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Sailian SD, Salifu Y, Preston N. Dignity enhanced through faith & family support in palliative care: a qualitative study. BMC Palliat Care 2024; 23:142. [PMID: 38849809 PMCID: PMC11157805 DOI: 10.1186/s12904-024-01478-4] [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: 10/12/2023] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Dignity is integral to palliative care. Illness can diminish it, causing hopelessness and the wish to hasten death. Yet, dignity is a complex multidimensional phenomenon, influenced by values and context. Understanding its varying interpretations can inform practice and policy. The aim of the study is to explore the understanding of dignity in adult patients with palliative care needs from a Lebanese perspective and how it is preserved during illness and while receiving health services. DESIGN Qualitative interview study underpinned with a social constructionist lens. Fourteen patients recruited from home-based hospice and outpatient clinics in Lebanon. Data analysed using reflexive thematic analysis. RESULTS Four themes were developed across all the interviews: (a) Dignity anchored through faith in God and religious practices; (b) Family support in maintaining physical, psychological wellbeing, and social connectedness; (c) Physical fitness, mental acuity, and healthy appearance through which patients may escape the stigma of disease, (d) accessible, equitable, and compassionate healthcare. DISCUSSION Dignity is elusive and difficult to define but faith and religious beliefs play a significant contribution in this study. For the participants, illness is seen as a natural part of life that does not necessarily diminish dignity, but it is the illness related changes that potentially affect dignity. Findings show the importance of family and children in preserving dignity during illness and how their active presence provide a sense of pride and identity. Participants aspired to restore physical, social, and mental well-being to reclaim their dignity and normalize their lives. Challenges related to physical appearance, memory loss, vitality, and social stigma associated with illness diminished dignity. Accessible, equitable and compassionate healthcare services are also crucial in preserving dignity. Participants valued clear communication, respect, and empathy from healthcare providers and identified affordability of care essential for maintaining dignity. CONCLUSION Faith in God, and strong family ties are dominant elements to maintaining dignity in the Lebanese context. Relational connectedness with family, children or God is also a need in maintaining dignity in other communal countries with variations in emphasis. The study indicates that religious and cultural context shapes the needs and perceptions of dignity during illness. These findings are likely to be transferable to many Middle Eastern countries but also countries with strong religious and family ties globally.
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Affiliation(s)
- Silva Dakessian Sailian
- American University of Beirut, Hariri School of Nursing, Riad El Solh, PO Box: 11 0236, Beirut, 1107, 2020, Lebanon.
| | - Yakubu Salifu
- International Observatory on End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4YW, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4YW, UK
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Polakova K, Ahmed F, Vlckova K, Brearley SG. Parents' experiences of being involved in medical decision-making for their child with a life-limiting condition: A systematic review with narrative synthesis. Palliat Med 2024; 38:7-24. [PMID: 38053373 PMCID: PMC10798032 DOI: 10.1177/02692163231214414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Parental involvement in the decision-making processes about medical treatment for children with life-limiting conditions is recognised as good practice. Previous research highlighted factors affecting the decision-making process, but little is known about how parents experience their participation. AIM To explore how parents experience their participation in the process of decision-making about treatment and future care for their children with life-limiting conditions. DESIGN A systematically constructed review using narrative synthesis. The PRISMA guidelines were followed to report the findings. Databases Medline, EMBASE, SCOPUS, CINAHL and PsycINFO were searched up to December 2023. The study protocol was registered at PROSPERO (RN CRD42021215863). RESULTS From the initial 2512 citations identified, 28 papers met the inclusion criteria and were included in the review. A wide range of medical decisions was identified; stopping general or life-sustaining treatment was most frequent. Narrative synthesis revealed six themes: (1) Temporal aspects affecting the experience with decision-making; (2) Losing control of the situation; (3) Transferring the power to decide to doctors; (4) To be a 'good' parent and protect the child; (5) The emotional state of parents and (6) Sources of support to alleviate the parental experience. CONCLUSIONS Parental experiences with decision-making are complex and multifactorial. Parents' ability to effectively participate in the process is limited, as they are not empowered to do so and the circumstances in which the decisions are taking place are challenging. Healthcare professionals need to support parental involvement in an effective way instead of just formally asking them to participate.
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Affiliation(s)
- Kristyna Polakova
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Center for Palliative Care, Prague, Czech Republic
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Sarah G Brearley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Wangi K, Birriel B, Smith C. Psychosocial burden in transfusion dependent beta-thalassemia patients and its impact on the quality of life and the problem of dignity. J Taibah Univ Med Sci 2023; 18:1217-1219. [PMID: 37250810 PMCID: PMC10209453 DOI: 10.1016/j.jtumed.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Beta-thalassemia major is a genetic blood disorder that impacts hemoglobin production with several symptoms that decrease quality of life in patients. Blood transfusions may help them to regulate their hemoglobin needs, though this is a lifelong intervention. Struggling with dependent blood transfusion status impacts patients greatly including their bio, psycho, social, and spiritual health, potentially raising a bioethical issue related to human dignity.
