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Tanzi S, Artioli G, De Panfilis L, Ghirotto L, Rabitti E, Sacchi S. A qualitative study with Italian patients exploring the spiritual dimension during a chronic disease. Chronic Illn 2024; 20:335-348. [PMID: 37248628 DOI: 10.1177/17423953231178236] [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: 05/31/2023]
Abstract
BACKGROUND Spirituality is a vast dimension influenced by cultural and personal differences. Little is known about the spirituality of patients suffering from a chronic disease in Italy from palliative care hospital settings. AIM To investigate patients' perspectives about their spirituality during their illness. METHOD The research question was: 'How does living with chronic disease inform/shape the spiritual dimension of patients?'. To address it, we conducted a qualitative interview study with thematic analysis. RESULTS We enrolled 21 participants among patients suffering from rheumatic, haematologic, neurodegenerative and respiratory chronic diseases. Participants generally had great difficulty answering the questions researchers posed and often could not define 'spirituality'. We found different topics grouped under four main themes: definition of spirituality, internal dialogue, expression of spirituality in everyday life and take stock. Religion is not reported as an answer to spiritual suffering, even in a country that is felt religious-driven like Italy. DISCUSSION Patients are generally not cognizant of this dimension even living with a chronic disease; consequently, they cannot express spiritual needs because they can't recognise them. Health professionals should identify this dimension and its characteristics to recognise potential spiritual suffering.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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van der Velden NCA, Smets EMA, van Vliet LM, Brom L, van Laarhoven HWM, Henselmans I. Effects of Prognostic Communication Strategies on Prognostic Perceptions, Treatment Decisions and End-Of-Life Anticipation in Advanced Cancer: An Experimental Study among Analogue Patients. J Pain Symptom Manage 2024; 67:478-489.e13. [PMID: 38428696 DOI: 10.1016/j.jpainsymman.2024.02.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
CONTEXT Evidence-based guidance for oncologists on how to communicate prognosis is scarce. OBJECTIVES To investigate the effects of prognostic communication strategies (prognostic disclosure vs. communication of unpredictability vs. non-disclosure; standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on prognostic perceptions, treatment decision-making and end-of-life anticipation in advanced cancer. METHODS This experimental study used eight videos of a scripted oncological consultation, varying only in prognostic communication strategies. Cancer-naive individuals, who imagined being the depicted patient, completed surveys before and after watching one video (n = 1036). RESULTS Individuals generally perceived dying within 1 year as more likely after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001), and after numerical versus word-based estimates (P < 0.001). Individuals felt better informed about prognosis to decide about treatment after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001); after communication of unpredictability versus non-disclosure (P < 0.001); and after numerical versus word-based estimates (P = 0.017). Chemotherapy was more often favored after prognostic disclosure versus non-disclosure (P = 0.010), but less often after numerical versus word-based estimates (P < 0.001). Individuals felt more certain about the treatment decision after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001). Effects of different survival scenarios were absent. No effects on end-of-life anticipation were observed. Evidence for moderating individual characteristics was limited. CONCLUSION If and how oncologists discuss prognosis can influence how individuals perceive prognosis, which treatment they prefer, and how they feel about treatment decisions. Communicating numerical estimates may stimulate prognostic understanding and informed treatment decision-making.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Ellen M A Smets
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology (L.M.V.), University of Leiden, Leiden, The Netherlands
| | - Linda Brom
- Department of Research and Development (L.B.), Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Netherlands Association for Palliative Care (PZNL) (L.B.), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands; Department of Medical Oncology (H.W.M.L.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Sedhom R, Bates-Pappas GE, Feldman J, Elk R, Gupta A, Fisch MJ, Soto-Perez-de-Celis E. Tumor Is Not the Only Target: Ensuring Equitable Person-Centered Supportive Care in the Era of Precision Medicine. Am Soc Clin Oncol Educ Book 2024; 44:e434026. [PMID: 39177644 DOI: 10.1200/edbk_434026] [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: 08/24/2024]
Abstract
Communication in oncology has always been challenging. The new era of precision oncology creates prognostic uncertainty. Still, person-centered care requires attention to people and their care needs. Living with cancer portends an experience that is life-altering, no matter what the outcome. Supporting patients and families through this unique experience requires careful attention, honed skills, an understanding of process and balance measures of innovation, and recognizing that supportive care is a foundational element of cancer medicine, rather than an either-or approach, an and-with approach that emphasizes the regular integration of palliative care (PC), geriatric oncology, and skilled communication.
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Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA
| | - Gleneara E Bates-Pappas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ronit Elk
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL
- Division of Geriatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Arjun Gupta
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis
| | | | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Hasegawa T, Okuyama T, Akechi T. The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients? Jpn J Clin Oncol 2024; 54:507-515. [PMID: 38336476 PMCID: PMC11075734 DOI: 10.1093/jjco/hyae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.
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Affiliation(s)
- Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Psychiatry/Palliative Care Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Tatsuo Akechi
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Chung I, Khoo SY, Low LL. An Insight Into the Experiences of Malaysian Patients With Advanced Cancer and Their Preferences in End-of-Life Care: A Qualitative Study. Am J Hosp Palliat Care 2024:10499091241233599. [PMID: 38394223 DOI: 10.1177/10499091241233599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care. OBJECTIVES To explore the experiences and preferences of Malaysian patients with advanced cancer. DESIGN Qualitative study of semi-structured interviews with thematic analysis. SETTING/SUBJECTS Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia. RESULTS Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning. CONCLUSION This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts.
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Affiliation(s)
- Iris Chung
- National Cancer Institute, Putrajaya, Ministry of Health Malaysia
- Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia
| | - Shiao-Yen Khoo
- National Cancer Institute, Putrajaya, Ministry of Health Malaysia
- Sunway Medical Centre, Bandar Sunway, Malaysia
| | - Lee Lan Low
- National Institutes of Health, Shah Alam, Ministry of Health Malaysia (former)
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Manalo MFC, Yang GM, Reandelar M, Ozdemir Van Dyk S, Malhotra C, Finkelstein EA. Cancer patients' awareness of extent of disease: anxiety, depression, quality of life. BMJ Support Palliat Care 2023:spcare-2022-004112. [PMID: 38050040 DOI: 10.1136/spcare-2022-004112] [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: 12/02/2022] [Accepted: 11/15/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE In Asian cultures, the belief that full disclosure would harm the patient's health would lead to non-disclosure. The study aimed to determine whether making patients aware of the extent of their disease will lead to psychological morbidity and poor quality of life (QOL). METHODS This was a cross-sectional study among 195 patients with stage 4 cancer who were aware of their cancer diagnosis at the medical oncology, radiation oncology and palliative care units at an academic cancer centre. Participants were asked about their cancer stage, treatment goal and if they prefer to know their life expectancy. They answered the 14-item Hospital Anxiety and Depression Scale and 27-item validated Functional Assessment of Cancer Therapy-General questionnaires. Determination of the association of patients' awareness of the extent of the disease with psychological status and QOL was analysed using univariate and multivariate statistics. RESULTS About three-fourths of patients with cancer knew they had an advanced disease, but very few were aware that the current treatments they were taking for their cancer would not cure them. No association between awareness of the extent of the disease and psychological morbidity was found. Still, those aware of the advanced disease had significantly higher QOL scores for social well-being. CONCLUSIONS This study revealed that physicians should not hesitate to communicate the cancer diagnosis and prognosis to patients, as the disclosure was not associated with psychological morbidity. Open communication between physicians, patients and their families on the extent of the disease could empower patients to make informed decisions about their treatment, engage in advance care planning and seek the necessary support.
