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Wakefield D, Dewhurst F, Koffman J, Chamberlain C. Palliative Medicine Specialist Trainee Research experience, interest and opportunities: a national survey. BMJ Support Palliat Care 2021:bmjspcare-2020-002609. [PMID: 33558305 DOI: 10.1136/bmjspcare-2020-002609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/06/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite the acknowledged benefits of research, Palliative Medicine receives minimal research funding and has few dedicated research training posts. This study investigated the opportunities and barriers to participating in research for the current cohort of UK Palliative Medicine Specialist Trainees (PMSTs), to better understand the opportunities to improve evidence-based practice within the specialty. METHODS Two surveys, one for PMSTs and a second for training programme directors (TPDs), were developed. Surveys were piloted and then reviewed by the UK Palliative trainee Research Collaborative and the Palliative Medicine Specialty Advisory Committee (SAC) before distribution. All current PMSTs and TPDs representing all of the UK training regions (n=13) were invited to complete the appropriate survey. RESULTS Overall, 85% (11/13) and 45% (102/225) of TPDs and PMSTs responded, respectively. Almost all (92%) PMSTs reported that they were either 'very interested' or 'quite interested' in taking part in clinical research. PMSTs generally felt that educationaland clinical supervisors were supportive of them taking part in research; however, few (35%) believed they had access to personnel with adequate research experience to provide practical support. Opportunity for appropriate research supervision varied considerably by training region. Where research was being conducted, it was often conducted in trainees' personal time due to the wide regional variation in dedicated research time. CONCLUSION Despite significant interest in clinical research and support by TPDs and clinical supervisors, access to experienced researchers and equitable protected research time by region needs urgent attention to enhance progress in evidence-based palliative medicine.
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Affiliation(s)
- Donna Wakefield
- Specialist Palliative Care Team, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Felicity Dewhurst
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Jonathan Koffman
- Department of Palliative Care, King's College London, London, UK
| | - Charlotte Chamberlain
- Palliative & End of Life Care, Faculty of Health Sciences, University of Bristol, Bristol, UK
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2
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Seymour J, Payne S, Reid D, Sargeant A, Skilbeck J, Smith P. Ethical and methodological issues in palliative care studies. J Res Nurs 2016. [DOI: 10.1177/174498710501000206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper reports on the experiences of a nursing-led research group, ‘The Palliative and End of Life Care Research Group’, within the School of Nursing and Midwifery at the University of Sheffield. There is a long tradition of research in palliative care in which nurses have played an important role and currently opportunities to conduct research in palliative care are expanding. Nurses face a number of ethical and methodological challenges in conducting palliative care research, many of which extend beyond individual research conduct. Drawing on practical examples in each case, this paper explores the following themes: issues involved in raising participation and recruitment to studies of palliative care; how the topics of palliative and end-of-life care are introduced and explored with participants; what ‘special’ needs participants have in palliative care research; interpersonal issues in conducting palliative care research; and providing support and supervision to researchers.
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Affiliation(s)
| | | | | | | | | | - Paula Smith
- Palliative and End of Life Care Research Group, University of Sheffield
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3
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Abstract
OBJECTIVES Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses' accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions. DESIGN Qualitative study using semistructured interviews. SETTING Two health services with public as well as private clinical environments in a major metropolitan area of Australia. PARTICIPANTS Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care. RESULTS Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses' informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time. CONCLUSIONS The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health professionals, patients and families is required to provide a broader interdisciplinary understanding of futility and contributions to the negotiation of palliative care.
