatric home-based HPC programs across 3 different pediatric tertiary care hospitals. Eligible participants included parents and caregivers of children who were enrolled in a pediatric home-based hospice and palliative care program (HBHPC) from 2012 to 2016. The analysis was done using grounded theory methodology. Results Forty-three parents participated in 39 interviews across all 3 sites; 19 families were bereaved. Responses to the prompt regarding safe care produced 8 unique domains encompassing parental definitions of safe care in pediatric HPC. Discussion Parents of children in HPC programs describe "safe care" in novel ways, some of which echo Maslow's hierarchy of needs. The use of traditional hospital safety measures for patients receiving HPC could undermine the patient's goals or dignity, ultimately leading to harm to the patient. Concluding summary Patients' and families' unique goals and values must be considered when defining safety for children in this population. Future studies should continue to explore family perspectives of safety in the hospital and ambulatory settings and seek to identify measurable indicators in safety which are truly patient- and family-centered.
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Abstract
AbstractFor many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective treatments for patients with dementia, over the last years, several contributions have criticised the pervasive use of drugs for the management of behavioural and physiological symptoms related to dementia, proposing personalised interventions aimed at supporting patients and their relatives from diagnosis until death. With particular reference to long-term settings, in this work, we aim at understanding the organisational implications of three types of interventions (labelled supportive care interventions – SCIs) that have characterised this shift in dementia care: person-centred, palliative and multi-disciplinary care. Conducted by following the integrative review method, our review underlines how SCIs have controversial consequences on the quality of care, the care-givers’ quality of life and cultural backgrounds. After an in-depth analysis of selected papers, we offer some considerations about the implications of SCIs for long-term care organisations and future research directions.
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34
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Green S, Markaki A, Baird J, Murray P, Edwards R. Addressing Healthcare Professional Burnout: A Quality Improvement Intervention. Worldviews Evid Based Nurs 2020; 17:213-220. [DOI: 10.1111/wvn.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Green
- Children’s Hospital Los Angeles Los Angeles CA USA
- University of Alabama at Birmingham School of Nursing Birmingham AL USA
| | - Adelais Markaki
- PAHO/WHOCC for International Nursing University of Alabama at Birmingham School of Nursing Birmingham AL USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research Children’s Hospital Los Angeles Los Angeles CA USA
| | - Paula Murray
- Institute for Nursing and Interprofessional Research Children’s Hospital Los Angeles Los Angeles CA USA
| | - Rebecca Edwards
- University of Alabama at Birmingham School of Nursing Birmingham AL USA
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35
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Rosa WE. Healthcare Decision-Making of African-American Patients: Comparing Positivist and Postmodern Approaches to Care. Nurs Sci Q 2020; 32:140-147. [PMID: 30888293 DOI: 10.1177/0894318419826255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Healthcare decision-making (HCDM) may be a potentially challenging time for any person. When considered against the backdrop of being a minority, experiencing disparate care based on racial bias, and confronting the implications of advanced serious illness, the practices and processes of HCDM become increasingly complex. The purpose of this paper is to consider the HCDM of African-American patients with advanced serious illness through the lens of positivism and postmodernism and to make the argument that postmodern nursing is the ideal ethical and equitable approach to HCDM. Postmodernism reengages nurses to consider HCDM of African-American patients with advanced serious illness as an individualized, contextualized, whole-person process, requiring all ways of knowing. A postmodern nursing approach may promote sustainable and human-centered health interventions that will reposition an often marginalized group to the center of practice, policy, and research progress.
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Affiliation(s)
- William E Rosa
- 1 Robert Wood Johnson Foundation Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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36
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Kemp J, Zhang T, Inglis F, Wiljer D, Sockalingam S, Crawford A, Lo B, Charow R, Munnery M, Singh Takhar S, Strudwick G. Delivery of Compassionate Mental Health Care in a Digital Technology-Driven Age: Scoping Review. J Med Internet Res 2020; 22:e16263. [PMID: 32141833 PMCID: PMC7084292 DOI: 10.2196/16263] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/19/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. Objective This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. Methods We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. Results Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. Conclusions Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.
