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Tobiano G, Manias E, Chaboyer W, Latimer SL, Teasdale T, Wren K, Jenkinson K, Marshall AP. Enhancing patient participation in discharge medication communication: a feasibility pilot trial. BMJ Open 2024; 14:e083462. [PMID: 39327052 PMCID: PMC11429440 DOI: 10.1136/bmjopen-2023-083462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVES To pilot test a co-designed intervention that enhances patient participation in hospital discharge medication communication. DESIGN Pilot randomised controlled trial. SETTING One tertiary hospital. PARTICIPANTS Patients who were ≥45 years of age; ≥1 chronic illness and ≥1 regularly prescribed medication that they manage at home were recruited between October 2022 and May 2023. Healthcare professionals on participating units completed surveys. INTERVENTION The co-designed intervention included three websites: a medication search engine, a medication question builder and tools to facilitate medication management at home. Inpatient posters contained QR codes to provide access to these websites. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the feasibility of study processes and intervention acceptability. Feasibility of study processes was measured in terms of recruitment, fidelity, retention, missing data and contamination. Patients in the intervention group and healthcare professionals on the wards self-reported intervention acceptability. Secondary outcomes were medication understanding, use, self-efficacy and healthcare utilisation. RESULTS 60 patients were recruited and randomised; half in each study group. The intervention was largely delivered as intended, and 99.7% of data collected was complete. In total, 16/59 (27.1%) patients were lost to follow-up 28 days after hospital discharge, and 3 patients in the usual care group reported that they saw the intervention poster prior to hospital discharge. 21 of 24 intervention group patients (87.5%) deemed the intervention acceptable, while half of the healthcare professionals (n=5, 50%) thought it was acceptable. CONCLUSIONS We demonstrated that in a future definitive trial, intervention fidelity would be high with little missing data, and patients would likely find the intervention acceptable. Thus, a larger trial may be warranted, as the intervention is implementable and approved by patients. However, additional strategies to increase recruitment and retention of eligible participants are needed. Healthcare professionals may require more preparation for the intervention to enhance their perceptions of intervention acceptability. TRIAL REGISTRATION NUMBER ACTRN12622001028796.
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Affiliation(s)
- Georgia Tobiano
- NHMRC CRE in Wiser Wounds Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wounds Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Sharon L Latimer
- NHMRC CRE in Wiser Wounds Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Trudy Teasdale
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kellie Wren
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kim Jenkinson
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Llave K, Cheng KK, Ko A, Pham A, Ericson M, Campos B, Perez-Gilbe HR, Kim JHJ. Promising Directions: A Systematic Review of Psychosocial and Behavioral Interventions with Cultural Incorporation for Advanced and Metastatic Cancer. Int J Behav Med 2024:10.1007/s12529-024-10264-8. [PMID: 38472713 DOI: 10.1007/s12529-024-10264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Improving quality of life (QOL) in advanced and metastatic cancer is a priority with increasing survivorship. This systematic review synthesizes psychosocial and behavioral interventions incorporating culture with the goal of examining their benefit for understudied and medically underserved populations with advanced and metastatic cancer. METHOD Reports were systematically screened for (1) a focus on advanced and metastatic cancer survivors, (2) psychosocial or behavioral intervention intended to improve QOL, (3) evidence of incorporating the culture(s) of understudied/underserved populations, and (4) availability in English. Bias was evaluated using the JBI Critical Appraisal Checklist and the Methodological index for non-randomized studies. Qualitative synthesis and quantitative meta-analyses were completed. RESULTS Eighty-six reports containing 5981 participants' data were examined. Qualitative synthesis of 23 studies identified four overarching themes relevant for incorporating culture in interventions. Meta-analysis of 19 RCTs and 4 quasi-experimental studies containing considerable heterogeneity indicated greater improvements in QOL (g = 0.84), eudaimonic well-being (g = 0.53), distress (g = -0.49), and anxiety (g = -0.37) for main intervention conditions compared to controls. Meta-analysis of 10 single-arm trials containing minimal to moderate heterogeneity found benefit for anxiety (g = -0.54), physical symptoms (g = -0.39), and depression (g = -0.38). CONCLUSION Psychosocial and behavioral interventions with cultural incorporation appear beneficial for improving QOL-related outcomes in advanced and metastatic cancer. Studies incorporating culture in psychosocial or behavioral interventions offer noteworthy insight and suggestions for future efforts such as attending to deep cultural structure.