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Affiliation(s)
- Maria Fidelis Coronel Manalo
- Supportive Oncology & Palliative Care, Augusto P. Sarmiento Cancer Institute, The Medical City, Pasig City, Metro Manila, Philippines
- Department of Community & Family Medicine, Far Eastern University Doctor Nicanor Reyes Medical Foundation, Quezon City, Metro Manila, Philippines
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Programme for Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Macario Reandelar
- Department of Community & Family Medicine, Far Eastern University Doctor Nicanor Reyes Medical Foundation, Quezon City, Metro Manila, Philippines
- Research and Biotechnology, St. Luke's Medical Center, Quezon City, Metro Manila, Philippines
- College of Medicine, New Era University, Quezon City, Metro Manila, Philippines
| | - Semra Ozdemir Van Dyk
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Programme for Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Programme for Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Programme for Health Services & Systems Research, Duke-NUS Medical School, Singapore
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Spooner C, Vivat B, White N, Bruun A, Rohde G, Kwek PX, Stone P. What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies. Palliat Med 2023; 37:1345-1364. [PMID: 37586031 PMCID: PMC10548779 DOI: 10.1177/02692163231191148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important. AIM To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies. DESIGN A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022). DATA SOURCES Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients' and informal caregivers' experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion. RESULTS We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use. CONCLUSION Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders' priorities.
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Affiliation(s)
- Caitlin Spooner
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Gudrun Rohde
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Pei Xing Kwek
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Yamazaki T, Miyamoto S, Matsubara T, Yamagata H, Kobo H, Otani M, Abe H, Sumitani M, Shimizu K, Rodin G, Yoshiuchi K. Development of a Japanese Version of the Quality of Life at the End of Life-Cancer Scale. J Pain Symptom Manage 2023; 66:e189-e195. [PMID: 37121525 DOI: 10.1016/j.jpainsymman.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
CONTEXT The Quality of Life at the End of Life-Cancer Scale (QUAL-EC) is a self-reported instrument to assesses the quality of life of patients with cancer near the end of life. OBJECTIVE To test the reliability and validity of the QUAL-EC-J, a Japanese translated version of the QUAL-EC. METHODS A total of 179 Japanese patients with advanced cancer completed the QUAL-EC-J, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, Functional Assessment of Cancer Therapy-General Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual questionnaires. We performed confirmatory factor analysis of the four structures of the QUAL-EC and exploratory factor analysis of the QUAL-EC-J. Internal consistency was assessed using Cronbach's α coefficient and validity was examined by calculating correlations with relevant scales. RESULTS Confirmatory factor analysis showed an inadequate fit to the original QUAL-EC structure. Exploratory factor analysis revealed a three-factor structure of the QUAL-EC-J, with Cronbach's α values of 0.68-0.88. All subscales were negatively correlated with depression and anxiety. Each subscale was correlated with related measures: "symptom control" with "physical well-being"; "acceptance of disease and life" with "social and family well-being" and "meaning/peace"; and "preparation for end of life" with "emotional well-being" and "meaning/peace." CONCLUSIONS The QUAL-EC-J has a three-factor structure with acceptable reliability and sufficient validity. Differences in the factor structure between the QUAL-EC-J and the QUAL-EC may be due to cultural factors. Study findings suggest that utilization of the QUAL-EC-J could help to improve research and clinical care in advanced cancer in Japan.
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Affiliation(s)
- Tadahiro Yamazaki
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seraki Miyamoto
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience (T.M.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroshi Yamagata
- Department of Anesthesiology (H.Y.), Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan; Palliative Care Center (H.Y.), Yamaguchi University Hospital, Yamaguchi, Japan
| | - Hiroshi Kobo
- Department of Psycho-Oncology (H.K., K.S.), Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Otani
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicine (H.A., M.S.), The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine (H.A., M.S.), The University of Tokyo Hospital, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology (H.K., K.S.), Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Gary Rodin
- Department of Supportive Care (G.R.), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine (T.Y., S.M., M.O., K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Wen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psychooncology 2023. [PMID: 37114337 DOI: 10.1002/pon.6146] [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: 01/10/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND/OBJECTIVE Facilitating death preparedness is important for improving cancer patients' quality of death and dying. We aimed to identify factors associated with the four death-preparedness states (no-preparedness, cognitive-only, emotional-only, and sufficient-preparedness) focusing on modifiable factors. METHODS In this cohort study, we identified factors associated with 314 Taiwanese cancer patients' death-preparedness states from time-invariant socio-demographics and lagged time-varying modifiable variables, including disease burden, physician prognostic disclosure, patient-family communication on end-of-life (EOL) issues, and perceived social support using hierarchical generalized linear modeling. RESULTS Patients who were male, older, without financial hardship to make ends meet, and suffered lower symptom distress were more likely to be in the emotional-only and sufficient-preparedness states than the no-death-preparedness-state. Younger age (adjusted odds ratio [95% confidence interval] = 0.95 [0.91, 0.99] per year increase in age) and greater functional dependency (1.05 [1.00, 1.11]) were associated with being in the cognitive-only state. Physician prognostic disclosure increased the likelihood of being in the cognitive-only (51.51 [14.01, 189.36]) and sufficient-preparedness (47.42 [10.93, 205.79]) states, whereas higher patient-family communication on EOL issues reduced likelihood for the emotional-only state (0.38 [0.21, 0.69]). Higher perceived social support reduced the likelihood of cognitive-only (0.94 [0.91, 0.98]) but increased the chance of emotional-only (1.09 [1.05, 1.14]) state membership. CONCLUSIONS Death-preparedness states are associated with patients' socio-demographics, disease burden, physician prognostic disclosure, patient-family communication on EOL issues, and perceived social support. Providing accurate prognostic disclosure, adequately managing symptom distress, supporting those with higher functional dependence, promoting empathetic patient-family communication on EOL issues, and enhancing perceived social support may facilitate death preparedness.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, ROC
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC
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Finlayson CS, Rosa WE, Mathew S, Applebaum A, Squires A, Fu MR. Awareness of Disease Status Among Patients With Cancer: An Integrative Review. Cancer Nurs 2023; 47:00002820-990000000-00091. [PMID: 36728162 PMCID: PMC10349894 DOI: 10.1097/ncc.0000000000001170] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND As the quality of cancer care improves, oncology patients face a rapidly increasing number of treatment options. Thus, it is vital that they are full and active partners in the treatment decision-making process. Awareness of disease status has been investigated in the literature; it has been inconsistently conceptualized and operationalized. OBJECTIVE The aim of this integrative review was to develop a conceptual definition and model of the awareness of disease status among patients with cancer. METHODS Whittemore and Knafl's integrative review methodology guided this article. We obtained data through a systematic search of 8 databases. Key terms utilized were awareness, perception, truth disclosure, diagnosis, prognosis, terminal illness, status, neoplasm, and metastasis. Dates through January 2020 were searched to capture all relevant articles. Sixty-nine articles met inclusion criteria. RESULTS The integrative review methodology guided the development of a conceptual definition and model. The concept of "awareness of disease status" was defined as the individual patient's understanding of being diagnosed and treated for cancer based on the multifactorial components of individual patient characteristics and contextually driven communication practices of healthcare providers. This understanding is dynamic and changes throughout the disease trajectory. CONCLUSION These findings will inform consistency in the literature. Such consistency may improve person-centered clinical communication, care planning practices, and, ultimately, cancer-related outcomes. IMPLICATIONS FOR PRACTICE With a greater understanding of the complexity of patients' awareness of disease status, nurses will be able to guide their patients to make informed decisions throughout their disease trajectory.
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Affiliation(s)
- Catherine S Finlayson
- Author Affiliations: Department of PhD in Nursing, Pace University Lienhard School of Nursing, Pleasantville (Dr Finlayson and Ms Mathew); and Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center (Drs Rosa and Applebaum); New York University Rory Meyers College of Nursing (Dr Squires), New York; and Rutgers, The State University of New Jersey School of Nursing, New Brunswick, New Jersey (Dr Fu)
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11
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Hayden L, Byrne E, Deegan A, Dunne S, Gallagher P. A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer. Health Psychol Open 2022; 9:20551029221121526. [PMID: 36105766 PMCID: PMC9465615 DOI: 10.1177/20551029221121526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.
