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Betker L, Seifart C, von Blanckenburg P. Questionnaires About the End of Life for Cancer Patients - Is the Response Burden Acceptable? J Pain Symptom Manage 2024; 67:233-240. [PMID: 38016508 DOI: 10.1016/j.jpainsymman.2023.11.025] [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] [Received: 07/25/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
CONTEXT Research about the end of life with the help of patient-reported outcomes in vulnerable populations such as cancer patients is needed but is potentially burdensome and can therefore raise concerns. OBJECTIVES To assess the response burden due to questionnaires about the end of life in cancer patients and to explore associations with individual variables. METHODS In a cross-sectional design response burden was assessed using a six-item instrument after completion of a survey that concerned the end of life. Associations with age, gender, type of care (curative/palliative), years since diagnosis, distress, depression, anxiety, death anxiety, readiness for end-of-life conversations, and readiness for advance care planning were explored via correlational analyses and multiple regressions. Burden due to the topic of end-of-life and completing questionnaires in general was compared. RESULTS A total of 269 cancer patients (mean age 61.4 (SD =12.3); 59.5% male; 58.4% in palliative care) completed the survey in a German hospital. The majority did not report response burden; 29.7% reported at least some burden due to study participation. The multiple regression (F [10,26] = 9.97, p < 0.001) indicated that stable predictors of response burden were higher death anxiety (ß = 0.4), lower readiness to talk about one's end of life (ß = -0.34) and higher age (ß = 0.23). No additional subjective burden due to the topic of end-of-life was reported. CONCLUSION The reported response burden seems acceptable since it was generally low. However, a subgroup did report some burden. Minimising burden and enhancing participants' benefits without compromising the research quality should further influence study designs in this field.
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Affiliation(s)
- Liv Betker
- Department of Clinical Psychology and Psychotherapy (L.B., P.B.), Philipps-University Marburg, Marburg, Germany.
| | - Carola Seifart
- Department of Medicine, Research Group Medical Ethics (C.S.), Philipps-University Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy (L.B., P.B.), Philipps-University Marburg, Marburg, Germany
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Wakefield D, Ta Y, Dewhurst F, Hussain J, Chamberlain C, Etkind S. Qualified and motivated, but limited by specialty-specific barriers: a national survey of UK Palliative Medicine consultants research experience. BMJ Support Palliat Care 2024; 14:76-86. [PMID: 37611937 DOI: 10.1136/spcare-2023-004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Providing high-quality safe palliative care requires high-quality clinically driven research. Little is known about how to optimise clinical research capacity in this field.To understand interest and capacity to conduct clinical research in palliative medicine and identify key facilitators and barriers, by surveying palliative medicine consultants and academic trainees. METHODS National online survey exploring experience in conducting research, including facilitators and barriers. Sent to all current UK palliative medicine consultants, and previous/current academic trainees. Descriptive statistics are reported with framework analysis of free text responses. RESULTS 195 surveys were submitted including 15 respondents with Integrated Academic Training (IAT) experience. 78% (n=140/180) of consultants were interested in conducting research. Despite this enthusiasm, 83% had no allocated time within their job plan. 88% of those who undertook IAT would recommend IAT, but 60% reported difficulty transitioning from academic trainee to research active consultant.Barriers to research included; insufficient research culture and integration, with small teams working in a mixture of National Health Service (NHS) and non-NHS settings, leading to isolated, silo working. Even those who had undertaken IAT, felt a 'cliff edge' in opportunities after completing IAT. Filling service gaps was routinely prioritised over research activity. CONCLUSION Palliative medicine consultants, including those who have completed academic training want to conduct research but overwhelming barriers limit activity. A palliative care-specific strategy that permeates different palliative care settings, promotes interspecialty collaboration and improves the current infrastructure for palliative care research to maximise gains from IAT and embed a research culture are suggested.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Felicity Dewhurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle upon Tyne, UK
| | - Jamilla Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Charlotte Chamberlain
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Paiva CE, Bonilla-Sierra P, Tripodoro VA, Rodríguez-Nunez A, De Simone G, Rodriguez LH, de Oliveira Vidal EI, Ríos MR, Crispim DH, Pérez-Cruz P, de Angelis Nascimento MS, Ospina PMR, de Lima L, Pastrana T, Zimmerman C, Hui D, Bruera E, Paiva BSR. How to Advance Palliative Care Research in South America? Findings From a Delphi Study. J Pain Symptom Manage 2023; 65:193-202. [PMID: 36455800 DOI: 10.1016/j.jpainsymman.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
CONTEXT Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved. OBJECTIVES To develop a set of recommendations to advance PC research in SA. METHODS Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%. RESULTS 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant. CONCLUSION Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region.