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Affiliation(s)
- Karen Llave
- Department of Population Health & Preventive Disease, University of California, Irvine, USA
| | - Karli K Cheng
- Department of Medicine, University of California, 100 Theory, Suite 100, Irvine, CA, 92697, USA
| | - Amy Ko
- Department of Medicine, University of California, 100 Theory, Suite 100, Irvine, CA, 92697, USA
| | - Annie Pham
- Department of Medicine, University of California, 100 Theory, Suite 100, Irvine, CA, 92697, USA
| | - Marissa Ericson
- Institute for Clinical and Translational Science, University of Southern California, Los Angeles, USA
| | - Belinda Campos
- Department of Chicano/Latino Studies, University of California, Irvine, USA
| | | | - Jacqueline H J Kim
- Department of Population Health & Preventive Disease, University of California, Irvine, USA.
- Department of Medicine, University of California, 100 Theory, Suite 100, Irvine, CA, 92697, USA.
- Chao Family Comprehensive Cancer Center, University of California, Irvine, USA.
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Amano K, Koshimoto S, Hopkinson JB, Baracos VE, Mori N, Morita T, Oyamada S, Ishiki H, Satomi E, Takeuchi T. Perspectives of Health Care Professionals on Multimodal Interventions for Cancer Cachexia. Palliat Med Rep 2022; 3:244-254. [PMID: 36636614 PMCID: PMC9811833 DOI: 10.1089/pmr.2022.0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background Holistic multimodal interventions have not been established for cancer cachexia. The beliefs and perceptions of health care professionals (HCPs) based on their experiences influence the interventions. Objectives HCPs' knowledge, perceptions, and practices in cancer cachexia management were evaluated. Design/Setting/Subjects/Measurements A nationwide questionnaire survey was conducted that focused on the perspectives of HCPs on interventions in 451 designated cancer hospitals across Japan. Descriptive statistics were applied. Results Among 2255 participants, 1320 responded (58.5%), and 1188 in 258 institutes were included in the analysis. The current international definition of cancer cachexia is not commonly known and recent clinical practice guidelines have not been widely adopted. More than 50% of participants considered ≥5% weight loss in six months and ECOG PS (Eastern Cooperative Oncology Group Performance Status) 2-4 to be cancer cachexia, whereas 50% answered that there was no relationship between life expectancy and cancer cachexia. Participants tended to consider it important to initiate nutritional and exercise interventions before cancer cachexia becomes apparent. The majority of participants recognized the importance of holistic multimodal interventions, particularly for the management of physical and psychological symptoms; however, only 20% reported that they educated patients and families. Furthermore, 33% of participants considered themselves to have provided patients and families with sufficient nutritional and exercise interventions and evidence-based information. Conclusion The results reveal that HCPs are not regularly providing education and emotional support to patients and families suffering from cancer cachexia. The results also show the need for education for HCPs to enhance implementation of holistic multimodal interventions for cancer cachexia.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan.,Address correspondence to: Koji Amano, MD, Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Saori Koshimoto
- School of Health Care Sciences, Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Human Nutrition, Faculty of Human Nutrition. Tokyo Kasei Gakuin University, Tokyo, Japan
| | - Jane B. Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu City, Japan
| | | | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Takeuchi
- Liaison Psychiatry and Psycho-oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Guedes MR, Galiza DDFD, Almeida Cabral L, Lacerda VWDS, Fernandes Leal AL, Sampaio HADC. Difficulties experienced by caregivers of patients with Alzheimer's Disease in relation to dietary care: integrative review. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i3.