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Laidsaar-Powell R, Giunta S, Butow P, Turner S, Costa D, Saunders C, Koczwara B, Kay J, Jefford M, Schofield P, Boyle F, Yates P, White K, Sundaresan P, Varadarajan S, Juraskova I. An online intervention to improve oncology health professional self-efficacy in communicating with carers: Hybrid effectiveness-implementation evaluation of the eTRIO program. PATIENT EDUCATION AND COUNSELING 2024; 124:108251. [PMID: 38626502 DOI: 10.1016/j.pec.2024.108251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed. METHODS This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed. RESULTS Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful. CONCLUSIONS AND PRACTICE IMPLICATIONS eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia.
| | - Sarah Giunta
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, Australia; Flinders University, Adelaide, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Australia; Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate White
- Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Puma Sundaresan
- Trans Tasman Radiation Oncology Group, New South Wales, Australia; Sydney West Radiation Oncology Network, WSLHD, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Suganthy Varadarajan
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
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Muntefering C, Kastrinos A, McAndrew NS, Ahrens M, Applebaum AJ, Bangerter L, Fields B. Integrating family caregivers in older adults' hospital stays: a needed cultural shift. Hosp Pract (1995) 2024:1-13. [PMID: 38767120 DOI: 10.1080/21548331.2024.2357510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/16/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study aimed to examine perceived barriers and facilitators to caregiver inclusion in the hospital care of older adult family members or friends through the perspectives of (1) hospitalized older adults, (2) caregivers of a hospitalized older adult, (3) healthcare clinicians, and (4) policymakers. METHODS This qualitative descriptive exploratory study utilized semi-structured interviews with N = 24 participants and was analyzed using a framework method. RESULTS Eight codes arose that were categorized into four domains guided by the Social Ecological Model. Individual-level factors were determined both for the caregiver and for the clinician. Relationship-level factors were revealed pertaining to communication style and method. Hospital-level factors included hospital environment and resources. Societal-level factors included healthcare climate and policies. DISCUSSION Findings indicated that hospital workflows and policies inadequately support family caregivers. This study highlights potential solutions to caregivers' integration into hospital workflows.
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Affiliation(s)
- Chloe Muntefering
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amanda Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Chennai, India
| | - Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin- Milwaukee, Milwaukee, WI, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, WI, USA
| | - Madelyn Ahrens
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Chennai, India
| | - Lauren Bangerter
- Health Economics Aging Research Institute, MedStar Health, Hyatssville, MD, USA
| | - Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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Laidsaar-Powell R, Giunta S, Butow P, Keast R, Koczwara B, Kay J, Jefford M, Turner S, Saunders C, Schofield P, Boyle F, Yates P, White K, Miller A, Butt Z, Bonnaudet M, Juraskova I. Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers. JMIR MEDICAL EDUCATION 2024; 10:e50118. [PMID: 38630531 PMCID: PMC11063882 DOI: 10.2196/50118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. OBJECTIVE To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. METHODS The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). RESULTS The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. CONCLUSIONS The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Sarah Giunta
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Rachael Keast
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Penelope Schofield
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate White
- Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia
| | - Annie Miller
- Cancer Council New South Wales, Sydney, Australia
| | - Zoe Butt
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Melanie Bonnaudet
- School of Computer Science, The University of Sydney, Sydney, Australia
- School of Electrical Engineering and Computer Science, Kungliga Tekniska högskolan Royal Institute of Technology, Stockholm, Sweden
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
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Coumoundouros C, El Arab RA, Farrand P, Hamilton A, Sanderman R, von Essen L, Woodford J. Potential Implementers' Perspectives on the Development and Implementation of an e-Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study. JMIR Hum Factors 2023; 10:e51461. [PMID: 37792676 PMCID: PMC10692875 DOI: 10.2196/51461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND e-Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e-mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. OBJECTIVE This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e-mental health intervention for caregivers of people living with CKD. METHODS Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. RESULTS A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e-mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. CONCLUSIONS Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e-mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development.