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Affiliation(s)
- Lucy Hayden
- School of Psychology, Dublin City University, Ireland
| | - Emma Byrne
- School of Psychology, Dublin City University, Ireland
| | - Avril Deegan
- School of Psychology, Dublin City University, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Ireland
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12
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Mohanraj L, Elswick RK, Buch M, Knight JM, Guidry J. Perceptions and Experiences of Hematopoietic Cell Transplantation Patients During the COVID-19 Pandemic. Semin Oncol Nurs 2022; 38:151257. [PMID: 35379527 PMCID: PMC8907028 DOI: 10.1016/j.soncn.2022.151257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives Data Sources Conclusion Implication for Nursing Practice
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Affiliation(s)
- Lathika Mohanraj
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, 1100 E Leigh Street, Richmond, Virginia, 23298, USA.
| | - R K Elswick
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, 1100 E Leigh Street, Richmond, Virginia, 23298, USA; Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Box 980032, Richmond, Virginia, 23298, USA.
| | - Molly Buch
- NSABP Foundation Inc, Pittsburgh, Pennsylvania, 15212, USA.
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226, USA.
| | - Jeanine Guidry
- Richard T. Robertson School of Media and Culture, Virginia Commonwealth University, Box 842034, Richmond, Virginia, 23284, USA.
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13
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Brenner K, Greer JA, Jackson V, Park E, Wright E, Jacobsen J, Topping C, Jagielo A, Elyze M, Sereno I, Temel JS, El-Jawahri A. Development of a Prognostic Awareness Impact Scale for Patients with Advanced Cancer. J Palliat Med 2021; 25:445-454. [PMID: 34637630 DOI: 10.1089/jpm.2021.0238] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer. Methods: We developed the Prognostic Awareness Impact Scale (PAIS) using a qualitative approach. During phase 1, we convened a working group with a transdisciplinary team of clinicians from oncology (n = 2), psychology (n = 2), psychiatry (n = 1), palliative care (n = 3), and survey development (n = 1) to identify key domains of PAIS. Using a consensus-driven process, the team generated an item bank for each domain. During phase 2, we conducted cognitive interviews with 39 patients with advanced cancer to assess the understandability of the PAIS. Results: The working group developed a conceptual framework for PAIS, identifying three domains: (1) cognitive understanding of prognosis (capacity to understand intellectually one's prognosis), (2) emotional coping (capacity to process prognostic uncertainty and terminal prognosis), and (3) adaptive response (capacity to use prognostic awareness to inform life decisions). Cognitive interviews revealed that patients had an accurate understanding of most PAIS items. Patients reported difficulty with binary response options for questions pertaining to emotional coping. They expressed difficulty answering numerous questions regarding their cognitive understanding of their prognosis. We revised the PAIS by (1) replacing binary response options with ordinal agreement scales; and (2) reducing the number of items focused on cognitive understanding of prognosis. Conclusion: We developed a conceptual framework to capture prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer using the PAIS. Future work should focus on validating the PAIS by testing its psychometric properties.
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Affiliation(s)
- Keri Brenner
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Stanford University, Palo Alto, California, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki Jackson
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse Park
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Wright
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Jennifer S Temel
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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14
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Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting. Palliat Support Care 2021; 18:513-518. [PMID: 31771668 DOI: 10.1017/s1478951519001020] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. METHOD We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress. RESULTS The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. SIGNIFICANCE OF RESULTS The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.
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15
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Missing in Action: Reports of Interdisciplinary Integration in Canadian Palliative Care. ACTA ACUST UNITED AC 2021; 28:2699-2707. [PMID: 34287310 PMCID: PMC8293061 DOI: 10.3390/curroncol28040235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
Palliative care has an interdisciplinary tradition and Canada is a leader in its research and practice. Yet even in Canada, a full interdisciplinary complement is often lacking, with psychosocial presence ranging from 0–67.4% depending on the discipline and region. We sought to examine the most notable gaps in care from the perspective of Canadian palliative professionals. Canadian directors of palliative care programs were surveyed with respect to interdisciplinary integration. Participants responded in writing or by phone interview. We operationalized reports of interdisciplinary professions as either “present” or “under/not-represented”. The Vaismoradi, Turunen, and Bondas’ procedure was used for content analysis. Our 14 participants consisted of physicians (85.7%), nurses (14.3%), and a social worker (7.1%) from Ontario (35.7%), British Columbia (14.3%), Alberta (14.3%), Quebec (14.3%), Nova Scotia (14.3%), and New Brunswick (7.1%). Psychology and social work were equally and most frequently reported as “under/not represented” (5/14, each). All participants reported the presence of medical professionals (physicians and nurses) and these groups were not reported as under/not represented. Spiritual care and others (e.g., rehabilitation and volunteers) were infrequently reported as “under/not represented”. Qualitative themes included Commonly Represented Disciplines, Quality of Multidisciplinary Collaboration, Commonly Under-Represented Disciplines, and Special Concern: Psychosocial Care. Similar to previous reports, we found that (1) psychology was under-represented yet highly valued and (2) despite social work’s relative high presence in care, our participants reported a higher need for more. These finding highlight those psychosocial gaps in care are most frequently noted by palliative care professionals, especially psychology and social work. We speculate on barriers and enablers to addressing this need.
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16
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Redondo Elvira T, Ibáñez Del Prado C, Cruzado JA. Psychological well-being in palliative care: A systematic review. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:377-400. [PMID: 34039108 DOI: 10.1177/00302228211019203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review which are the most influential variables in achieving levels of psychological well-being at the end of life and to verify whether, as certain studies suggest, spirituality, resilience and social support are the pillars on which the psychological well-being construct is based. METHOD A systematic search through the Scopus, Pubmed and PsycInfo electronic databases was carried out using keywords such as: "wellbeing" OR "psychological-well-being" AND "resilience" AND "spirituality" AND "social support" AND "palliative care" and their multiple combinations. RESULTS Eleven studies were selected, in which terms such as spiritual well-being, absence of discomfort and quality of life were used in substitution of psychological well-being and a certain consensus was found regarding whether resilience, spirituality and social support are predictive variables of psychological well-being. CONCLUSIONS Resilience, social support and spirituality are highly relevant variables at the end of life and contribute decisively towards psychological well-being.
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17
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Rodenbach RA, Althouse AD, Schenker Y, Smith TJ, Chu E, White DB, Bakitas M, Arnold RM. Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding, Treatment Preferences, and Advance Care Planning. J Pain Symptom Manage 2021; 61:723-731.e1. [PMID: 32926962 PMCID: PMC7952460 DOI: 10.1016/j.jpainsymman.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Patients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care. OBJECTIVES To explore relationships between patients' worry about dying and their illness understanding, treatment preferences, and advance care planning (ACP). METHODS This cross-sectional study used baseline data from a primary palliative care intervention trial. All participants had metastatic solid tumors. Using patients' response to I worry about dying from the Functional Assessment of Chronic Illness-Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding, treatment preferences, and ACP. RESULTS Of 672 patients, 47% reported worrying about dying not at all, whereas 9.7% worried quite a bit or very much. In regression analysis, compared with patients who reported not worrying about dying, those who reported high levels of worry were more likely to describe themselves as terminally ill (adjusted odds ratio [AOR] = 1.98; 95% CI = 1.10-3.54; P = 0.021) and prefer life-extending therapy over symptom-focused care (AOR = 2.61; 95% CI = 1.30-5.22; P = 0.007). They were less likely to have completed an advance directive (AOR = 0.49; 95% CI = 0.25-0.94; P = 0.032). The same relationships were seen using patients' response to I feel scared about my future from the Herth Hope Index. CONCLUSION Patients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.