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To analyze the problems experienced by caregivers of patients with Alzheimer's Disease (AD) in dietary care. Methods: An integrative review was carried out, whose guiding question was "What are the experiences and difficulties reported by caregivers of people with Alzheimer's disease concerning dietary care?". The search occurred in April/2021 in the following databases: MEDLINE, Science Direct, SCOPUS, Web of Science, SciELO, and Lilacs. Publications fromthe last 10 years in English, Portuguese or Spanish were included. Results: Of the 2,418 articles initially found, the titles of 39 seemed to fit the research objectives. Of these, 11 articles were selected for full reading, and 8 were evaluated to answer the research question. A gap in the approach to the problems experienced by caregivers of patients with AD concerning dietary care was observed. Difficulties dealing with reduced appetite, dysphagia, inability to remember eating, mealtime refusal, and food repulsion were reported. Allied to this, caregiver stress was reported. Conclusion: The main problems experienced by caregivers of patients with AD involve reduced appetite, dysphagia, difficulty remembering what they have already eaten, refusal at mealtimes, and food repulsion. Thus, the theme deserves the attention and involvement of health professionals to focus on the most frequent difficulties and teach caregivers to overcome them.
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Nutritional Status and Related Factors in Patients with Gastric Cancer after Gastrectomy: A Cross-Sectional Study. Nutrients 2022; 14:nu14132634. [PMID: 35807815 PMCID: PMC9268084 DOI: 10.3390/nu14132634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
Patients after gastrectomy for gastric cancer are at risk of malnutrition, and poor nutritional status negatively affects patients’ clinical outcomes. Knowledge of the factors influencing patients’ nutritional status can inform interventions for improving patients’ nutrition. A cross-sectional study was conducted to describe nutritional status and related factors in gastric cancer patients after gastrectomy. A convenience sample of gastric cancer patients with gastrectomy was recruited from general surgery or oncology clinics of a medical center in northern Taiwan. Data were collected with self-reported questionnaires, including the Functional Assessment Cancer Therapy—Gastric Module version 4, the Concerns in Meal Preparation scale, the Center for Epidemiologic Studies Depression Scale, and the Mini Nutrition Assessment. One hundred and one gastric cancer patients participated in the study. There were 81 cases of subtotal gastrectomy and 20 cases of total gastrectomy. Most patients (52.5%) were malnourished or at risk. Linear regression showed that symptom severity (β = −0.43), employment status (β = 0.19), and difficulty in diet preparation (β = −0.21) were significant predictors of nutritional status. Together, these three variables explained 35.8% of the variance in patient nutritional status (F = 20.3, p < 0.001). More than 50% of our participants were malnourished or at risk for malnutrition, indicating a need for continued monitoring and support after discharge from hospitals. Special attention should be given to patients with severe symptoms, unemployment, and difficulties in diet preparation.
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Hui-Lin C, Ting G. The experiences, perceptions, and support needs among family caregivers of patients with advanced cancer and eating problems: An integrative review. Palliat Med 2022; 36:219-236. [PMID: 35188004 DOI: 10.1177/02692163211058598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advanced cancer patients often present with numerous eating problems, posing a significant challenge for family caregivers during the provision of nutritional care. AIM To systematically identify and synthesize empirical literature on the experiences, perceptions, and support needs of family caregivers of patients with advanced cancer and eating problems to ascertain directions for future research. DESIGN Integrative review guided by Whittemore and Knafl's methodological framework. DATA SOURCES Five electronic databases were searched from their inception to April 2021. Studies were eligible if they examined family caregivers' perspectives and experiences when caring for their relatives with advanced cancer and eating problems and were primary quantitative, qualitative, and mixed-methods studies published in English-language peer-reviewed journals. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. RESULTS Twenty-seven papers from 21 studies met the eligibility criteria and were included in this review. The included papers were mostly qualitative studies and were of moderate to high methodological quality. Three themes were identified: (a) multiple negative effects of advanced cancer patients' eating problems; (b) coping responses in managing advanced cancer patients' eating problems; and (c) unmet support needs in the provision of nutritional care. CONCLUSIONS Research on the studied topic was descriptive and predominantly qualitative in nature. Quantitative research examining the impact of caregiving experiences in relation to food and eating in the context of advanced cancer patients is the first important step moving this research area forward.