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Affiliation(s)
- Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Exeter, United Kingdom
| | - Rabie Adel El Arab
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Healthcare Research Group (GRECS), Institute for Biomedical Research (IRBLleida), Lleida, Spain
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Exeter, United Kingdom
| | - Alexander Hamilton
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Faculty of Health and Life Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Cronin M, McLoughlin K, Foley T, McGilloway S. Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations. BMC PRIMARY CARE 2023; 24:234. [PMID: 37932659 PMCID: PMC10626724 DOI: 10.1186/s12875-023-02188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role. METHODS A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O'Malley's framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020. RESULTS The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways. CONCLUSION Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.
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Affiliation(s)
- Mary Cronin
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland.
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland
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Cronin M, McGilloway S. Supporting family carers in Ireland: the role of the general practitioner. Ir J Med Sci 2023; 192:951-961. [PMID: 35701648 PMCID: PMC9197724 DOI: 10.1007/s11845-022-03031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ireland has over half a million family carers who provide care to a family member or loved one. Internationally, it is recognised that general practitioners (GPs) have a critical role to play in the identification and support of family carers, but, to date, no guidelines exist in Ireland to support GPs in this role. AIMS The aim of this study was to examine how carers are currently supported (or not) by healthcare professionals in Ireland, with a particular focus on the role of the GP. METHODS A mixed method design was used, involving a national online survey (N = 132) of family carers in Ireland and one-to-one interviews with 10 stakeholders (4 GPs; 6 carers). The quantitative data were analysed using a series of descriptive and inferential statistics; the interview data were analysed using framework analysis. RESULTS Sixty-one per cent of the carer sample reported experiencing psychological distress, more than two-thirds of whom (69%) reported 'rarely' or 'never' being asked about their own health and wellbeing. Sixty-one per cent also felt misunderstood in terms of the challenges they face in their caring role. Three key themes were identified from the interview data including (1) GP role ambiguity; (2) navigating informal processes and (3) changing needs along the care trajectory. CONCLUSIONS The findings suggest important gaps in terms of the role of GPs vis-à-vis their support of family carers. GPs themselves indicated that they need both greater clarity regarding their role with family carers and more training and resources in this regard. A requirement for more streamlined communication and information provision was also highlighted by both GPs and carers. Carers reported a need for more information on the role of GPs in supporting carers as well as more support in addressing, in particular, the psychological complexities of carer identity and help seeking.
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Affiliation(s)
- Mary Cronin
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland.
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland
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Cormican O, Dowling M. Providing Care to People Living with a Chronic Hematological Malignancy: A Qualitative Evidence Synthesis of Informal Carers' Experiences. Semin Oncol Nurs 2022; 38:151338. [PMID: 36270864 DOI: 10.1016/j.soncn.2022.151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Chronic hematological malignancies such as multiple myeloma, chronic lymphocytic leukemia (CLL), indolent B-cell lymphomas, and myelodysplastic syndromes (MDS) have seen significant advances in treatment. Treatment developments have resulted in patients living for many years, often between periods of being acutely unwell, relapses, and remission. Informal carers play a major role in supporting patients through the uncertain and long illness trajectory. This qualitative evidence synthesis (QES) aims to synthesize qualitative research evidence on the experiences of informal carers caring for a patient with a chronic hematological malignancy (CHM). DATA SOURCES This qualitative evidence synthesis followed the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines and adopted a "best fit" framework synthesis approach using a "redefining normal" conceptual framework. A systematic search of seven databases was undertaken. CONCLUSION Sixteen qualitative studies were synthesized in this review. Eight review findings illuminated carers' unmet information needs, challenges with caring responsibilities, end-of-life care, and changes in the dyad carer-patient relationship. IMPLICATIONS FOR NURSING PRACTICE This best-fit framework synthesis illuminates the wide-ranging challenges experienced by informal caregivers of people living with a chronic hematological malignancy. Carers' fear for the future highlights the need for interventions to support them with their fears. Carers' priority on their loved one's quality of life is impaired by late end-of-life discussions often not occurring until a sudden deterioration in the patient's condition. Early supportive relationships between carers and health care providers can promote conversations on poor prognosis and end-of-life care. Future research should focus on qualitative longitudinal studies with caregiver-patient dyads.
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Affiliation(s)
- Orlaith Cormican
- School of Nursing and Midwifery, University of Galway, University Road, Galway, Ireland H91 TK33.