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Affiliation(s)
- Carlos Eduardo Paiva
- Palliative and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, Brazil.
| | - Patricia Bonilla-Sierra
- Department of Health Sciences (P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
| | | | - Alfredo Rodríguez-Nunez
- Palliative Care Program, Faculty of Medicine (A.R.N.), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gustavo De Simone
- Instituto Pallium Latinoamérica (V.A.T., G.S.), Buenos Aires, Argentina
| | | | | | - Miriam Riveros Ríos
- Departamento de Cuidados Paliativos, Hospital de Clinicas (M.R.R.), Universidad Nacional de Asunción, Paraguay
| | - Douglas Henrique Crispim
- Hospital das Clínicas, Faculdade de Medicina FMUSP (D.H.C.), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Pérez-Cruz
- Sección Medicina Paliativa, Facultad de Medicina (P.P.C.), Pontificia Universidad Católica de Chile
| | | | | | - Liliana de Lima
- International Association for Hospice and Palliative Care (IAHPC) (L.L.), Houston, Texas, USA
| | - Tania Pastrana
- Department of Palliative Medicine (T.P.), RWTH Aachen University, Aachen, Germany
| | - Camilla Zimmerman
- Department of Supportive Care (C.Z.), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bianca Sakamoto Ribeiro Paiva
- Palliative and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, Brazil
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [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: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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van der Steen JT, Bloomer MJ, Martins Pereira S. The importance of methodology to palliative care research: A new article type for Palliative Medicine. Palliat Med 2022; 36:4-6. [PMID: 34965752 PMCID: PMC8796148 DOI: 10.1177/02692163211069566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
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Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
Abstract Purpose of the Review The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. Recent Findings The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Summary Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
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Hasson F, Nicholson E, Muldrew D, Bamidele O, Payne S, McIlfatrick S. International palliative care research priorities: A systematic review. BMC Palliat Care 2020; 19:16. [PMID: 32013949 PMCID: PMC6998205 DOI: 10.1186/s12904-020-0520-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been increasing evidence and debate on palliative care research priorities and the international research agenda. To date, however, there is a lack of synthesis of this evidence, examining commonalities, differences, and gaps. To identify and synthesize literature on international palliative care research priorities originating from Western countries mapped to a quality assessment framework. METHODS A systematic review of several academic and grey databases were searched from January 2008-June 2019 for studies eliciting research priorities in palliative care in English. Two researchers independently reviewed, critically appraised, and conducted data extraction and synthesis. RESULTS The search yielded 10,235 articles (academic databases, n = 4108; grey literature, n = 6127), of which ten were included for appraisal and review. Priority areas were identified: service models; continuity of care; training and education; inequality; communication; living well and independently; and recognising family/carer needs and the importance of families. Methodological approaches and process of reporting varied. There was little representation of patient and caregiver driven agendas. The priorities were mapped to the Donabedian framework for assessing quality reflecting structure, process and outcomes and key priority areas. CONCLUSIONS Limited evidence exists pertaining to research priorities across palliative care. Whilst a broad range of topics were elicited, approaches and samples varied questioning the credibility of findings. The voice of the care provider dominated, calling for more inclusive means to capture the patient and family voice. The findings of this study may serve as a template to understand the commonalities of research, identify gaps, and extend the palliative care research agenda.
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Affiliation(s)
- Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland.
| | - Emma Nicholson
- UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Deborah Muldrew
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
| | - Olufikayo Bamidele
- Academcy of Primary Care, Hull York Medical School, Allam Medical Building, University of Hull, Hull, HU6 7RZ, England
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, LA14YX, Lancaster, UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
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Affiliation(s)
- Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Bridget Johnston
- School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Sonja McIlfatrick
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
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Abstract
AbstractObjectiveThe objective of this study is to map the existent research undertaken in Australia into broad thematic areas and identify the characteristics of the studies and areas of future research in the literature.MethodsA scoping review methodology was employed to map the current areas of research undertaken in Australia since January 2000 until the end of December 2018 according to years of publications, types of studies, populations studied, research themes, and areas of focus.ResultsOur review identified 1,405 Australian palliative care research publications between January 2000 and December 2018. Nearly 40% of the studies were quantitative (39%) and a third were qualitative studies (31%). The remainder of the studies were reviews, mixed methods, quality improvement projects, and others. One-third (30%) of the research was done with carers' participants followed by nurses (22%) and doctors and physicians (18%). The most frequently reported diagnosis in the studies was cancer with 42% of the publication total. The most frequently explored theme was physical symptoms (such as pain, breathlessness, nausea, delirium, and dyspnea) with a total of 16% of all articles followed by communication (15%). There was a large gap to the next most frequently explored theme with service delivery (9%) and coordination of care (8%). Assessment of patients (7%), end-of-life decision-making (6%), and rural/regional (6%) all produced a similar number of publications. Very few studies addressed topics such as quality of life, E-Health, after-hours care, spirituality, and health economics. Moreover, there were only 15 (1%) studies focused on the last days of life.Significance of the resultsThe current review presented a comprehensive search of the literature across almost two decades in Australia in the palliative care setting. It has covered a breadth of research topics and highlighted urgent areas for further research.
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McIlfatrick S. Guest Editorial Palliative care: across boundaries, conditions, groups and settings. J Res Nurs 2019; 24:363-365. [PMID: 34394549 PMCID: PMC7932265 DOI: 10.1177/1744987119870335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024] Open
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