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Affiliation(s)
- Karolus Wangi
- Ross & Carol Nese College of Nursing, Pennsylvania State University, 307 Nursing Science Building, University Park, PA, USA
| | - Barbara Birriel
- Nursing and Bioethics, Ross & Carol Nese College of Nursing, Pennsylvania State University, Hershey, PA, USA
| | - Colin Smith
- Department of Philosophy, College of Liberal Arts, Pennsylvania State University, 234 Sparks Building, University Park, PA, USA
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Kirtania M, Katta A. Essential Elements of Home-based Palliative Care Model: A Rapid Review. Indian J Palliat Care 2023; 29:359-367. [PMID: 38058483 PMCID: PMC10696356 DOI: 10.25259/ijpc_227_2022] [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: 09/29/2022] [Accepted: 10/05/2023] [Indexed: 12/08/2023] Open
Abstract
The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient's individual healthcare needs. Palliative care improves the patients' and caregivers' quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.
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Affiliation(s)
- Mousami Kirtania
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Ajitha Katta
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
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Phillips J, Wood E, Loveard T, McKinlay E, MacDonald C, Parker G, Gray L. New Zealand hospice staff perspectives on 'Xcellent Gowns' for big bodied palliative care patients: a qualitative study. J Prim Health Care 2023; 15:238-245. [PMID: 37756236 DOI: 10.1071/hc23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/03/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care. Aim This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective. Methods Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM . Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement. Results The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants' interview transcripts. Discussion The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing.
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Affiliation(s)
| | - Emily Wood
- Department of Primary Health Care & General Practice, University of Otago, Wellington/Te Whare Wananga o Otago ki Te Whanga-Nui-a-Tara, Wellington 6242, New Zealand
| | | | | | | | | | - Lesley Gray
- Department of Primary Health Care & General Practice, University of Otago, Wellington/Te Whare Wananga o Otago ki Te Whanga-Nui-a-Tara, Wellington 6242, New Zealand
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Laranjeira C. Dignity promotion in people with advanced chronic diseases: contributions for a value-based healthcare practice. Front Public Health 2023; 11:1156830. [PMID: 37575126 PMCID: PMC10415073 DOI: 10.3389/fpubh.2023.1156830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Carlos Laranjeira
- Department of Nursing Science, School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Butkevičienė R, Kuznecovienė J, Harrison D, Peičius E, Urbonas G, Astromskė K, Kalėdienė R. Being Heard: A Qualitative Study of Lithuanian Health Care Professionals' Perceptions of Dignity at the End-of-Life. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1318. [PMID: 34946263 PMCID: PMC8707950 DOI: 10.3390/medicina57121318] [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] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
Background: The literature on professionals' perceptions of dignity at the end-of-life (EOL) shows that there is a need for studies set in different cultural contexts. Lithuania represents one of these little-studied contexts. The aim of this study is to understand professionals' attitudes, experiences, and suggestions concerning EOL dignity to provide knowledge upon which efforts to improve EOL care can be grounded. The research questions are "How do Lithuanian health care professionals understand the essence of dignity at the end-of-life of terminally ill patients?" and "How do they believe that dignity at the EOL can be enhanced?". Materials and Methods: The study was exploratory and descriptive. It employed an interpretive phenomenological method to understand the essence of the phenomenon. Lightly structured interviews were conducted with professionals who had EOL experience, primarily with elderly and late middle-aged patients. from medicine, nursing, social work, and spiritual services. The interviews were primarily conducted by audiovisual means due to pandemic restrictions. Using a constant comparative method, the research team systematically codified text and developed themes by consensus after numerous analytic data iterations. Results: Four primary themes about EOL dignity were identified: Physical Comfort, Place of Care and Death, Effects of Death as a Taboo Topic, and Social Relations and Communication. A fifth, overarching theme, Being Heard, included elements of the primary themes and was identified as a key component or essence of dignity at the EOL. Conclusions: Patient dignity is both a human right and a constitutional right in Lithuania, but in many settings, it remains an aspiration rather than a reality. Being Heard is embedded in internationally recognized patient-centered models of EOL care. Hearing and acknowledging individuals who are dying is a specific skill, especially with elderly patients. Building the question "Is this patient being heard?" into practice protocols and conventions would be a step toward enhancing dignity at the EOL.
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Affiliation(s)
- Rūta Butkevičienė
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (J.K.); (D.H.); (E.P.); (G.U.)
| | - Jolanta Kuznecovienė
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (J.K.); (D.H.); (E.P.); (G.U.)
| | - David Harrison
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (J.K.); (D.H.); (E.P.); (G.U.)
| | - Eimantas Peičius
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (J.K.); (D.H.); (E.P.); (G.U.)
| | - Gvidas Urbonas
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (J.K.); (D.H.); (E.P.); (G.U.)
| | - Kristina Astromskė
- Department of Health Management, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (K.A.); (R.K.)
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Tilžės Str. 18, LT-47181 Kaunas, Lithuania; (K.A.); (R.K.)
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