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, University Road, Galway, Ireland H91 TK33
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Hiatt J, Young A, Brown T, Banks M, Segon B, Bauer J. A qualitative comparison of the nutrition care experiences of carers supporting patients with head and neck cancer throughout surgery and radiation treatment and survivorship. Support Care Cancer 2022; 30:9359-9368. [PMID: 36109395 PMCID: PMC9633518 DOI: 10.1007/s00520-022-07348-0] [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: 01/18/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To understand and compare the nutrition care experiences of carers supporting patients throughout surgery and radiation treatment for head and neck cancer (HNC) to inform changes to service delivery in the inpatient and outpatient setting to ensure carers needs in their supportive role throughout the treatment and survivorship period are met. METHODS As part of a larger study, narrative interviews were completed with fourteen carers of patients diagnosed with HNC at 2 weeks, 3 months and 12 months post-treatment completion. Reflexive thematic analysis was used to interpret and understand differences in carer experiences of nutrition care between surgery and radiation treatment. RESULTS Two main themes across each treatment modality were identified: (1) access to information and support from healthcare professionals and (2) adjustment to the physical and psychological impact of treatment. CONCLUSION This study highlights the increasing need to ensure carers are included in the provision of nutrition information and support to patients throughout and beyond their treatment trajectory. Having structured support available to patients and carers throughout radiation treatment meant that carer needs were reduced. However, without the opportunity for structured support in the inpatient setting, many carers expressed high care needs in supporting patients in the post-surgical phase. IMPLICATIONS FOR CANCER SURVIVORS Providing carers with access to structured support for nutrition care in the inpatient and outpatient setting can reduce their supportive care needs throughout the treatment and survivorship period.
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Affiliation(s)
- Joanne Hiatt
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia. .,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia.
| | - Adrienne Young
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Merrilyn Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Bronwyn Segon
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
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Swan S, Meade R, Cavers D, Kimbell B, Lloyd A, Carduff E. Factors influencing adult carer support planning for unpaid caregiving at the end of life in Scotland: Qualitative insights from triangulated interviews and focus groups. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1422-1432. [PMID: 34427355 PMCID: PMC9290463 DOI: 10.1111/hsc.13472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
Caring for a relative or friend at the end of life can be rewarding but all-encompassing. These caregivers are often not identified, meaning their diverse needs remain unmet, and the lack of assessment, support and planning increases the likelihood of crisis and burnout. The Carers (Scotland) Act 2016 places responsibility on local authorities to implement such a plan, which will be fast-tracked for carers supporting someone at the end of life. Our research described the factors which might influence this planning, triangulating primary focus groups with 15 carers and secondary qualitative data from transcripts with 30 carers, all of whom who had looked after someone with a terminal illness. Analysis was iterative, and constant comparative analysis of the secondary data informed the primary focus groups. Three main themes were identified; 1. The importance of early identification as a carer to enable timely assessment and support. 2. Carers experience isolation and loneliness which limits opportunities for support. 3. Responding in a timely fashion to carer assessment and support is vital to avoid crises. This research confirms that identifying carers early in the illness trajectory, ideally at diagnosis, is vital to avoid carer burnout. Health and social care providers have a key role in identification and should ensure, where possible, that carer needs are dynamically assessed, supported and documented. Finally, caring does not end after death, it extends into bereavement. Thus, we need to consider system and cultural change to ensure the experiences and needs of carers are addressed and valued.
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Affiliation(s)
| | | | - Debbie Cavers
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Barbara Kimbell
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Anna Lloyd
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
- St Columba's HospiceEdinburghUK
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Laidsaar-Powell R, Keast R, Butow P, Mahony J, Hagerty F, Townsend J, Young J, Butt Z, Juraskova I. Improving breast cancer nurses' management of challenging situations involving family carers: Pilot evaluation of a brief targeted online education module (TRIO-Conflict). PATIENT EDUCATION AND COUNSELING 2021; 104:3023-3031. [PMID: 33941422 DOI: 10.1016/j.pec.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Given the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict. METHODS Nurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis. RESULTS 52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one's own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%). CONCLUSION TRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence. PRACTICE IMPLICATIONS TRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia.