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Affiliation(s)
- Emma Kirby
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Alex Broom
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Hospital, Brisbane, Queensland, Australia
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4
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Lynch T, Payne S, Reeve J, Lloyd-Williams M. Learning from challenges in the recruitment of patients with advanced cancer from hospice day care. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pleschberger S, Seymour JE, Payne S, Deschepper R, Onwuteaka-Philipsen BD, Rurup ML. Interviews on end-of-life care with older people: reflections on six european studies. QUALITATIVE HEALTH RESEARCH 2011; 21:1588-1600. [PMID: 21734225 DOI: 10.1177/1049732311415286] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom. The reflection process was informed by four full-day meetings between the authors and referral to sources including the study interview guides, summary "pen portraits" about key issues encountered in the interviews, and key sections of the interview transcripts. We identified as major challenges accessing people, the introduction of end-of-life issues in an interview, managing emotions, the presence of companions, and reciprocity. Formal ethical review committees rarely take into account these complex issues. We concluded that is it necessary to maintain an ongoing reflexive stance to enhance qualitative research practice in the intersecting fields of aging and end-of-life studies.
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Riopelle D, Wagner GJ, Steckart J, Lorenz KA, Rosenfeld KE. Evaluating a palliative care intervention for veterans: challenges and lessons learned in a longitudinal study of patients with serious illness. J Pain Symptom Manage 2011; 41:1003-14. [PMID: 21402457 DOI: 10.1016/j.jpainsymman.2010.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/01/2010] [Indexed: 11/23/2022]
Abstract
CONTEXT Longitudinal studies examining care for seriously ill patients are needed to understand patients' experience of illness, evaluate interventions, and improve quality of care. Unfortunately, such studies face substantial methodological challenges. OBJECTIVES This article describes such challenges and the strategies used to overcome them in a successfully implemented palliative care intervention trial for veterans. METHODS Veterans admitted with a physician-estimated moderate-to-high one-year mortality risk were enrolled and followed up to three years, until death or study completion. Study protocols, procedures, and process data were intermittently analyzed to identify and develop strategies to address issues affecting study enrollment and interview completion rates. RESULTS Of 561 patients who were eligible, 400 (71%) enrolled in the study; 357 (87%) alive at the end of Month 1 completed interviews; and 254 (88%) alive at Month 6 completed interviews. Of the 208 patients who died during the study and had identified a caregiver, we were able to conduct an after-death interview with 154 (74%) caregivers. A variety of strategies, such as systematic tracking and check-in calls, minimizing respondent burden, and maintaining interviewer-respondent dyads over time, were used to maximize enrollment rates, data collection, and retention. CONCLUSION These data demonstrate that the use of diverse strategies and flexibility with regard to study protocols can result in successful recruitment, data collection, and retention of participants with serious illness. They thus show that longitudinal research can be successfully implemented with this population to evaluate interventions and examine patient experiences.
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Affiliation(s)
- Deborah Riopelle
- Veterans Administration Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
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7
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Duke S, Bennett H. Review: a narrative review of the published ethical debates in palliative care research and an assessment of their adequacy to inform research governance. Palliat Med 2010; 24:111-26. [PMID: 19965950 DOI: 10.1177/0269216309352714] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The quality of research, and the resulting quality of evidence available to guide palliative care, is dependent on the ethical decisions underpinning its design, conduct and report. Whilst much has been published debating the ethics of palliative care research, an assessment of the quality and synthesis of the central debates is not available. Such a review is timely to inform research governance. The methodology of this study is based on the principles of systematic reviews. Fifty-seven papers were reviewed following a thorough search, and were critically appraised for their literary quality, the knowledge on which they drew and the research standards they addressed. The debates identified address vulnerability, moral appropriateness, consent, gate-keeping and inclusion and research culture. The quality of debate and the sources of knowledge varied. The debate was rich in quality and knowledge with respect to the protection of the dignity, rights and safety of research participants, but less developed in relation to those of researchers and other staff. There is also little debate about the ethics of reporting of research and the ethics underpinning research leadership. A framework is offered that reconciles the ethical issues raised with potential methodological strategies identified from the review.
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Affiliation(s)
- Sue Duke
- University of Southampton, Southampton, UK.