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Affiliation(s)
- Cheng Hui-Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Gan Ting
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Kiew SJ, Majid HA, Mohd Taib NA. A qualitative exploration: Dietary behaviour of Malaysian breast cancer survivors. Eur J Cancer Care (Engl) 2021; 31:e13530. [PMID: 34693588 DOI: 10.1111/ecc.13530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to explore the dietary practices and factors affecting Malaysian breast cancer survivors' dietary behaviours. METHODS We conducted an in-depth qualitative interview on 20 participants from a cohort study. An ecological framework was used to construct the semi-structured topic guide. The interviews were audio-recorded and transcribed verbatim. Thematic analysis with theoretical saturation was used in data analysis. RESULTS The participants were found to have variable dietary practices that either followed or did not follow dietary recommendations. The social environment was critical as most women relied on family and friends for food choices; additionally, individuals in charge of food preparation had to prepare food based on their family member preferences. Furthermore, individuals had difficulty sustaining healthy dietary changes during the acute survivorship phase due to a lack of health consciousness and difficulty in healthy food access. Notably, there was a lack of dietary guidance from health care professionals, especially dietitians, in long-term survivorship care. CONCLUSION This study highlights the lack of breast cancer survivors' healthy diet and lifestyle knowledge. A holistic multidisciplinary approach involving individual, social, physical, and macro-level environmental elements are crucial to influencing healthy eating behaviours.
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Affiliation(s)
- Siew Juan Kiew
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health and Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Nutrition, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Nur Aishah Mohd Taib
- UM Cancer Research Institute and Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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8
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Tewes M, Baumann F, Teufel M, Ostgathe C. Symptoms During Outpatient Cancer Treatment and Options for Their Management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0028. [PMID: 33531117 DOI: 10.3238/arztebl.m2021.0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer patients account for a large segment of the German healthcare system, with a 5-year prevalence of around 1.7 million persons. Advances in oncological treatment, now frequently performed on an outpatient basis, are granting many of these individuals a longer life span. At the same time, cancer patients often suffer disease-related symptoms and adverse effects from their tumor treatment, which may strongly impair their quality of life despite the improved techniques for management of side effects. METHODS This review is based on a selective literature search of the PubMed and Cochrane Library databases carried out in December 2019 and January 2020. Special attention was paid to guidelines, expert opinions, and recommendations from professional societies. RESULTS Alongside decreased well-being, cancer patients often suffer from fatigue (70-100%), loss of appetite (6-53%), pain (30-80 %), and dyspnea (10-70%). The prevalence and severity of the symptoms varies depending on the tumor entity and the patient's sex. A meta-analysis showed that besides causal treatment, physical activity achieves moderately strong effects in tumor-associated fatigue syndrome (Cohen's d = 0.30 [0.25; 0.36]). The WHO recommends early use of opioids in tumor-associated pain. A meta-analysis of randomized trials described symptom relief by means of opioids also in dyspnea (standardized mean difference: -0.32 [-0.53; -0.10]). Increasingly, guidelines are recommending regular palliative medical symptom screening. CONCLUSION Regular documentation of symptoms in outpatients offers the opportunity for targeted management of symptoms during treatment with the involvement of various disciplines such as palliative medicine, exercise therapy, and psychotherapy.