| | - Rachael Keast
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | - Phyllis Butow
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | | | | | | | - Jade Young
- McGrath Foundation, Sydney, NSW, Australia
| | - Zoe Butt
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
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11
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Fry M, Elliott R, Murphy S, Curtis K. The role and contribution of family carers accompanying community-living older people with cognitive impairment to the emergency department: An interview study. J Clin Nurs 2021; 31:975-984. [PMID: 34254383 DOI: 10.1111/jocn.15954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older people with cognitive impairment may have lack of understanding of their health and ability to co-ordinate care needs. Family carers play a key role in supporting older people but the role of family carers in emergency discharge has not been explored well. OBJECTIVE To explore and describe the role and contribution of family carers accompanying the older person with cognitive impairment to the emergency department. DESIGN A exploratory descriptive study was conducted in which telephone interviews were performed. SETTING Three emergency departments located in metropolitan Sydney, Australia; two major tertiary referral centres and one district hospital. The EQUATOR research checklist (COnsolidated criteria for REporting Qualitative research) (COREQ) was used to report the qualitative study. SUBJECTS Participants were family carers accompanying people aged ≥64 years with cognitive impairment; with non-urgent triage classifications; English speaking and eligible for discharge home. Semi-structured telephone interviews were conducted 2 to 4 weeks after the older person was discharged. Data were reflexively thematically analysed in NVIVO independently by three researchers. RESULTS Twenty-eight interviews were conducted. Three key themes were evident: (1) 'communicating knowledge of the older person's health status and usual behaviour'; (2) 'providing advocacy, translation, surrogacy and care co-ordination'; and (3) 'ensuring safe transition from the emergency department to home'. CONCLUSIONS Study findings detailed how family carers created an important safety net while the older person was in emergency, through advocacy and the communication of vital health information. More importantly, their knowledge influenced the healthcare management of the older person and ensured safe discharge and co-ordination of care in the community. RELEVANCE TO CLINICAL PRACTICE The study identified for older persons with cognitive impairment a safe stay in the ED and transition home from hospital was supported by family carers and assisted to ensure that discharge information was understood and adhered to optimise wellbeing and prevent adverse outcomes. The findings of this study can inform discharge processes for nurses, nurse practitioners and doctors. Additionally, processes to support family carer engagement would optimise older person compliance and better inform healthcare decision-making and choice for older peoples, family carers. The findings of the study should inform discharge processes to minimise risk of readmission, financial burden and harm.
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Affiliation(s)
- Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Sandra Murphy
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Nursing and Midwifery Research Centre, Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kate Curtis
- Faculty of Medicine and Health, University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
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12
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Juraskova I, Laidsaar-Powell R, Keast R, Schofield P, Costa DS, Kay J, Turner S, Koczwara B, Saunders C, Jefford M, Yates P, Boyle F, White K, Miller A, Morton RL, Butt Z, Butow P. eTRIO trial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology. BMJ Open 2021; 11:e043224. [PMID: 34049902 PMCID: PMC8166623 DOI: 10.1136/bmjopen-2020-043224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Informal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc). METHODS AND ANALYSIS Thirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient-caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient-caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician-patient-caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient-caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention. ETHICS AND DISSEMINATION Ethical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules. TRIAL REGISTRATION NUMBER ACTRN12619001507178.
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Affiliation(s)
- Ilona Juraskova
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Rachael Keast
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Sj Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Faculty of Engineering, Sydney, New South Wales, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bogda Koczwara
- Flinders University School of Medicine, Adelaide, South Australia, Australia
| | - Christobel Saunders
- Division of Surgery, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Patsy Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, New South Wales, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Annie Miller
- Cancer Information and Support Services Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Zoe Butt
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
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13
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Burkhart L, Coglianese M, Kaelin J, Moorhead S, Joyce C. Communicating Spiritual Care in the Electronic Health Record. Comput Inform Nurs 2021; 39:538-546. [PMID: 34623338 DOI: 10.1097/cin.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chaplains must document their ministry of care in electronic health records that primarily focus on the physical dimension of care. Creating chaplain documentation that reflects the spiritual dimension of care requires chaplains to participate in the screen design. This article describes how chaplain documentation was designed and refined using psychometric methods. The resulting system successfully supported chaplain workflow, provided an ability to aggregate chaplain workload, and integrated the chaplain into the interprofessional team by structuring, linking, and sharing both the chaplain and nursing assessment of spiritual distress in the electronic health record. Documentation used 5-point Likert scales to measure different dimensions of patient spirituality. Reliability and validity were further evaluated as part of a workshop at an Association of Professional Chaplains annual meeting. Findings supported interrater reliability and the ability to predict and discriminate change pre and post encounter. Documentation screen content is presented.