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8
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Meert KL, Eggly S, Dean JM, Pollack M, Zimmerman J, Anand KJS, Newth CJL, Willson DF, Nicholson C. Ethical and logistical considerations of multicenter parental bereavement research. J Palliat Med 2008; 11:444-50. [PMID: 18363487 PMCID: PMC3279723 DOI: 10.1089/jpm.2007.0120] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multicenter research has the potential to recruit participants with diverse racial, ethnic, and geographic backgrounds and is essential for understanding heterogeneity in bereavement. The National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) is a multicenter network charged with conducting research on the pathophysiology and management of critical illness in childhood. Among its research activities, the CPCCRN has undertaken research in parental bereavement because most childhood deaths in the United States occur in hospitals, primarily in critical care units. OBJECTIVE The purpose of this paper is to discuss ethical and logistical issues found by the CPCCRN to be problematic to multicenter research with bereaved parents and to explore research strategies that may be practicably implemented. RESULTS Ethical and logistical challenges encountered by the CPCCRN included issues of privacy; confidentiality; voluntariness; minimizing risks; working with multiple institutional review boards; researcher qualifications, training and support; and methods of data collection. Strategies to address these challenges included local recruitment of participants; flexibility in consent methods across sites; participant options for methods of data collection; involvement of local bereavement support services; central training of researchers with systematic monitoring and opportunities for support; and use of a secure Web-based collaborative workspace. CONCLUSIONS Multicenter parental bereavement research has distinct ethical issues that must be addressed by the logistics of the research plan. Greater attention to the issues identified may facilitate research to reduce adverse mental and physical health outcomes in a diverse population of bereaved individuals.
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Affiliation(s)
- Kathleen Lynn Meert
- Department of Peditrics, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan 48201, USA.
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Steinhauser KE, Clipp EC, Hays JC, Olsen M, Arnold R, Christakis NA, Lindquist JH, Tulsky JA. Identifying, recruiting, and retaining seriously-ill patients and their caregivers in longitudinal research. Palliat Med 2006; 20:745-54. [PMID: 17148529 DOI: 10.1177/0269216306073112] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In order to improve the state of science in palliative care, we must increase our ability to document the real-time experience of patients and families as they traverse the end of life. Yet, frequently, prospective measurement is impeded by difficulty with patient identification, recruitment, enrollment, and retention. The palliative care literature is replete with descriptions of studies unable to meet enrollment goals, and that as a result, do not have adequate power to test hypotheses or draw conclusions. OBJECTIVES To review the literature describing difficulties associated with ascertainment, enrollment, and attrition. To outline the successful recruitment methods of a new longitudinal study of patients and their caregivers. DESIGN A two-year longitudinal study of 240 patients with Stage IV cancer (breast, prostate, colorectal, lung), advanced congestive heart failure (CHF) LVEFB < 40 or advanced chronic obstructive pulmonary disease (COPD) pCO(2) > 46, and their caregivers, interviewed monthly for up to two years. Patients were identified using clinical and administrative databases from one geographic region. RESULTS Representative and successful ascertainment was associated with use of clinical criteria and medical record review versus physician or other provider prognostication, use of recruitment letters from personal physician, recruitment letter content, brochure content, small monetary incentives, refined phone scripts, use of matched ethnicity interviewers, in-home and phone interview strategies, measure selection, patient and caregiver rapport, and on-going staff support (including grief and bereavement). CONCLUSIONS Recruitment to prospective longitudinal studies at the end of life is difficult, but possible. The lessons learned from this study are applicable to future investigators conducting prospective research.
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Affiliation(s)
- Karen E Steinhauser
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Duke University, NC 27705, USA.