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Affiliation(s)
- Rachel A Rodenbach
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| | - Andrew D Althouse
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Edward Chu
- Division of Hematology-Oncology and Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marie Bakitas
- School of Nursing, Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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Hui D, Mo L, Paiva CE. The Importance of Prognostication: Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes. Curr Treat Options Oncol 2021; 22:12. [PMID: 33432524 DOI: 10.1007/s11864-020-00810-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 02/05/2023]
Abstract
OPINION STATEMENT In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70-90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: "I don't want to know"; discordant, "I never wanted to know"; anxious, "I don't know what's happening"; concerned, "I don't like this"; acceptance, "I know how to plan ahead"). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414 - 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414 - 1515 Holcombe Blvd, Houston, TX, 77030, USA.,The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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19
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Wen FH, Chou WC, Hsieh CH, Chen JS, Chang WC, Tang ST. Conjoint cognitive and emotional death-preparedness states and their changes within cancer patients' last 6 months. Psychooncology 2021; 30:691-698. [PMID: 33345399 DOI: 10.1002/pon.5614] [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: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVE Cognitive prognostic awareness (PA) and emotional preparedness for death are distinct but related concepts that have rarely been investigated conjointly and without considering the dynamic nature of death preparedness. To fill this gap, this secondary-analysis study identified distinct patterns/states of death preparedness and their changes within cancer patients' last 6 months. METHODS Distinct death-preparedness states, determined by conjoint cognitive PA and emotional preparedness for death, as well as their changes between consecutive times were identified and estimated, respectively, by latent transition modeling with hidden Markov modeling among 383 cancer patients within their last 6 months. RESULTS Four death-preparedness states (prevalence) were initially identified: no death preparedness (17.1%), cognitive death preparedness only (23.3%), emotional death preparedness only (39.9%), and sufficient death preparedness (19.7%). Patients in the no-death-preparedness state had neither accurate PA nor adequate emotional preparedness for death. The sufficient-death-preparedness state was characterized by both accurate PA and adequate emotional preparedness for death. In the cognitive- and emotional-death-preparedness-only states, patients were accurately aware of their prognosis and adequately emotionally prepared for their forthcoming death only, respectively. As death approached, state prevalence fluctuated within a narrow range for the no- and sufficient-death-preparedness states, whereas prevalence of cognitive- and emotional-death-preparedness-only states increased and decreased substantially, respectively. CONCLUSION Cancer patients heterogeneously experienced conjoint cognitive PA and emotional preparedness for death, and prevalence of death-preparedness states changed substantially as death approached. Effective interventions are warranted to cultivate cognitive PA and facilitate emotional death-preparedness to improve end-of-life-care quality, thereby helping patients achieve a good death.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Suzhou, Taiwan, ROC
| | - Wen-Chi Chou
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,Chang Gung University, School of Nursing, Tao-Yuan, Taiwan, ROC.,Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
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20
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Saracino RM, Polacek LC, Applebaum AJ, Rosenfeld B, Pessin H, Breitbart W. Health Information Preferences and Curability Beliefs Among Patients With Advanced Cancer. J Pain Symptom Manage 2021; 61:121-127. [PMID: 32739562 PMCID: PMC7770014 DOI: 10.1016/j.jpainsymman.2020.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Accurate prognostic understanding is associated with increased advance care planning, symptom control, and patient autonomy in oncology. The impact of prognostic understanding on patients' health information preferences (HIPs) and prognostic information preferences is unknown and has important implications for health care communication. OBJECTIVES The present study characterized the HIPs of patients with advanced cancer; examined differences in HIPs between patients with varying curability beliefs; and identified differences in the characteristics and psychological well-being of patients with varying curability beliefs. METHODS This cross-sectional study used a secondary data analysis of baseline data (prerandomization) for patients enrolled in a large randomized controlled psychotherapy trial. 206 participants were recruited from outpatient clinics at a single facility. Inclusion criteria included: 18 years and older; English speaking, Stage IV solid tumor cancer, and Distress Thermometer score of ≥4. RESULTS Most participants preferred as many details as possible about their diagnosis and treatment (69.4%; n = 143), and the likely outcome of their disease (72.3%; n = 149). Most participants accurately described their cancer as unlikely curable or incurable (62.6%; n = 129). There were no significant differences in HIPs based on level of prognostic understanding. Poorer prognostic understanding was associated with religiosity and better quality of life and existential well-being. CONCLUSION In the present study, prognostic understanding (i.e., curability beliefs) was not associated with HIPs. Therefore, oncology clinicians must individually and interatively evaluate patients' interest and preferences for receiving information. Future research should further clarify preferences for the framing and content of prognostic information from providers and improve the measurement of prognostic understanding to facilitate patient-centered end-of-life care.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Psychology Department, Fordham University, New York, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Psychology Department, Fordham University, New York, New York, USA
| | - Hayley Pessin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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21
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Chinh K, Secinti E, Johns SA, Hirsh AT, Miller KD, Schneider B, Storniolo AM, Mina L, Newton EV, Champion VL, Mosher CE. Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers. Oncol Nurs Forum 2020; 47:739-752. [PMID: 33063774 DOI: 10.1188/20.onf.739-752] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine relationships in mindfulness and illness acceptance and psychosocial functioning in patients with metastatic breast cancer and their family caregivers. SAMPLE & SETTING 33 dyads from an academic cancer center in the United States. METHODS & VARIABLES Participants completed questionnaires on mindfulness, illness acceptance, relationship quality, anxiety, and depressive symptoms. Dyadic, cross-sectional data were analyzed using actor-partner interdependence models. RESULTS Greater nonjudging, acting with awareness, and illness acceptance among caregivers were associated with patients' and caregivers' perceptions of better relationship quality. Higher levels of these processes were associated with reduced anxiety and depressive symptoms in patients and caregivers. IMPLICATIONS FOR NURSING Aspects of mindfulness and illness acceptance in dyads confer benefits that are primarily intrapersonal in nature. Nurses may consider introducing mindfulness and acceptance-based interventions to patients and caregivers with adjustment difficulties.
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Affiliation(s)
- Kelly Chinh
- Indiana University-Purdue University Indianapolis
| | - Ekin Secinti
- Indiana University-Purdue University Indianapolis
| | | | - Adam T Hirsh
- Indiana University-Purdue University Indianapolis
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22
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Tang ST, Chou WC, Hsieh CH, Chang WC, Chen JS, Wen FH. Terminally Ill Cancer Patients' Emotional Preparedness for Death Is Distinct From Their Accurate Prognostic Awareness. J Pain Symptom Manage 2020; 60:774-781.e1. [PMID: 32360990 DOI: 10.1016/j.jpainsymman.2020.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Emotional preparedness for death (hereafter called death preparedness) and prognostic awareness (PA), a distinct but related concept, each contributes to patients' practical, psychological, and interpersonal preparations for death. However, the distinction between these two concepts has never been investigated. OBJECTIVES To evaluate the distinction between death preparedness and accurate PA by examining their agreement during cancer patients' last year and the similarity of their predictors. METHODS For this secondary analysis of a longitudinal study of death preparedness for 277 patients with cancer, agreement between death preparedness and accurate PA was evaluated by percentages and kappa coefficients, and predictors of the two outcomes were evaluated by multivariate logistic regression models with the generalized estimating equation. RESULTS Levels of agreement between reported death preparedness and accurate PA increased slightly (42.44%-52.85%) from 181-365 days to one to 30 days before death, with kappa values from -0.190 (-0.319, -0.061) to -0.006 (-0.106, 0.093), indicating poor agreement. Participants who were male, older, reported financial sufficiency, had fewer distressing symptoms, and perceived higher levels of social support were more likely to report death preparedness. Participants who were female, had greater than high-school educational attainment, and endured higher levels of functional dependence were more likely to report accurate PA. CONCLUSION The distinction between death preparedness and accurate PA was supported by their poor agreement, lack of reciprocal associations, and two different sets of predictors. Health care professionals should not only cultivate cancer patients' accurate PA but also facilitate emotional preparation for death to achieve a good death and improve end-of-life care quality.
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Affiliation(s)
- Siew Tzuh Tang
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, ROC; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan, ROC.