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Molassiotis A, Brown T, Cheng HL, Byrnes A, Chan RJ, Wyld D, Eastgate M, Yates P, Marshall AP, Fichera R, Isenring L, To KF, Ko PS, Lam W, Lam YF, Au LF, Lo RSK. The effects of a family-centered psychosocial-based nutrition intervention in patients with advanced cancer: the PiCNIC2 pilot randomised controlled trial. Nutr J 2021; 20:2. [PMID: 33388075 PMCID: PMC7778804 DOI: 10.1186/s12937-020-00657-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background Malnutrition in advanced cancer patients is common but limited and inconclusive data exists on the effectiveness of nutrition interventions. Feasibility and acceptability of a novel family-based nutritional psychosocial intervention were established recently. The aims of this present study were to assess the feasibility of undertaking a randomised controlled trial of the latter intervention, to pilot test outcome measures and to explore preliminary outcomes. Methods Pilot randomised controlled trial recruiting advanced cancer patients and family caregivers in Australia and Hong Kong. Participants were randomised and assigned to one of two groups, either a family-centered nutritional intervention or the control group receiving usual care only. The intervention provided 2–3 h of direct dietitian contact time with patients and family members over a 4–6-week period. During the intervention, issues with nutrition impact symptoms and food or eating-related psychosocial concerns were addressed through nutrition counselling, with a focus on improving nutrition-related communication between the dyads and setting nutritional goals. Feasibility assessment included recruitment, consent rate, retention rate, and acceptability of assessment tools. Validated nutritional and quality of life self-reported measures were used to collect patient and caregiver outcome data, including the 3-day food diary, the Patient-Generated Subjective Global Assessment Short Form, the Functional Assessment Anorexia/Cachexia scale, Eating-related Distress or Enjoyment, and measures of self-efficacy, carers’ distress, anxiety and depression. Results Seventy-four patients and 54 family caregivers participated in the study. Recruitment was challenging, and for every patient agreeing to participate, 14–31 patients had to be screened. The consent rate was 44% in patients and 55% in caregivers. Only half the participants completed the trial’s final assessment. The data showed promise for some patient outcomes in the intervention group, particularly with improvements in eating-related distress (p = 0.046 in the Australian data; p = 0.07 in the Hong Kong data), eating-related enjoyment (p = 0.024, Hong Kong data) and quality of life (p = 0.045, Australian data). Energy and protein intake also increased in a clinically meaningful way. Caregiver data on eating-related distress, anxiety, depression and caregiving burden, however, showed little or no change. Conclusions Despite challenges with participant recruitment, the intervention demonstrates good potential to have positive effects on patients’ nutritional status and eating-related distress. The results of this trial warrant a larger and fully-powered trial to ascertain the effectiveness of this intervention. Trial registration The trial was registered with the Australian & New Zealand Clinical Trials Registry, registration number ACTRN12618001352291.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Teresa Brown
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Angela Byrnes
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Raymond Javan Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Melissa Eastgate
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Patsy Yates
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.,Gold Coast University Hospital, Southport, Australia
| | | | - Liz Isenring
- Nutrition & Dietetics, Bond University, Gold Coast, Australia
| | - Ki Fung To
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Po Shan Ko
- Kowloon East Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Wang Lam
- Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Yuk Fong Lam
- Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Lai Fan Au
- Shatin Hospital, Ma On Shan, New Territories, Hong Kong
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Li Y, Sun D, Zhang X, Li H, Zhao Y, Ma D, Li Z, Sun J. Informal dementia caregivers' experiences and perceptions about mealtime care: A qualitative evidence synthesis. J Adv Nurs 2020; 76:3317-3328. [PMID: 32996617 DOI: 10.1111/jan.14550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
AIMS To systematically identify, evaluate and synthesize the available qualitative evidence on the mealtime care experiences of informal caregivers of people with dementia. DESIGN A qualitative evidence synthesis using the Thomas and Harden method. DATA SOURCES All qualitative and mixed-method studies in English and Chinese were retrieved from PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang, and Vip from the inception of each database until November 2019. REVIEW METHODS Two researchers independently selected the studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis. RESULTS Ten studies were chosen for this review. The analytical themes identified included injecting a new element, moving forward in the challenge and external supports facilitating better coping. CONCLUSION Community nurses should effectively use resources to provide food-related information and services to families with dementia. Future research should combine informal caregiver experiences and clinical skills to develop high-quality interventions to improve the quality of mealtimes. IMPACT The findings established that informal caregivers experienced not only changes in their roles and concerns but also emotional changes. Informal caregivers develop different coping strategies to adapt to feeding issues without professional support. Although informal caregivers attach great importance to mealtimes and nutrition issues, they experience a lack of information and support services. Community nurses can provide more economical, practical, and accessible information resources based on informal caregivers' perceptions of mealtime care. Future interventions need to be more aware of the importance of dyad or family-centred support services.
