1
|
Collins A, Gurren L, McLachlan SA, Wawryk O, Philip J. Communication about early palliative care: A qualitative study of oncology providers' perspectives of navigating the artful introduction to the palliative care team. Front Oncol 2022; 12:1003357. [PMID: 36568185 PMCID: PMC9780660 DOI: 10.3389/fonc.2022.1003357] [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: 07/26/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background Despite robust evidence for the integration of early palliative care for patients with advanced cancer, many patients still access this approach to care late. Communication about the introduction of Early Palliative Care is an important skill of healthcare providers working in this setting. In the context of limited community understanding about palliative care, patients and their families may express fear or negative reactions to its early introduction. Health professionals may lack the confidence or skill to describe the role and benefits of early palliative care. Aim This study sought to explore clinicians' perspectives on communication about referral to early palliative care, specifically identifying facilitators in undertaking this communication task. Methods An exploratory qualitative study set within a tertiary oncology service in Victoria, Australia. Semi-structured interviews were conducted with purposively sampled oncology clinicians exploring their perspectives on communication about referral to early palliative care. A reflexive thematic analysis was undertaken by two researchers, including both latent and semantic coding relevant to the research question. Reporting of the research was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Twelve oncology clinicians (58% female, with 67% > 15 years clinical experience) from medical oncology, surgical oncology, and haematology participated. The artful navigation of communication about early palliative care was characterised by the need for a 'spiel' involving the adoption of a series of strategies or 'tactics' when introducing this service. These themes included: 1) Using carefully selected and rehearsed language; 2) Framing in terms of symptom control; 3) Framing as additive to patient care; 4) Selling the service benefits of early palliative care; 5) Framing acceptance of referral as an altruistic act; and 6) Adopting a phased approach to delivering information about palliative care. Implications This study highlights the wide ranging and innovative communication strategies and skills required by health professionals to facilitate referral to early palliative care for cancer patients and their families. Future focus on upskilling clinicians around communication of this topic will be important to ensure successful implementation of models of early palliative care in routine cancer care.
Collapse
Affiliation(s)
- Anna Collins
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Anna Collins,
| | - Lorna Gurren
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Sue-Anne McLachlan
- Department of Medical Oncology, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Olivia Wawryk
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia,Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Harnischfeger N, Rath H, Alt-Epping B, Brand H, Haller K, Letsch A, Rieder N, Thuss-Patience P, Bokemeyer C, Bergelt C, Oechsle K. Effects of a communication training for oncologists on early addressing palliative and end-of-life care in advanced cancer care (PALLI-COM): a randomized, controlled trial. ESMO Open 2022; 7:100623. [PMID: 36356411 PMCID: PMC9808464 DOI: 10.1016/j.esmoop.2022.100623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In advanced cancer care, early communication about palliative care (PC) and end-of-life (EoL)-related issues is recommended, but is often impeded by physicians' communication insecurities. We investigated the effect of a newly developed compact communication skills training 'PALLI-COM' on oncologists' competencies to early address PC/EoL-related issues. MATERIALS AND METHODS We conducted a randomized, controlled trial (RCT) with an intervention group (IG; 2 × 90 min training) and a wait list control group (CG) at five sites. At two assessment points, participating oncologists led videotaped medical consultations with simulated patients (SPs) via a privacy compliant video conference platform. SPs were represented by trained actors. The taped conversations were rated for primary outcome (communication skills assessed by adapted COM-ON-checklist and COM-ON-coaching rating scales) by raters blinded for study group. Secondary outcomes included oncologists' self-reported communication skills (Self-Efficacy in Palliative Care Scale, Thanatophobia-Scale, Communication about End of Life Survey, study-specific items) as well as external rating of the SPs. Univariate analyses of covariance with baseline adjustment were used to analyze intervention effects. RESULTS A total of 141 oncologists [age: mean (standard deviation) = 32.7 (6.3) years, 60% female (nIG = 73, nCG = 68)] participated. Following intervention, the IG showed significantly more improvement in four out of five assessed communication skills: 'reacting to emotions and showing empathy', 'pointing out opportunities and giving hope', 'addressing the EoL' and 'explaining the concept of PC'. IG participants also improved more than CG participants in almost all secondary outcomes assessed by participants and SPs: oncologists' self-efficacy, attitudes towards caring for terminally ill patients, communication strategies and confidence in dealing with PC/EoL-related issues as well as communication quality from the SPs' perspective. CONCLUSION Findings indicate that the compact communication skills training PALLI-COM increases oncologists' competencies in early addressing PC/EoL-related issues from different perspectives. Implementation in routine oncology residency might improve advanced cancer care by strengthening these communication skills.
Collapse
Affiliation(s)
- N. Harnischfeger
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Correspondence to: Nele Harnischfeger, Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - H.M. Rath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B. Alt-Epping
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - H. Brand
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - K. Haller
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - A. Letsch
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité – University Medicine Berlin, Berlin, Germany
| | - N. Rieder
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - P. Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - C. Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - K. Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Chen J, Zhou M, Zeng K, Zhang X, Yang X, He L, Pan X. The risk factors of autogenous arteriovenous fistula dysfunction in maintenance hemodialysis patients and the curative effect of personalized nursing. Am J Transl Res 2021; 13:5107-5116. [PMID: 34150099 PMCID: PMC8205782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of individualized nursing intervention on autologous arteriovenous fistula (AVF) dysfunction and the risk factors leading to failures in maintenance hemodialysis (MHD) patients. METHODS A total of 196 patients undergoing MHD in our hospital from March 2017 to May 2019 were recruited as the study cohort and divided into two groups according to the nursing method each patient underwent. The patients who underwent individualized nursing intervention were placed in the research group (RG, n = 107), and the patients who underwent routine nursing intervention were placed in the control group (CG, n = 89). The proportion of patients with primary dysfunction in the use of AVF was recorded, and the patients' psychological states, treatment compliance, and self-nursing abilities in the two groups before and after the nursing intervention were observed. The complications, the life treatment scores, and the patients' nursing satisfaction were recorded after the nursing intervention. A logistic regression analysis was performed for the patients with initial AVF dysfunction. RESULTS Compared with the CG, the patients in the RG after the nursing intervention had statistically lower AVF dysfunction rates, notably lower SAS and SDS scores, remarkably higher total compliance rates and ESCA scores, and a dramatically lower total incidence of complications. AVF dysfunction occurred in 26 of 196 patients (13.4%) during the follow-up, with an increased risk of AVF loss in patients over 60 years old, lower blood pressure, higher hemoglobin concentrations, lower treatment compliance, self-care inability, and routine nursing interventions. After the nursing, the WHOQOL-BREF and nursing satisfaction scores in the RG were noticeably higher than they were in the CG. CONCLUSION Autologous AVF dysfunction is the result of multiple risk factors, and personalized nursing can reduce the incidence of complications, improve patients' treatment compliance and self-care abilities, and ameliorate their quality of life.
Collapse
Affiliation(s)
- Jun Chen
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Mei Zhou
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Ke Zeng
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Xiaofeng Zhang
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Xin Yang
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Liyun He
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| | - Xiaoling Pan
- Department of Nephrology, Chongqing Changshou District People's Hospital Chongqing 401220, China
| |
Collapse
|