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
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23
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Taber JM, Stacey CL, Sheehan DK. Understanding Hospice Patients' Beliefs About Their Life Expectancy: A Qualitative Interview Study. Am J Hosp Palliat Care 2020; 38:238-245. [PMID: 32772719 DOI: 10.1177/1049909120948486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. OBJECTIVE To examine the nature and source of hospice patients' life expectancy estimates, about which little is known. DESIGN Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. SETTING/SUBJECTS Participants were hospice patients (n = 20, 55% male; 60% cancer). MEASUREMENT We conducted thematic analysis using open and focused coding. RESULTS Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients' prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider's estimate. Some patients said providers do not know prognosis or that time of death was unknowable. CONCLUSIONS Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients' life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, 4229Kent State University, Kent, OH, USA
| | - Clare L Stacey
- Department of Sociology, 4229Kent State University, Kent, OH, USA
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Arantzamendi M, García-Rueda N, Carvajal A, Robinson CA. People With Advanced Cancer: The Process of Living Well With Awareness of Dying. QUALITATIVE HEALTH RESEARCH 2020; 30:1143-1155. [PMID: 30539681 PMCID: PMC7307002 DOI: 10.1177/1049732318816298] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Literature suggests that it is possible to live well with advanced cancer but little is known about the process. In this article, we present a secondary analysis of experiences of living with advanced cancer (n = 22) that refines the theory of "Living Well with Chronic Illness" for a different context and population. The refined theory explains the experience of living well with advanced cancer illuminating a five-phase iterative process: struggling, accepting, living with advanced cancer, sharing the illness experience, and reconstructing life. These five phases revolve around the core concept of Awareness of Dying, which varied from awareness of the possibility of dying, to accepting the possibility of dying, to acceptance that "I am dying." Awareness of Dying led to a focus on living well with advanced cancer and movement towards living a life rather than living an illness.
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Affiliation(s)
- Maria Arantzamendi
- Universidad de Navarra, ICS, Grupo
ATLANTES, Pamplona, Spain
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Maria Arantzamendi, Universidad de
Navarra, Institute for Culture and Society, ATLANTES Research Program,
Edificio de Bibliotecas, 31009, Spain.
Pamplona, Spain
| | - Noelia García-Rueda
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Universidad de Navarra, Faculty of
Nursing, Pamplona, Spain
| | - Ana Carvajal
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Universidad de Navarra, Faculty of
Nursing, Pamplona, Spain
| | - Carole A. Robinson
- Universidad de Navarra, ICS, Grupo
ATLANTES, Pamplona, Spain
- University of British Columbia,
Faculty of Health and Social Development, School of Nursing, Kelowna,
British Columbia, Canada
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25
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Kang E, Keam B, Lee NR, Kang JH, Kim YJ, Shim HJ, Jung KH, Koh SJ, Ryu H, Lee J, Choo J, Yoo SH, Yun YH. Impact of family caregivers' awareness of the prognosis on their quality of life/depression and those of patients with advanced cancer: a prospective cohort study. Support Care Cancer 2020; 29:397-407. [PMID: 32372177 DOI: 10.1007/s00520-020-05489-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A caregiver's prognostic awareness can affect clinical decisions for the patient. The purpose of this study was to examine the impact of family caregivers' prognostic awareness on the quality of life (QOL) and emotional state of both patients with advanced cancer and their caregivers. METHODS This prospective cohort study was conducted from December of 2016 to January of 2018. A total of 159 patients with advanced cancer and an equal number of caregivers participated. The investigation tools used include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-Palliative, the McGill Quality of Life Questionnaire, and the Patient Health Questionnaire-9, and evaluation was performed at baseline, 3 months, and 6 months. Covariance analysis with a general linear modeling was used to compare changes in quality of life scores according to the caregivers' awareness of the prognosis. RESULTS Mean patient overall QOL score increased in the group of caregivers who were aware of prognosis and decreased in the caregivers who were not aware of the prognosis (p = 0.018). The changes over time in the patients' QOL scores associated with symptoms improved with caregiver awareness (pain, p = 0.017; dyspnea, p = 0.048; appetite loss, p = 0.045). The percentage of depressed patients was smaller after 3 months in the group with caregivers aware of the prognosis (baseline to 3 months p = 0.028). Caregivers who did not understand their patients' prognosis exhibited better existential well-being (p = 0.036), and the incidence of depression was lower in this group at 3 months (p = 0.024). CONCLUSION Caregivers' prognostic awareness may improve the quality of life and mood in patients with advanced cancer; however, this awareness may harm the quality of life and mood of the caregivers. These results may aid in developing in-depth interventions regarding prognosis for both patients and their caregivers.
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Affiliation(s)
- EunKyo Kang
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, Seoul, South Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Na-Ri Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang University Hospital, Jinju, South Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Hyewon Ryu
- Internal Medicine, Chungnam National University College of Medicine, Chungnam, South Korea
| | - Jihye Lee
- Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jiyeon Choo
- Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea. .,Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea.
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26
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Kang E, Kang JH, Koh SJ, Song EK, Shim HJ, Keam B, Maeng CH, Kim YJ, Yun HJ, Jung KH, Kwon JH, Lee SN, Lee JL, Do YR, Min J, Lee J, Choo J, Yun YH. The Impacts of Prognostic Awareness on Mood and Quality of Life Among Patients With Advanced Cancer. Am J Hosp Palliat Care 2020; 37:904-912. [PMID: 32052654 DOI: 10.1177/1049909120905789] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient's satisfaction and increase depression. AIM The purpose of this study is to assess whether patients' prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer. DESIGN AND PARTICIPANTS In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients' prognostic awareness at baseline, 3 months, and 6 months. RESULTS This study found significant differences in changes of QoL based on patients' prognostic awareness. From baseline to 3 months, emotional functioning (P = .039), pain (P = .042), existential well-being (P = .025), and social support (P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning (P = .037), emotional functioning (P = .002), nausea/vomiting (P = .048), and constipation (P = .039) subscale scores and existential well-being scores (P = .025). No significant difference between the groups was found in terms of depression. CONCLUSION Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.
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Affiliation(s)
- EunKyo Kang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, School of Medicine, Gyeongsang University, Jinju, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Eun-Kee Song
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chi-Hoon Maeng
- Division of Hemato-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-Oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - JeongHee Min
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jihye Lee
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyeon Choo
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
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27
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Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:915-925. [PMID: 32023161 DOI: 10.1200/jco.19.00013] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Juliet C Jacobsen
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Vicki A Jackson
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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28
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Tang ST, Chou WC, Chang WC, Chen JS, Hsieh CH, Wen FH, Chung SC. Courses of Change in Good Emotional Preparedness for Death and Accurate Prognostic Awareness and Their Associations With Psychological Distress and Quality of Life in Terminally Ill Cancer Patients' Last Year of Life. J Pain Symptom Manage 2019; 58:623-631.e1. [PMID: 31276808 DOI: 10.1016/j.jpainsymman.2019.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Emotional preparedness for death is a distinct but related concept to prognostic awareness (PA). Both allow patients to prepare psychologically and interpersonally for death, but they have primarily been examined in cross-sectional studies. OBJECTIVES To 1) explore the courses of change in good emotional preparedness for death and accurate PA and 2) evaluate their associations with severe anxiety symptoms, severe depressive symptoms, and quality of life in cancer patients' last year. METHODS For this prospective, longitudinal study, we consecutively recruited 277 terminally ill cancer patients. Aims 1 and 2 were examined by univariate and multivariate generalized estimating equation analyses, respectively. RESULTS The prevalence of good emotional preparedness for death was 54.43%-65.85% in the last year, with a significant decrease only 91-180 vs. 181-365 days before death (odds ratio [95% CI] = 0.67 [0.47, 0.97]). Good emotional preparedness for death was associated with a lower likelihood of severe anxiety symptoms (adjusted odds ratio [95% CI] = 0.47 [0.27, 0.79]) and severe depressive symptoms (0.61 [0.39, 0.95]), but not with quality of life (β [95% CI] = 0.49 [-2.13, 3.11]). However, accurate PA improved substantially (55.12%-70.73%) as death approached and accurate PA was positively associated with severe depressive symptoms (2.63 [1.63, 4.25]). CONCLUSION Good emotional preparedness for death and accurate PA remained largely stable and improved substantially, respectively, in cancer patients' last year. Both measures were significantly associated with psychological distress. Health care professionals should not only cultivate accurate PA but also promote cancer patients' emotional preparedness for death, which may improve their psychological well-being.
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Affiliation(s)
- Siew Tzuh Tang
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C.; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, R.O.C..