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Affiliation(s)
- Yijing Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Dan Sun
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Xu Zhang
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Dongfei Ma
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Zehui Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
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11
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Roberts S, Chaboyer W, Marshall AP. Hospital patients' perceptions of using a technology-based intervention to participate in their nutrition care: A qualitative descriptive study. Clin Nutr ESPEN 2020; 39:79-86. [PMID: 32859333 DOI: 10.1016/j.clnesp.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Promoting patient participation in health care is a worldwide health care priority. When patients participate in their nutrition care during hospitalisation, they are more likely to meet their dietary needs. Patient participation is a potential solution to hospital malnutrition, for which inadequate dietary intake is the major modifiable risk factor. Our team developed a health information technology (HIT) intervention aiming to improve patients' dietary intakes during hospitalisation by engaging them in their nutrition care. The aim of this study was to explore patient perceptions and acceptability of the intervention. METHODS This qualitative descriptive study was conducted at a tertiary teaching hospital in Australia. Participants were a subset of patients from a larger feasibility study, selected using maximum variation purposive sampling to include a broad representation of patients in terms of age, gender and experience with technology. All patients had used the HIT intervention to participate in their nutrition care in hospital, through nutritional goal setting and dietary intake monitoring. A semi-structured interview guide was used to collect qualitative data on patients' perceptions of the intervention, focusing on acceptability. Data were analysed thematically. FINDINGS 11 patients participated in interviews, from which two main themes emerged. The first captured patients' experiences and perceptions of using technology to participate in their nutrition care. Patients found it easy to use, useful and valuable, but still valued interaction with researchers and hospital staff. The second theme portrayed the spectrum of participation, from simply learning about nutrition, to self-monitoring and evaluating, to changing behaviour. Participants enjoyed gaining new knowledge and awareness around nutrition. Most self-monitored their food intake and evaluated their goals, and some changed what foods they ordered based on what they had learned. CONCLUSIONS Patients responded positively to the intervention, likely because they found it valuable and easy to use. These findings are promising for potential future use of HIT to engage hospital patients in care. Future research should investigate the effects of HIT interventions on patient-centred outcomes in hospital.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Griffith University, Australia; Gold Coast Hospital and Health Service, Australia; Menzies Health Institute Queensland, Australia.