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Affiliation(s)
- Jessica Kemp
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Timothy Zhang
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fiona Inglis
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Charow
- Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shuranjeet Singh Takhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Scott M, Shaver N, Lapenskie J, Isenberg SR, Saunders S, Hsu AT, Tanuseputro P. Does inpatient palliative care consultation impact outcomes following hospital discharge? A narrative systematic review. Palliat Med 2020; 34:5-15. [PMID: 31581888 DOI: 10.1177/0269216319870649] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While most patients desire to die at home or in a community-based hospice, the transition from hospital to community settings often lacks streamlined coordination of care to ensure that adequate support is provided in the preferred care setting. The impact of hospital-based palliative care consultations on post-discharge care and outcomes has not been extensively studied. AIM The aim of this study was to appraise available research on the impact of inpatient palliative care consultations on transitions from hospital to community settings. DESIGN We conducted a narrative systematic review and used the Effective Public Health Practice Project tool to appraise the quality of selected studies. Studies were included if they assessed the transition from hospital to community and examined outcomes after an inpatient palliative care consultation. A protocol for this study was registered and published in PROSPERO, Centre for Reviews and Dissemination (ID: CRD42018094924). DATA SOURCES We searched for quantitative studies indexed in PubMED, CINAHL and Cochrane and published between 1 January 1 2000 and 11 March 2018. RESULTS Our search retrieved 2749 articles. From these, 123 articles were full-text screened and 15 studies met our inclusion criteria. Studies reported that inpatient palliative care consultations are associated with high rates of discharge to community settings, greater provision of services post-discharge, improved coordination and lower rates of rehospitalization. CONCLUSION Existing evidence suggest that inpatient palliative care consultations have a positive impact on patient outcomes and transitions to the community, demonstrating the potential to improve patient quality of life and relieve overburdened acute care systems.
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Affiliation(s)
- Mary Scott
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Julie Lapenskie
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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38
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Abstract
PURPOSE OF REVIEW Compassion has been recognized as a key aspect of high-quality healthcare, particularly in palliative care. This article provides a general review of the current understanding of compassion in palliative care and summarizes emergent compassionate initiatives in palliative care at three interdependent levels: compassion for patients, compassion in healthcare professionals, and compassionate communities at the end of life. RECENT FINDINGS Compassion is a constructive response to suffering that enhances treatment outcomes, fosters the dignity of the recipient, and provides self-care for the giver. Patients and healthcare professionals value compassion and perceive a general lack of compassion in healthcare systems. Compassion for patients and for professionals' self-care can be trained and implemented top-down (institutional policies) and bottom-up (compassion training). 'Compassionate communities' is an important emerging movement that complements regular healthcare and social services with a community-level approach to offer compassionate care for people at the end of life. SUMMARY Compassion can be enhanced through diverse methodologies at the organizational, professional, and community levels. This enhancement of compassion has the potential to improve quality of palliative care treatments, enhance healthcare providers' satisfaction, and reduce healthcare costs.
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O'Callaghan EL, Lam L, Cant R, Moss C. Compassion satisfaction and compassion fatigue in Australian emergency nurses: A descriptive cross-sectional study. Int Emerg Nurs 2019; 48:100785. [PMID: 31331839 DOI: 10.1016/j.ienj.2019.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual's personal wellbeing and reduce work efficiency. METHODS A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. RESULTS The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses' stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. CONCLUSION/S Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses' levels of stress and help limit staff burnout.
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Affiliation(s)
- Erin L O'Callaghan
- Monash University, Nursing and Midwifery, Clayton, VIC 3800, Australia; Monash Health, Emergency Department, Clayton, Victoria 3156, Australia
| | - Louisa Lam
- Monash University, Nursing and Midwifery, Clayton, VIC 3800, Australia; Federation University Australia, School of Nursing and Healthcare Professions, Berwick, VIC 3806, Australia.