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, R.O.C.; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, R.O.C
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, R.O.C.; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, R.O.C
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, R.O.C.; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, R.O.C
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, R.O.C.; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, R.O.C
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, R.O.C
| | - Shih-Chi Chung
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
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29
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Ahlam A, Hind M, Haddou Rahou B, Rachid R, Hassan E. Quality of life of Moroccan patients on the palliative phase of advanced cancer. BMC Res Notes 2019; 12:351. [PMID: 31227021 PMCID: PMC6588852 DOI: 10.1186/s13104-019-4390-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The aim of this study is to assess the quality of life of caregiver’s. The study was conducted at the RABAT National Institute of Oncology in MOROCCO. Results 120 patients on the palliative phase of advanced cancer were included. Severe fatigue was observed in 64.2% of patients with an average of 90.55 ± 14.7. There was a positive association between functional dimensions and overall quality of life and a negative association between symptoms and overall quality of life. Patients under 30 years had a lower quality of life. According to the multi-varied analysis, physical function, emotional functioning and fatigue were significant predictors of Health related quality of life/overall quality of life (p < 0.05). Electronic supplementary material The online version of this article (10.1186/s13104-019-4390-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aitouma Ahlam
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco. .,Translational Oncology Research Team, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | - Mrabti Hind
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.,Translational Oncology Research Team, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Bouchra Haddou Rahou
- Research Department, Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco
| | - Razine Rachid
- Laboratory of Social Medicine and Public Health, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Errihani Hassan
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.,Translational Oncology Research Team, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
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30
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Plys E, Smith R, Jacobs ML. Masculinity and Military Culture in VA Hospice and Palliative Care: A Narrative Review With Clinical Recommendations. J Palliat Care 2019; 35:120-126. [PMID: 31146630 DOI: 10.1177/0825859719851483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines the intersection between masculinity, military culture, and hospice and palliative care (HPC). The authors conducted a narrative literature review, supplemented with clinical annotations, to identify the impact of masculinity and military culture on the following topics salient to end-of-life care with older male veterans: pain management, mental health, coping, communication, autonomy and respect, and family roles. Findings suggest that traits associated with masculinity and military culture have an influence on the end-of-life process and HPC for older male veterans. Specifically, results suggest that older male veterans may deny or minimize physical pain, decline mental health treatment, utilize maladaptive coping strategies, avoid emotional conversations, struggle to manage perceived shifts in autonomy, and experience challenges negotiating changing family roles. The authors provide clinical recommendations for providers across various disciplines to address the aforementioned concerns with older male veterans in HPC. Overall, information presented in this article may be an important contribution to the literature for building cultural competencies with older male veterans and has the potential to improve the delivery of HPC for veterans and their families.
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Affiliation(s)
- Evan Plys
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA.,Department of Internal Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Ronald Smith
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA
| | - M Lindsey Jacobs
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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31
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Mah K, Hales S, Weerakkody I, Liu L, Fernandes S, Rydall A, Vehling S, Zimmermann C, Rodin G. Measuring the quality of dying and death in advanced cancer: Item characteristics and factor structure of the Quality of Dying and Death Questionnaire. Palliat Med 2019; 33:369-380. [PMID: 30561236 DOI: 10.1177/0269216318819607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Ensuring a good death in individuals with advanced disease is a fundamental goal of palliative care. However, the lack of a validated patient-centered measure of quality of dying and death in advanced cancer has limited quality assessments of palliative-care interventions and outcomes. Aim: To examine item characteristics and the factor structure of the Quality of Dying and Death Questionnaire in advanced cancer. Design: Cross-sectional study with pooled samples. Setting/participants: Caregivers of deceased advanced-cancer patients ( N = 602; mean ages = 56.39–62.23 years), pooled from three studies involving urban hospitals, a hospice, and a community care access center in Ontario, Canada, completed the Quality of Dying and Death Questionnaire 8–10 months after patient death. Results: Psychosocial and practical item ratings demonstrated negative skewness, suggesting positive perceptions; ratings of symptoms and function were poorer. Of four models evaluated using confirmatory factor analyses, a 20-item, four-factor model, derived through exploratory factor analysis and comprising Symptoms and Functioning, Preparation for Death, Spiritual Activities, and Acceptance of Dying, demonstrated good fit and internally consistent factors (Cronbach’s α = 0.70–0.83). Multiple regression analyses indicated that quality of dying was most strongly associated with Symptoms and Functioning and that quality of death was most strongly associated with Preparation for Death ( p < 0.001). Conclusion: A new four-factor model best characterized quality of dying and death in advanced cancer as measured by the Quality of Dying and Death Questionnaire. Future research should examine the value of adding a connectedness factor and evaluate the sensitivity of the scale to detect intervention effects across factors.
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Affiliation(s)
- Kenneth Mah
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Isuri Weerakkody
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lucy Liu
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samantha Fernandes
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anne Rydall
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sigrun Vehling
- 3 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,4 Palliative Care Unit, Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Camilla Zimmermann
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,5 Department of Medicine, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
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32
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Bail JR, Traeger L, Pirl WF, Bakitas MA. Psychological Symptoms in Advanced Cancer. Semin Oncol Nurs 2018; 34:241-251. [DOI: 10.1016/j.soncn.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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33
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Sherman AC, Simonton-Atchley S, Mikeal CW, Anderson KM, Arnaoutakis K, Hutchins LF, Makhoul I, Mahmoud F, Milojkovic N, Harrington SE, Suen JY. Cancer patient perspectives regarding preparedness for end-of-life care: A qualitative study. J Psychosoc Oncol 2018; 36:454-469. [PMID: 29863447 DOI: 10.1080/07347332.2018.1466845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE The extent to which patients feel prepared for end-of-life (EOL) may be associated with important clinical outcomes. Despite growing interest in the concept of "preparedness," however, there is insufficient information about what cancer patients actually need to feel prepared. Such information is foundational for patient-centered care, theory-building, and instrument development. DESIGN This qualitative study examined patient perspectives regarding preparedness for EOL care. PARTICIPANTS AND METHODS In-depth interviews were conducted with patients with advanced malignancies and limited life expectancies. Participants were drawn from a large academic cancer center and had a diverse range of malignancies. Thematic text analysis was used to analyze the data. FINDINGS Six overarching themes emerged. These included readiness to manage concerns about: (1) EOL planning (e.g., goals of care, location of care); (2) interactions with healthcare providers (e.g., communication, symptom control); (3) interactions with family/friends (e.g., perceived burden, support); (4) emotional well-being (e.g., existential distress, fulfillment); (5) spiritual well-being (e.g., spiritual comfort, congregational support); and (6) financial well-being (e.g., medical expenses, estate planning). CONCLUSIONS Findings highlight areas that patients themselves regard as critical for a sense of preparedness for EOL care. Participants emphasized broader concerns than those previously construed as facets of patient preparedness, and these domains offer modifiable targets for intervention.
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Affiliation(s)
- Allen C Sherman
- a Behavioral Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Stephanie Simonton-Atchley
- a Behavioral Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Cindy W Mikeal
- b Department of Neurology , University of Texas Health Science Center at Houston, McGovern Medical School , Houston , Little Rock, Arkansas , USA
| | - Kendra M Anderson
- c Department of Neurology , University of Texas Health Science Center at Houston, McGovern Medical School , Houston , Texas , USA
| | - Konstantinos Arnaoutakis
- d Division of Hematology Oncology, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Laura F Hutchins
- d Division of Hematology Oncology, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Issam Makhoul
- d Division of Hematology Oncology, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Fade Mahmoud
- d Division of Hematology Oncology, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Natasa Milojkovic
- d Division of Hematology Oncology, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Sarah E Harrington
- e Division of Palliative Care, Department of Internal Medicine , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - James Y Suen
- f Department of Otolaryngology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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Liao YC, Liao WY, Sun JL, Ko JC, Yu CJ. Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study. Support Care Cancer 2017; 26:989-996. [PMID: 29019055 DOI: 10.1007/s00520-017-3919-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress. METHODS A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts. RESULTS Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance. CONCLUSIONS Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.