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, Australia; Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia
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Marshall AP, Tobiano G, Roberts S, Isenring E, Sanmugarajah J, Kiefer D, Fulton R, Cheng HL, To KF, Ko PS, Lam YF, Lam W, Molassiotis A. End-user perceptions of a patient- and family-centred intervention to improve nutrition intake among oncology patients: a descriptive qualitative analysis. BMC Nutr 2020; 6:29. [PMID: 32699640 PMCID: PMC7372777 DOI: 10.1186/s40795-020-00353-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background People with cancer are at high risk of malnutrition. Nutrition education is an effective strategy to improve patient outcomes, however, little is known regarding the impact of family and/or carer involvement in nutrition education and requires investigation. The purpose of the study was to evaluate PIcNIC (Partnering with families to promote nutrition in cancer care) intervention acceptability from the perspective of patients, families and health care providers. Methods A descriptive qualitative study was undertaken at an inpatient and an outpatient hospital setting in Australia and an outpatient/home setting in Hong Kong. A patient-and-family centred intervention including nutrition education, goals setting/nutrition plans, and food diaries, was delivered to patients and/or families in the inpatient, outpatient or home setting. Semi-structured interviews were used to explore perceptions of the intervention. 64 participants were interviewed; 20 patients, 15 family members, and 29 health care professionals. Data were analysed using deductive and inductive content analysis. Results Two categories were identified; 1) ‘context and intervention acceptability’; and 2) ‘benefits of patient- and family-centred nutrition care’. Within each category redundant concepts were identified. For category 1 the redundant concepts were: the intervention works in outpatient settings, the food diary is easy but needs to be tailored, the information booklet is a good resource, and the intervention should be delivered by a dietitian, but could be delivered by a nurse. The redundant concepts for category 2 were: a personalised nutrition plan is required, patient and family involvement in the intervention is valued and the intervention has benefits for patients and families. Converging and diverging perceptions across participant groups and settings were identified. Conclusions In this paper we have described an acceptable patient- and family-centred nutrition intervention, which may be effective in increasing patient and family engagement in nutrition care and may result in improved nutrition intakes. Our study highlights important contextual considerations for nutrition education; the outpatient and home setting are optimal for engaging patients and families in learning opportunities.
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Affiliation(s)
- Andrea P Marshall
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia.,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast Campus Parklands Drive, Southport, QLD 4215 Australia
| | - Georgia Tobiano
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia.,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD 4215 Australia.,Division of Allied Health, Gold Coast Health 1 Hospital Blvd, Southport, QLD 4215 Australia.,School of Allied Health, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Elisabeth Isenring
- Nutrition & Dietetics, Faculty of Health Sciences & Medicine, Bond University Level 2, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD 4226 Australia
| | - Jasotha Sanmugarajah
- Medical Oncology, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Deborah Kiefer
- Division of Allied Health, Gold Coast Health 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Rachael Fulton
- School of Allied Health, Griffith University, Parklands Drive, Southport, QLD 4215 Australia
| | - Hui Lin Cheng
- School of Nursing, Faculty of Health and Social Sciences, Room A401, Chung Sze Yuen Building, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ki Fung To
- Dietetics Department, Alice Ho Miu Ling Nethersole Hospital Hospital Authority, Chuen On Rd, Tai Po, Hong Kong
| | - Po Shan Ko
- Kowloon East Cluster, Hospital Authority, Hong Kong, China
| | - Yuk Fong Lam
- Department of Medicine, Haven of Hope Hospital, Haven of Hope Rd, 8, Tseung Kwan O, Hong Kong
| | - Wang Lam
- Dietetics Department, Haven of Hope Hospital, Haven of Hope Rd, 8, Tseung Kwan O, Hong Kong
| | - Alex Molassiotis
- School of Nursing, Faculty of Health and Social Sciences, Room A401, Chung Sze Yuen Building, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Zimmermann FF, Jordan J, Burrell B. Coping with cancer mindfully: A feasibility study of a mindfulness intervention focused on acceptance and meaning in life for adults with advanced cancer. Eur J Oncol Nurs 2020; 44:101715. [DOI: 10.1016/j.ejon.2019.101715] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 01/04/2023]
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Marshall S, van der Meij BS, Milte R, Collins CE, de van der Schueren MA, Banbury M, Warner MM, Isenring E. Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study. JMIR Res Protoc 2019; 8:e12647. [PMID: 31038466 PMCID: PMC6658316 DOI: 10.2196/12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. OBJECTIVE The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. METHODS This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. RESULTS Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. CONCLUSIONS This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12647.
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Affiliation(s)
- Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Barbara S van der Meij
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Dietetics and Foodservices, Mater Health, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Rachel Milte
- Institute for Choice, University of South Australia, Adelaide, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Marian Ae de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands.,Department of Nutrition and Dietetics, HAN University of Applied Sciences, Amsterdam, Netherlands
| | - Mark Banbury
- Northern NSW Local Health District, NSW Health, Tweed Heads, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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