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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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Sezgin D, Hendry A, Liew A, O'Donovan M, Salem M, Carriazo AM, López-Samaniego L, Rodríguez-Acuña R, Kennelly S, Illario M, Arnal Carda C, Inzitari M, Hammar T, O'Caoimh R. Transitional palliative care interventions for older adults with advanced non-malignant diseases and frailty: a systematic review. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-02-2020-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PurposeTo identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions.Design/methodology/approachA systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal.FindingsA total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear.Research limitations/implicationsPositive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited.Originality/valueStudies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty.
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Bennardi M, Diviani N, Gamondi C, Stüssi G, Saletti P, Cinesi I, Rubinelli S. Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families. BMC Palliat Care 2020; 19:47. [PMID: 32284064 PMCID: PMC7155286 DOI: 10.1186/s12904-020-00556-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families. METHODS A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis. RESULTS Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients' openness to their own needs). CONCLUSIONS To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals' communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.
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Affiliation(s)
- Marco Bennardi
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication; University of Lucerne, Department of Health Sciences and Medicine, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland.
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication; University of Lucerne, Department of Health Sciences and Medicine, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland
| | - Claudia Gamondi
- Oncology Institute of Southern Switzerland, Palliative Care, Ospedale San Giovanni, 6500, Bellinzona, Switzerland
| | - Georg Stüssi
- Oncology Institute of Southern Switzerland, Hematology, Ospedale San Giovanni, 6500, Bellinzona, Switzerland
| | - Piercarlo Saletti
- Oncology Institute of Southern Switzerland, Medical Oncology, Ospedale Regionale Lugano, 6962, Viganello, Switzerland
| | - Ivan Cinesi
- Palliative TI - Associazione Cure Palliative Ticino, Via San Leonardo, 6599, Cadenazzo, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication; University of Lucerne, Department of Health Sciences and Medicine, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland
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Hulbert-Williams NJ, Norwood S, Gillanders D, Finucane A, Spiller J, Strachan J, Millington S, Swash B. Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care. Pilot Feasibility Stud 2019; 5:104. [PMID: 31452926 PMCID: PMC6702709 DOI: 10.1186/s40814-019-0488-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components. Discussion This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach. Trial registration Open Science Framework, 46033. Registered 19 April 2018.
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Affiliation(s)
- Nicholas J Hulbert-Williams
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Sabrina Norwood
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - David Gillanders
- 2School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sue Millington
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Brooke Swash
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
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Thompson GN, Mcclement SE, Daeninck PJ. “Changing Lanes”: Facilitating the Transition from Curative to Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200205] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little empirical work has been conducted assessing the perspectives of nurses regarding the barriers, facilitators, and strategies associated with achieving quality patient care at the end of life. A grounded theory study was conducted examining nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of generalist nurses (n=10) working in an acute care setting. An inductively derived preliminary model, “creating a haven for safe passage”, was developed based on the findings from this study and has been published elsewhere (1). This article provides a detailed description of one of the subprocesses of the model regarding the transition from curative to palliative care—the subprocess of “facilitating and maintaining a lane change”. The various strategies which nurses used to effect a lane change, as well as the facilitators and barriers they encountered in this process, are presented. The consequences associated with both successful and unsuccessful lane changes are reported.