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Affiliation(s)
- Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, 306, Yuanpei Street, Hsinchu, 30015, Taiwan.
| | - Wei-Yu Liao
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
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Standing H, Jarvis H, Orr J, Exley C, Hudson M, Kaner E, Hanratty B. How can primary care enhance end-of-life care for liver disease? Qualitative study of general practitioners' perceptions and experiences. BMJ Open 2017; 7:e017106. [PMID: 28864486 PMCID: PMC5588936 DOI: 10.1136/bmjopen-2017-017106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Liver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor. Little is known about general practitioners' (GPs) perceptions of their role in managing end-stage liver disease. OBJECTIVE To explore GPs' experiences and perceptions of how primary care can enhance end-of-life care for patients with liver disease. DESIGN Qualitative interview study, thematic analysis. PARTICIPANTS Purposive sample of 25 GPs from five regions of England. RESULTS GPs expressed a desire to be more closely involved in end-of-life care for patients with liver disease but identified a number of factors that constrained their ability to contribute. These fell into three main areas; those relating directly to the condition, (symptom management and the need to combine a palliative care approach with ongoing medical interventions); issues arising from patients' social circumstances (stigma, social isolation and the social consequences of liver disease) and deficiencies in the organisation and delivery of services. Collaborative working with support from specialist hospital clinicians was regarded as essential, with GPs acknowledging their lack of experience and expertise in this area. CONCLUSIONS End-of-life care for patients with liver disease merits attention from both primary and secondary care services. Development of care pathways and equitable access to symptom relief should be a priority.
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Affiliation(s)
- Holly Standing
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - James Orr
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mark Hudson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Liver Unit, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Hofmann S, Hess S, Klein C, Lindena G, Radbruch L, Ostgathe C. Patients in palliative care-Development of a predictive model for anxiety using routine data. PLoS One 2017; 12:e0179415. [PMID: 28771478 PMCID: PMC5542653 DOI: 10.1371/journal.pone.0179415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 05/29/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. Methods Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set. Results An analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72). Conclusions Routinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.
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Affiliation(s)
- Sonja Hofmann
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
| | - Stephanie Hess
- Department of Anaesthesiology, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Klein
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gabriele Lindena
- Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Kaufmann TL, Kamal AH. Oncology and Palliative Care Integration: Cocreating Quality and Value in the Era of Health Care Reform. J Oncol Pract 2017; 13:580-588. [PMID: 28682666 DOI: 10.1200/jop.2017.023762] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Recent payment reforms in health care have spurred thinking regarding how strengthened partnerships can cocreate quality and value. Oncology is an important area in which to consider further collaborations in patient care, as a result of increasing treatment complexity from an expanding armamentarium of interventions, large resource expenditures related to cancer care, and a growing disease prevalence related to an aging population. Many have highlighted the important role of palliative care in the routine care of patients with advanced cancer and high symptom burden. Yet, how integration can occur that translates research into usual clinical practice while prioritizing the right patients and settings to maximize outcomes of interest has been inadequately described. We review the evidence for integration of palliative care into routine oncology care and then map the benefits to the requirements put forward by the Centers for Medicare and Medicaid Services Oncology Care Model as a use case; we also discuss applications to other evolving payment models.
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Affiliation(s)
- Tara L Kaufmann
- University of Pennsylvania, Philadelphia, PA; and Duke Cancer Institute, Durham, NC
| | - Arif H Kamal
- University of Pennsylvania, Philadelphia, PA; and Duke Cancer Institute, Durham, NC
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Measuring Adaptive Coping of Hospitalized Patients With a Severe Medical Condition: The Sickness Insight in Coping Questionnaire. Crit Care Med 2017; 44:e818-26. [PMID: 27088158 DOI: 10.1097/ccm.0000000000001743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adaptive coping strategies are associated with less psychological distress. However, there is no brief, specific, and validated instrument for assessing adaptive coping among seriously ill patients. Our objective was to examine the validity and patient-proxy agreement of a novel instrument, the Sickness Insight in Coping Questionnaire. DESIGN A cross-sectional design which included two related studies. SETTING A single university-affiliated Dutch hospital. SUBJECTS Hospitalized patients (study 1) and ICU-patients and proxies (study 2). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Study 1 (n = 103 hospitalized patients) addressed the Sickness Insight in Coping Questionnaire's performance relative to questionnaires addressing similar content areas. Coping subscales of the BRIEF COPE, Illness Cognition Questionnaire, and Utrecht Coping List were used as comparator measures in testing the construct validity of the Sickness Insight in Coping Questionnaire-subscales (fighting spirit, toughness, redefinition, positivism, and non-acceptance). The Sickness Insight in Coping Questionnaire had good internal consistency (0.64 ≤ α ≤ 0.79), a clear initial factor structure, and fair convergent (0.24 ≤ r ≤ 0.50) and divergent (r, ≤ 0.12) construct validity. Study 2 examined the performance of the Sickness Insight in Coping Questionnaire among 100 ICU patients and their close family members. This study showed that the Sickness Insight in Coping Questionnaire has good structural validity (confirmatory factor analyses with Comparative Fit Index > 0.90 and Root Mean Square Error of Approximation < 0.08) and moderate (r, 0.37; non-acceptance) to strong (r, > 0.50; fighting spirit, toughness, redefinition, and positivism) patient-close proxy agreement. CONCLUSIONS Overall, the Sickness Insight in Coping Questionnaire has good psychometric properties. ICU clinicians can use the Sickness Insight in Coping Questionnaire to gain insight in adaptive coping style of patients through ratings of patients or their close family members.
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Hagan TL, Fishbein JN, Nipp RD, Jacobs JM, Traeger L, Irwin KE, Pirl WF, Greer JA, Park ER, Jackson VA, Temel JS. Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE. J Pain Symptom Manage 2017; 53:131-138. [PMID: 27725249 PMCID: PMC5191904 DOI: 10.1016/j.jpainsymman.2016.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/01/2016] [Accepted: 06/23/2016] [Indexed: 01/06/2023]
Abstract
CONTEXT Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple and distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer. OBJECTIVES We sought to validate seven subscales of the Brief COPE in a large sample of patients newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers (N = 350). METHODS Participants completed the Brief COPE and measures assessing quality of life (QOL) (Functional Assessment of Cancer Therapy-General) and psychological distress (Hospital Anxiety and Depression Scale) within eight weeks of diagnosis of incurable cancer. We evaluated the psychometric properties of the Brief COPE using a confirmatory factor analysis and tests of correlation with the QOL and distress scales. RESULTS The Brief COPE factors were consistent with the original subscales, although the Behavioral Disengagement Scale had low internal consistency. Factors showed anticipated relationships with QOL and distress measures, except emotional support coping, which was correlated with increased depression and anxiety. We also conducted an exploratory high-order factor analysis to determine if subscales' score variances grouped together. The high-order factor analysis resulted in two factors, with active, emotional support, positive reframing, and acceptance loading onto one factor and denial and self-blame loading onto the second. CONCLUSION The selected subscales of the Brief COPE are appropriate measures of coping among individuals newly diagnosed with incurable lung and gastrointestinal cancers.
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Affiliation(s)
- Teresa L Hagan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Joel N Fishbein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly E Irwin
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Palliative care specialists’ beliefs about spiritual care. Support Care Cancer 2016; 24:3295-306. [DOI: 10.1007/s00520-016-3135-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
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Solomon BK, Wilson KG, Henderson PR, Poulin PA, Kowal J, McKim DA. Loss of Dignity in Severe Chronic Obstructive Pulmonary Disease. J Pain Symptom Manage 2016; 51:529-37. [PMID: 26620235 DOI: 10.1016/j.jpainsymman.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 02/02/2023]
Abstract
CONTEXT The maintenance of dignity is an important concept in palliative care, and the loss of dignity is a significant concern among patients with advanced cancer. OBJECTIVES The goals of this study were to examine whether loss of dignity is also a concern for patients receiving interdisciplinary rehabilitation for Stage III or IV chronic obstructive pulmonary disease. We examined the prevalence and correlates of loss of dignity and determined whether it improves with treatment. METHODS Inpatients underwent a structured interview inquiry around their sense of dignity and completed measures of pulmonary, physical, and psychological function at admission (n = 195) and discharge (n = 162). RESULTS Loss of dignity was identified as a prominent ongoing concern for 13% of patients. It was correlated with measures of depression and anxiety sensitivity, but not with pulmonary capacity or functional performance. A robust improvement in loss of dignity was demonstrated, with 88% of those who reported a significant problem at admission no longer reporting one at discharge. CONCLUSION The prevalence of a problematic loss of dignity among patients with severe chronic obstructive pulmonary disease is at least as high as among those receiving palliative cancer care. Loss of dignity may represent a concern among people with medical illnesses more broadly, and not just in the context of "death with dignity" at the end of life. Furthermore, interdisciplinary care may help to restore a sense of dignity to those individuals who are able to participate in rehabilitation.