| | - Robyn Cant
- Monash University, Nursing and Midwifery, Clayton, VIC 3800, Australia; Federation University Australia, School of Nursing and Healthcare Professions, Berwick, VIC 3806, Australia
| | - Cheryle Moss
- Monash University, Nursing and Midwifery, Clayton, VIC 3800, Australia
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Rawlings D, Devery K, Poole N. Improving quality in hospital end-of-life care: honest communication, compassion and empathy. BMJ Open Qual 2019; 8:e000669. [PMID: 31259290 PMCID: PMC6567943 DOI: 10.1136/bmjoq-2019-000669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/03/2022] Open
Abstract
Background With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: 'Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…'. Methods The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated. Findings Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice. Conclusion Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention-behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
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Affiliation(s)
- Deb Rawlings
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Naomi Poole
- Director, Partnering with Consumers, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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Wiljer D, Charow R, Costin H, Sequeira L, Anderson M, Strudwick G, Tripp T, Crawford A. Defining compassion in the digital health age: protocol for a scoping review. BMJ Open 2019; 9:e026338. [PMID: 30772865 PMCID: PMC6398782 DOI: 10.1136/bmjopen-2018-026338] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The notion of compassion and compassionate care is playing an increasingly important role in health professional education and in the delivery of high-quality healthcare. Digital contexts, however, are not considered in the conceptualisation of compassionate care, nor is there guidance on how compassionate care is to be exercised while using digital health technologies. The widespread diffusion of digital health technologies provides new contexts for compassionate care, with both opportunities for new forms and instantiations of compassion as well as new challenges. How compassion is both understood and enacted within this evolving, digital realm has not been synthesised. METHODS AND ANALYSIS This scoping review protocol follows Arksey and O'Malley's methodology to examine dimensions of compassionate professional practice when digital technologies are integrated into clinical care. Relevant peer-reviewed literature will be identified using a search strategy developed by medical librarians, which applies to six databases of medical, computer and information systems disciplines. Eligibility of articles will be determined using the two-stage screening process consisting of (1) title and abstract scan, and (2) full-text review. Screening, abstracting and charting will be conducted by two independent reviewers, with a third reviewer available for resolution when consensus is not achieved. In order to look at the range of current research in this area, extracted data will be thematically analysed and validated by content experts. Descriptive statistics will be calculated where necessary. ETHICS AND DISSEMINATION Research ethics approval and consent to participate is not required for this scoping review. The results of the review will inform resource development and strategy for Associated Medical Services (AMS) Healthcare, a Canadian charitable organisation at the forefront of advancing research and leadership development in health and humanities, as part of the AMS Phoenix Project: A Call to Caring, particularly for digital professionalism frameworks so that they are inclusive of a compassion competency.
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Affiliation(s)
- David Wiljer
- UHN Digital, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rebecca Charow
- UHN Digital, University Health Network, Toronto, Ontario, Canada
| | - Helen Costin
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Lydia Sequeira
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tim Tripp
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Allison Crawford
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
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Munz SM, Helman JI, Tiner MK, Hart AL. Recurrent oral squamous cell carcinoma-incorporating advance care planning in education and practice. SPECIAL CARE IN DENTISTRY 2019; 39:246-251. [PMID: 30748030 DOI: 10.1111/scd.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/18/2019] [Accepted: 02/02/2019] [Indexed: 12/30/2022]
Abstract
This reflection describes a life-limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70-year-old female was diagnosed with a T4aN2bM0 biopsy-proven invasive, well-differentiated keratinizing SCC. Surgical wide-local excision included teeth #11-16 with left unilateral neck dissection, levels I-V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus. She experienced multiple recurrences. At a certain point, negative margins could not be achieved without facial disfigurement. The patient, her husband, and providers decided together that further management would be palliative. Before the additional surgical procedures, she communicated a thorough ACP with her husband and providers who were prepared to facilitate difficult care decisions on her behalf. The patient passed away at home with hospice care at the age of 74. This motivated patient with oral SCC and impactful postmanagement complications appreciated the clarity of an ACP. Her values and goals of care were incorporated with ongoing communication and documentation of this plan, which was instrumental in facilitating her person-centered care. The providers apply lessons learned here in future practice and education of residents and students.