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Hughes R, Saleem T, Addington-Hall J. Towards a culturally acceptable end-of-life survey questionnaire: a Bengali translation of VOICES. Int J Palliat Nurs 2005; 11:116-23. [PMID: 15966451 DOI: 10.12968/ijpn.2005.11.3.18030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To assess the cultural acceptability and appropriateness of an English end-of-life survey questionnaire translated into Bengali for use in east London. STUDY DESIGN Group discussions with informal carers (n=3 groups) and professionals (n = l1 group). SAMPLE AND SETTING Informal carers within a Bengali-speaking community (n = 26) in east London participated in three groups discussions led by three community workers trained in interviewing procedures. These data were followed up with one group discussion with bilingual health and social care professionals (n = 6). ANALYSIS Data subject to content analysis. RESULTS Participants were supportive of the development of the translated questionnaire. However, attention should be paid to vocabulary, shared meanings, cultural equivalence and the ways people conceptualize health and illness, and death and dying. CONCLUSIONS These findings, together with participants' views on the administration of the questionnaire, will prompt revisions to the research approach when targeting ethnic and cultural groups in the future.
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Affiliation(s)
- Rhidian Hughes
- School for Policy Studies, University of Bristol, Bristol BS8 ITZ, UK.
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11
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Hughes R. Safety in nursing social research. Int J Nurs Stud 2004; 41:933-40. [PMID: 15476766 DOI: 10.1016/j.ijnurstu.2004.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 04/16/2004] [Accepted: 05/06/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Researcher safety is an important consideration in all areas of nursing social research. Risks to researchers' safety are multidimensional and manifest differently, contingent on the context of the research encounters. AIM To review researcher safety issues in social research with special attention to nursing. REVIEW FOCUS: A small number of studies are used in this article, as examples, to demonstrate the range of researcher safety issues in nursing. Some preliminary suggestions to help ensure researcher safety are outlined: organisational culture, resources, a researcher safety lead, systems and procedures, education and training and insurance. CONCLUSIONS There is a need to raise the profile of researcher safety issues in nursing for all involved, including researchers, students, funders and review committees. The article highlights the importance of nursing researchers writing reflexively about their safety. There is also a need for new nursing research to assess the nature and extent of safety issues. Taken together, these issues represent the starting point for establishing researcher safety guidelines and identifying good practice for the nursing research community.
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Affiliation(s)
- Rhidian Hughes
- Centre for Health and Social Care, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK.
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12
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Krouse RS, Easson AM, Angelos P. Ethical considerations and barriers to research in surgical palliative care. J Am Coll Surg 2003; 196:469-74. [PMID: 12648701 DOI: 10.1016/s1072-7515(02)01890-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Robert S Krouse
- Department of Surgery, Southern Arizona Veteran's Affairs Health Care System and the University of Arizona, Tucson, AZ 85723, USA
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13
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Easson AM, Lee KF, Brasel K, Krouse RS. Clinical research for surgeons in palliative care: challenges and opportunities. J Am Coll Surg 2003; 196:141-51. [PMID: 12517566 DOI: 10.1016/s1072-7515(02)01703-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Alexandra M Easson
- Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Abstract
Researching user views has become a central plank of UK cancer and palliative care policy, not least because it is recognized that current systems for treatment reflect inadequately the experiences and concerns of cancer patients. This paper examines the process of accessing user views about cancer and palliative care from an ethical perspective, drawing by way of example on a study of outcomes associated with Macmillan nursing. A moral theory framework is used to discuss some of the issues involved in trying to achieve ethically sound practice and some essentially political issues that frame the process of accessing users' views are highlighted. The paper recommends that models of research be developed for accessing user views that are congruent with the values and philosophies of supportive and palliative care. This requires striking a fine balance between the ethical duties of providing care and support, nurturing independence and autonomy, and achieving research outcomes that are rigorous while also being accessible and meaningful to users. It also requires developing an understanding of the social, political and economic context of research enquiry with users.
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Affiliation(s)
- J Seymour
- Sheffield Palliative Care Studies Group, The University of Sheffield and Trent Palliative Care Centre, Sheffield, UK.
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15
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Cook AM, Finlay IG, Butler-Keating RJ. Recruiting into palliative care trials: lessons learnt from a feasibility study. Palliat Med 2002; 16:163-5. [PMID: 11969148 DOI: 10.1191/0269216302pm551xx] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A M Cook
- Velindre NHS Trust and Holme Tower, Marie Curie Centre, Cardiff
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