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Affiliation(s)
- Lisa Burkhart
- Author Affiliations : Marcella Niehoff School of Nursing, Loyola University Chicago (Dr Burkhart); Parkinson School of Health Sciences and Public Health, Loyola University Chicago (Dr Joyce); Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital (Dr Burkhart); and Loyola University Medical Center, Maywood (Ms Coglianese and Mr Kaelin), IL; and College of Nursing, University of Iowa (Dr Moorhead)
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14
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Røen I, Brenne AT, Brunelli C, Stifoss-Hanssen H, Grande G, Solheim TS, Kaasa S, Knudsen AK. Spiritual quality of life in family carers of patients with advanced cancer-a cross-sectional study. Support Care Cancer 2021; 29:5329-5339. [PMID: 33661369 PMCID: PMC8295139 DOI: 10.1007/s00520-021-06080-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
Purpose Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer. Methods Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models. Results In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R2) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age. Conclusion The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.
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Affiliation(s)
- Ingebrigt Røen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway.
- Chaplaincy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hans Stifoss-Hanssen
- Center of diakonia and professional practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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15
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Martins Pereira S, Hernández-Marrero P, Pasman HR, Capelas ML, Larkin P, Francke AL. Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports. Palliat Med 2021; 35:130-141. [PMID: 32912033 DOI: 10.1177/0269216320956817] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses are the largest regulated group of healthcare professionals involved in palliative care. In 2004, a taskforce of the European Association for Palliative Care (EAPC) launched the 'Guide for development of palliative nurse education in Europe' (hereinafter, the EAPC 2004 Guide). No systematic evaluation of its impact in the development of palliative care education was undertaken. AIMS To describe current undergraduate and postgraduate nursing education across Europe; to identify the roles that nurses with different palliative care educational levels have in palliative care; and to assess the uptake of the EAPC 2004 Guide in the development of palliative care nursing in Europe. DESIGN Descriptive research involving an online survey among nursing experts, and the consultation of national representatives. SETTING/PARTICIPANTS A total of 135 nurses (52% response rate) from 25 countries completed the online survey; representatives from 16 countries were consulted. RESULTS In 14 (56%) countries, palliative care was not identified as a mandatory subject within undergraduate nursing education. The EAPC 2004 Guide is widely known and was/is being used in many countries to promote palliative care nursing education. Large variations were found across and within country responses. CONCLUSIONS Palliative care nursing education varies largely in Europe. The wide awareness and use of the EAPC 2004 Guide show how policy measures can influence the development of palliative care education. Recommendations are built and focus on both fostering the use of this guide and implementing policy measures to ensure that palliative care nursing is recognised and certified as a specialty in all European countries.