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Affiliation(s)
- Brahm K Solomon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Keith G Wilson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Peter R Henderson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Patricia A Poulin
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Douglas A McKim
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Fatigue and its associated psychosocial factors in cancer patients on active palliative treatment measured over time. Support Care Cancer 2015; 24:1349-55. [PMID: 26335403 PMCID: PMC4729797 DOI: 10.1007/s00520-015-2909-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/16/2015] [Indexed: 11/16/2022]
Abstract
Purpose Fatigue is a frequently reported symptom by patients with advanced cancer, but hardly any prospective information is available about fatigue while on treatment in the palliative setting. In a previous cross-sectional study, we found several factors contributing to fatigue in these patients. In this study, we investigated the course of fatigue over time and if psychosocial factors were associated with fatigue over time. Methods Patients on cancer treatment for incurable solid tumors were observed over 6 months. Patients filled in the Checklist Individual Strength monthly to measure the course of fatigue. Baseline questionnaires were used to measure disease acceptance, anxiety, depressive mood, fatigue catastrophizing, sleeping problems, discrepancies in social support, and self-reported physical activity for their relation with fatigue over time. Results At baseline 137 patients and after 6 months 89 patients participated. The mean duration of participation was 4.9 months. At most time points, fatigue scores were significantly higher in the group dropouts in comparison with the group participating 6 months (completers). Overall fatigue levels remained stable over time for the majority of participants. In the completers, 42 % never experienced severe fatigue, 29 % persisted being severely fatigued, and others had either an increasing or decreasing level. Of the investigated factors, low reported physical activity and non-acceptance of cancer were associated significantly to fatigue. Conclusion A substantial number of participants never experienced severe fatigue and fatigue levels remained stable over time. For those who do experience severe fatigue, non-acceptance of having incurable cancer and low self-reported physical activity may be fatigue-perpetuating factors.
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Tang ST, Chang WC, Chen JS, Chou WC, Hsieh CH, Chen CH. Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life. Psychooncology 2015; 25:455-62. [DOI: 10.1002/pon.3943] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/01/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Siew Tzuh Tang
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University; Tao-Yuan Taiwan
| | - Chen H. Chen
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Kang-Ning Junior College of Medical Care and Management; Taipei Taiwan
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Tang ST, Chen JS, Chou WC, Lin KC, Chang WC, Hsieh CH, Wu CE. Prevalence of severe depressive symptoms increases as death approaches and is associated with disease burden, tangible social support, and high self-perceived burden to others. Support Care Cancer 2015; 24:83-91. [DOI: 10.1007/s00520-015-2747-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
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Fisher K, Seow H, Cohen J, Declercq A, Freeman S, Guthrie DM. Patient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument. J Pain Symptom Manage 2015; 49:716-25. [PMID: 25220047 DOI: 10.1016/j.jpainsymman.2014.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Abstract
CONTEXT Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it. OBJECTIVES To identify patient characteristics associated with PA in a PC population. METHODS The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis. RESULTS The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis. CONCLUSION Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.
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Affiliation(s)
- Kathryn Fisher
- Aging and Community Health Research Unit, McMaster University, Hamilton, Ontario, Canada.
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Anja Declercq
- LUCAS & Faculty of Social Sciences, University of Leuven, Leuven, Belgium
| | - Shannon Freeman
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Lee CE, Tai IS, Yang GM, Akhileswaran R, Dignadice D, Lim A, Ng WR, Sarasvathy S, Neo SH. A retrospective audit of spirituality assessment in palliative care patients in Singapore. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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47
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van Vliet LM, Epstein AS. Current state of the art and science of patient-clinician communication in progressive disease: patients' need to know and need to feel known. J Clin Oncol 2014; 32:3474-8. [PMID: 25267758 DOI: 10.1200/jco.2014.56.0425] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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McPherson CJ, Hadjistavropoulos T, Devereaux A, Lobchuk MM. A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliat Care 2014; 13:39. [PMID: 25140119 PMCID: PMC4137110 DOI: 10.1186/1472-684x-13-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/31/2014] [Indexed: 12/04/2022] Open
Abstract
Background Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients’ and caregivers’ roles and perspectives managing pain is, therefore, fundamental to addressing cancer pain in this setting. Consequently, we sought to explore and describe their perspectives and roles. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with a purposeful sample of patient- family caregiver dyads. Participants included 18 patients aged 65 years and over, with advanced cancer, receiving palliative care at home, and 15 family caregivers. The interview data were analysed using thematic analyses. Strategies were used to establish rigour. Results Two main themes were identified. The first theme, "Communicating the pain", represented pain assessment and incorporated four subthemes in which participants described: their roles in pain assessment, the identification and expression of pain, and the communication of pain between patients and caregivers. The second theme, "Finding a solution", comprised of four subthemes that reflected participants’ roles and approaches in controlling pain; as well as their beliefs about cancer pain control, experience with side effects, and perspectives on the goals of treatment. Conclusions The findings support other studies in identifying knowledge and attitudinal barriers to pain control; while adding to the literature by highlighting practical and relational barriers faced by older patients and their family caregivers. Health care professionals can do much to address the barriers identified by: correcting misconceptions regarding cancer pain, facilitating the communication of pain within dyads, and ensuring that patients and family caregivers have the knowledge, skills, and ability to assess and implement pain treatment strategies. This support needs to be individually tailored to meet the ongoing needs of both members of the dyad so that the shared goals of pain management are accomplished.
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Affiliation(s)
- Christine J McPherson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | | | - Alana Devereaux
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Michelle M Lobchuk
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
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Tang ST, Lin KC, Chen JS, Chang WC, Hsieh CH, Chou WC. Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients. Psychooncology 2014; 24:147-54. [DOI: 10.1002/pon.3616] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Siew Tzuh Tang
- School of Nursing; Chang Gung University; Tao-Yuan Taiwan
| | - Kuan-Chia Lin
- Department of Health Care and Management; National Taipei University of Nursing and Health Science; Taipei Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; Tao-Yuan Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; Tao-Yuan Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; Tao-Yuan Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; Tao-Yuan Taiwan
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Acceptance and valued living as critical appraisal and coping strengths for caregivers dealing with terminal illness and bereavement. Palliat Support Care 2014; 13:359-68. [PMID: 24784235 DOI: 10.1017/s1478951514000431] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Informal caregivers of palliative care patients play an essential role in the coordination of care for patients during their final phases of life. However, undertaking a caregiving role can have enduring psychological consequences for caregivers and interfere with functioning. Studies have investigated a variety of factors associated with individual differences in caregiver psychosocial outcomes, but little is known about their relative impact, and there is a need for guiding models to support research in this area. METHOD A review of the literature was conducted on factors influencing the psychological distress and grief of caregivers. Drawing from acceptance and commitment therapy (ACT) and Stroebe and colleagues' integrative risk factor framework, we developed a process model to describe individual differences in caregiver psychological distress and grief. RESULTS The model presents caregiver psychological distress and grief as functions of death attitudes and communication about death and dying, mediated by acceptance and valued living from an ACT perspective. An outline of the empirical and theoretical underpinnings for each component in the model is provided. SIGNIFICANT OF RESULTS: The presented model is an inherently strengths-based model that is concordant with acceptance- and values- (ACT) based interventions to facilitate coping in caregivers.
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