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Affiliation(s)
- Stephanie M Munz
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, Michigan Medicine, Ann Arbor, Michigan
| | - Joseph I Helman
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, Michigan Medicine, Ann Arbor, Michigan
| | - Margaret K Tiner
- Speech-Language Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Anita L Hart
- Department of Nursing, Michigan Medicine, Ann Arbor, Michigan
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Haines L, Rahman OK, Sanders JJ, Johnson K, Kelley A. Factors That Impact Family Perception of Goal-Concordant Care at the End of Life. J Palliat Med 2019; 22:927-932. [PMID: 30758243 DOI: 10.1089/jpm.2018.0508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Goal-concordant care (GCC)-care aligned with a patient's known goals and values-is a measure of the quality of end-of-life (EOL) care that can be assessed by surveying family members after a patient's death. It is unknown whether patient characteristics affect this measure. Objective: The objective of the article was to examine family report of GCC and its associations with patient characteristics. Methods: Using the Health and Retirement Study, which is a nationally representative, longitudinal cohort of adults over age 50, we sampled decedents whose family completed the 2014 postdeath interview. Families reported frequency of GCC at the EOL. A multivariable regression model assessed the associations between family report of GCC and decedent characteristics. Results: Of 1175 respondents, 76% reported that the decedent "usually" or "always" received GCC. Proxy report of GCC was independently associated with age (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.01-1.03), having three or more chronic medical conditions (AOR 1.34, CI 1.02-1.77), the presence of written or verbal advance care planning (ACP) (AOR 1.38, CI 1.02-1.88), and an interaction term of race and ability to participate in EOL decision making (AOR 3.83, CI 1.02-14.40). African American race was not independently associated with GCC (AOR 0.73, CI 0.5-1.06). Conclusion: Family's report of GCC is associated with ACP, age, and multimorbidity. Being African American and perceived as able to participate in EOL decision making was significantly associated with report of GCC. Bringing the patient's voice into EOL care discussions through upstream ACP with likely surrogates may be particularly important to improving GCC for African Americans.
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Affiliation(s)
- Lindsay Haines
- 1Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Omari-Khalid Rahman
- 2Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin J Sanders
- 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kimberly Johnson
- 4Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,5Durham Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Durham, North Carolina
| | - Amy Kelley
- 2Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,6James J Peters Veterans Affairs Medical Center, Bronx, New York
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Alharbi J, Al Hadid L. Towards an understanding of compassion from an Islamic perspective. J Clin Nurs 2019; 28:1354-1358. [DOI: 10.1111/jocn.14725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/13/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jalal Alharbi
- University of New England; Armidale New South Wales Australia
| | - Lourance Al Hadid
- Princess Aisha Bint Al Hussein College of Nursing and Health Sciences Nursing Department; Al Hussein Bin Talal University; Maan Jordan
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Green SB, Markaki A. Interprofessional palliative care education for pediatric oncology clinicians: an evidence-based practice review. BMC Res Notes 2018; 11:797. [PMID: 30404659 PMCID: PMC6222984 DOI: 10.1186/s13104-018-3905-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Clinician education and expertise in palliative care varies widely across pediatric oncology programs. The purpose of this evidence-based practice review was to identify interprofessional palliative care education models applicable to pediatric oncology settings as well as methods for evaluating their impact on clinical practice. RESULTS Based on a literature search in PubMed, CINAHL and Embase, which identified 13 articles meeting inclusion/exclusion criteria, the following three themes emerged: (1) establishment of effective modalities and teaching strategies, (2) development of an interprofessional palliative care curriculum, and (3) program evaluation to assess impact on providers' self-perceived comfort in delivering palliative care and patient/family perceptions of care received. Remarkably, health professionals reported receiving limited palliative care training, with little evidence of systematic evaluation of practice changes following training completion. Improving palliative care delivery was linked to the development and integration of an interprofessional palliative care curriculum. Suggested evaluation strategies included: (1) eliciting patient and family feedback, (2) standardizing care delivery measures, and (3) evaluating outcomes of care.
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Affiliation(s)
- Sarah B Green
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294-1210, USA. .,Children's Hospital Los Angeles, 4650 Sunset Blvd. #54, Los Angeles, CA, 90027-6062, USA.
| | - Adelais Markaki
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294-1210, USA
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