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Affiliation(s)
- Sandra Martins Pereira
- Católica Porto Business School, CEGE: Research Centre in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - Pablo Hernández-Marrero
- Católica Porto Business School, CEGE: Research Centre in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - H Roeline Pasman
- Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Manuel Luís Capelas
- Portuguese Observatory for Palliative Care, Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Philip Larkin
- Centre Hospitalier Universitaire Vaudois (CHUV), UNIL
- Université de Lausanne, Lausanne, Switzerland
| | - Anneke L Francke
- Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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16
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Mélin M, Amieva H, Frasca M, Ouvrard C, Berger V, Hoarau H, Roumiguière C, Paternostre B, Stadelmaier N, Raoux N, Bergua V, Burucoa B. Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase. BMC Palliat Care 2020; 19:173. [PMID: 33213448 PMCID: PMC7678093 DOI: 10.1186/s12904-020-00680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background In the absence of extant recommendations, the aim of this study was to formalise support practices used by an interdisciplinary team in a palliative-care unit (PCU) for the relatives of patients in the agonal phase preceding death. The secondary objective was to understand the expectations of relatives during this phase in terms of the support provided by professionals and volunteers. Methods Thirty-two people took part in this study; all were interviewed through focus groups (FGs). Each FG comprised one category of individuals working in the PCU: nurses, care- assistants, doctors, psychologists, other professionals, palliative-care volunteers, and relatives. Groups were surveyed using an interview guide, and the interviews were recorded and transcribed to enable identification and characterization of all practices. Care practices were classified into four categories: current consensual practices (i.e. performed by all team members), occasional consensual practices, non-consensual practices (performed by one or a few participants), and practices to be developed. Results In total, 215 practices were mentioned by professionals and palliative-care volunteers: 150 current consensual practices, 48 occasional consensual practices, 1 non-consensual practice, 16 practices yet to be developed, and 29 practices for relatives. Many practices were mentioned by different categories of participants; thus, after cross-checking, the number of practices decreased from 215 to 52. A list of practices deemed desirable by all was drawn up and then validated by the entire interprofessional team. These practices were organised around four themes: providing care and ensuring comfort; communicating, informing, and explaining; interacting; and mobilising interdisciplinary skills. Conclusions These results underline the importance of the quality of care provided to patients, the attention given to the relatives themselves, and they highlight the importance of the helping relationship. Following this study, which established a list of varied practices aimed at supporting the relatives of patients in agonal phase, it will be important to set up a broader study seeking to establish a consensus on these practices with an interprofessional group of experts from other PCUs using broad surveys and an adapted methodology. Such studies will make it possible to develop training modules for teams working with relatives. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00680-4.
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Affiliation(s)
- M Mélin
- Palliative Care Service, Universitary Hospital Center Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux, France.
| | - H Amieva
- Inserm 1219 Psycho-epidemiology of Aging and Chronic Diseases - Population Health Research Center-ISPED-University Bordeaux, Bordeaux, France
| | - M Frasca
- Palliative Care Service, Universitary Hospital Center Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux, France
| | - C Ouvrard
- Inserm 1219 Psycho-epidemiology of Aging and Chronic Diseases - Population Health Research Center-ISPED-University Bordeaux, Bordeaux, France
| | - V Berger
- URISH, Universitary Hospital Center Bordeaux, Bordeaux, France
| | - H Hoarau
- URISH, Universitary Hospital Center Bordeaux, Bordeaux, France
| | - C Roumiguière
- Palliative Care Service, Universitary Hospital Center Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux, France
| | - B Paternostre
- Palliative Care Service, Universitary Hospital Center Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux, France
| | | | - N Raoux
- Inserm 1219 Psycho-epidemiology of Aging and Chronic Diseases - Population Health Research Center-ISPED-University Bordeaux, Bordeaux, France
| | - V Bergua
- Inserm 1219 Psycho-epidemiology of Aging and Chronic Diseases - Population Health Research Center-ISPED-University Bordeaux, Bordeaux, France
| | - B Burucoa
- Palliative Care Service, Universitary Hospital Center Bordeaux, 1, rue Jean Burguet, 33075, Bordeaux, France
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17
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Krieger T, Specht R, Errens B, Hagen U, Dorant E. Caring for Family Caregivers of Geriatric Patients: Results of a Participatory Health Research Project on Actual State and Needs of Hospital-Based Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5901. [PMID: 32823889 PMCID: PMC7460178 DOI: 10.3390/ijerph17165901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
Because of societal changes, family caregivers are becoming vital in long-term care provision for geriatric patients after discharge from hospital. Hospital-based geriatric care teams need tools to prepare and support family caregivers for their future caregiving role in the home environment. To explore the actual state and needs for implementing a suitable family caregiver support concept in a large geriatric hospital in Germany, a Participatory Health Research methodology was chosen. An academic investigator, assisted by a critical friend, facilitated all research steps. Geriatric care professionals joined as co-researchers and performed qualitative data collection using semi-structured interviews and focus group discussions. The entire co-research team took part in the thematic analyses. The existing family caregiver support was perceived as uncoordinated and incomplete, and a lack of knowledge about support programmes in the community was apparent. The needs regarding a comprehensive family caregiver support concept that acts on both individual caregiver as well as on system level, but also connects the two levels, were formulated. High grades of participation of hospital-based co-researchers could be achieved. A critical reflection on the research strategy revealed that the participatory methodology, although time-consuming, was perceived as a useful strategy within the hierarchically organized hospital.
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Affiliation(s)
- Theresia Krieger
- Department of Social Medicine, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands;
| | - Regina Specht
- Helios Klinikum, An der Gontardslust 7, 57319 Bad Berleburg, Germany;
| | - Babette Errens
- Rhein-Maas Klinikum, Mauerfeldchen 25, 52146 Würselen, Germany; (B.E.); (U.H.)
| | - Ulrike Hagen
- Rhein-Maas Klinikum, Mauerfeldchen 25, 52146 Würselen, Germany; (B.E.); (U.H.)
| | - Elisabeth Dorant
- Department of Social Medicine, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands;
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18
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Slev VN, Molenkamp CM, Eeltink CM, Roeline W Pasman H, Verdonck-de Leeuw IM, Francke AL, van Uden-Kraan CF. A nurse-led self-management support intervention for patients and informal caregivers facing incurable cancer: A feasibility study from the perspective of nurses. Eur J Oncol Nurs 2020; 45:101716. [PMID: 32023503 DOI: 10.1016/j.ejon.2019.101716] [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: 07/26/2019] [Revised: 12/09/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Investigation of the feasibility of recruitment through nurses of patients with incurable cancer, and the feasibility (adoption, usage) and nurses' evaluation of a nurse-led self-management support intervention, integrated in continuity home visits and based on the 5 A's Behavior Change Model. METHOD Questionnaire, registrations, evaluation forms, and interviews. RESULTS Recruitment was complicated; many patients were ineligible for participation, nurses appeared protective of their patients (gatekeeping), and recruitment during the first continuity home visit appeared to be a barrier as a lot of other issues had to be discussed. The adoption rate was 81%, meaning that 18 out of 22 nurses recruited were willing to use the intervention. The usage rate at the nurse level was 56%, meaning that 10 nurses applied the intervention in full (having applied all five A's) in at least one patient. Nurses used the intervention in full in 21 out of the 36 patients included, implying a usage rate at the patient level of 58%. Nurses' mean general satisfaction score for the intervention was 7.57 (range 0-10). Nurse were especially positive about the 5 A's model, and considered the continuity home visits to be an appropriate setting for the intervention. CONCLUSIONS Timing of recruitment and gatekeeping complicated recruitment of patients through nurses. Although nurses were positive about the intervention, nurses often did not fully apply the intervention. To improve its usage, it is suggested that nurses should first be trained in using the 5 A's model.
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Affiliation(s)
- Vina N Slev
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands.
| | - Cornelia M Molenkamp
- Evean, Department of Specialised Home Care Nursing, Waterlandplein 5, Purmerend, the Netherlands
| | - Corien M Eeltink
- Amsterdam UMC, location VU University Medical Center Department of Hematology, De Boelelaan, 1117, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands
| | - Irma M Verdonck-de Leeuw
- Amsterdam UMC, location VU University Medical Center Department of Otolaryngology - Head & Neck Surgery, De Boelelaan, 1117, Amsterdam, the Netherlands; Vrije Universiteit, Amsterdam Public Health, Faculty of Behavioral and Movement Sciences, Department of Clinical Psychology, Amsterdam, the Netherlands; Cancer Center Amsterdam (CCA), De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Anneke L Francke
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands; NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118 - 124, Utrecht, the Netherlands
| | - Cornelia F van Uden-Kraan
- Vrije Universiteit, Amsterdam Public Health, Faculty of Behavioral and Movement Sciences, Department of Clinical Psychology, Amsterdam, the Netherlands
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Lai XB, Chen LQ, Chen SH, Xia HO. An examination of home-based end-of-life care for cancer patients: a qualitative study. BMC Palliat Care 2019; 18:115. [PMID: 31843006 PMCID: PMC6915891 DOI: 10.1186/s12904-019-0501-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Only a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care. Methods This was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019. Results Four themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient’s condition, managing the patient’s symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care. Conclusions Several issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.
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Affiliation(s)
- Xiao Bin Lai
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China.
| | - Li Qun Chen
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Shu Hui Chen
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
| | - Hai Ou Xia
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, China
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