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Affiliation(s)
| | - Susan E. Mcclement
- Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg
| | - Paul J. Daeninck
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Affiliation(s)
- Isabelle Dumont
- Έcole de service social, Université Laval, Centre de recherche de l'Hôtel-Dieu de Québec, Έquipe de recherche de la Maison Michel-Sarrazin, CHUQ
| | - Serge Dumont
- Έcole de service social, Université Laval, Centre de recherche de l'Hôtel-Dieu de Québec, Έquipe de recherche de la Maison Michel-Sarrazin, CHUQ
| | - Jean Turgeon
- Faculté de médecine, Université Laval, Quebec, Quebec, Canada
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Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care. J Adv Nurs 2019; 75:2059-2071. [PMID: 30734354 DOI: 10.1111/jan.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers. BACKGROUND Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. DESIGN Qualitative metasynthesis. DATA SOURCES Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. REVIEW METHODS Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. RESULTS The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. CONCLUSION Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
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Åvik Persson H, Sandgren A, Fürst CJ, Ahlström G, Behm L. Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective. BMC Geriatr 2018; 18:134. [PMID: 29898674 PMCID: PMC6000966 DOI: 10.1186/s12877-018-0825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. METHODS The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, 221 00, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
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Broom A, Kirby E, Good P, Lwin Z. Nursing futility, managing medicine: Nurses’ perspectives on the transition from life-prolonging to palliative care. Health (London) 2016. [DOI: 10.1177/1363459315595845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The shift from life-prolonging and palliative care can be fraught with interpersonal complexities as patients face dilemmas around mortality and the dying process. Nurses can play a central role in managing these moments, often with a focus on promoting and enhancing communication around: the meaning of palliative care, the nature of futility and the dying process more broadly. These sites of nurse–patient communication can be highly charged and pose unique challenges to nurses including how to balance nursing perspectives versus those of other stakeholders including doctors. Here, drawing on interviews with nurses, we explore their accounts of communication about futility and the process of transitioning to palliative care. The interviews reveal nurses’ perspectives on the following: the art of conversing around futility and managing patient resistance, the influence of guilt and individual biographies in shaping communication, the importance of non-verbal and the informal in communication, the impact of conflicting organisational expectations on nurses and the process of learning to effectively communicate. We argue that these transitional moments articulate important, and at times problematic, aspects of contemporary nursing and nurse–medical relations.
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Affiliation(s)
- Alex Broom
- The University of New South Wales, Australia
| | - Emma Kirby
- The University of New South Wales, Australia
| | | | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Australia
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Day R, Hollywood C, Durrant D, Perkins P. Patient experience of non-malignant ascites and its treatment: a qualitative study. Int J Palliat Nurs 2015; 21:372-9. [PMID: 26312532 DOI: 10.12968/ijpn.2015.21.8.372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Ascites is an accumulation of serous fluid in the abdominal cavity. It can be caused by both malignant and non-malignant conditions and produces distressing symptoms. There have been no qualitative studies looking at the experiences of patients with non-malignant ascites. AIMS To explore the experiences of patients living with non-malignant ascites and its management. Also, to explore the views of these patients about services available to them. METHOD Phenomenological qualitative research study using digitally recorded semi-structured interviews. SETTING AND PARTICIPANTS Six adult patients with non-malignant ascites who were receiving paracentesis to manage their symptoms in an acute hospital day unit. RESULTS Participants experienced a wide variety of physical symptoms. They discussed how the ascites impacted on their social lives. They had views on diuretics, low sodium diet and paracentesis as methods of symptom management. Participants' confidence in staff performing paracentesis was a common finding, particularly as ultrasound was rarely used. While only some were suitable for liver transplant, all discussed their future care needs. CONCLUSION Participants' experiences of non-malignant ascites are that it has a considerable effect on their quality of life. Patients like the system of day case admission for drainage, but question whether this is sustainable. Advanced practitioners can successfully provide a paracentesis service for these patients in hospitals and potentially this is transferable to hospices. Patients seemed happy to consider the option of semi-permanent drains and pumps as methods of managing ascites.
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Affiliation(s)
- Rebecca Day
- Sue Ryder, Leckhampton Court Hospice, Cheltenham, UK
| | | | - Deborah Durrant
- Liver Specialist Nurse, both Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Paul Perkins
- Consultant in Palliative Medicine, Sue Ryder/Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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11
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Dong ST, Butow PN, Tong A, Agar M, Boyle F, Forster BC, Stockler M, Lovell MR. Patients’ experiences and perspectives of multiple concurrent symptoms in advanced cancer: a semi-structured interview study. Support Care Cancer 2015; 24:1373-86. [DOI: 10.1007/s00520-015-2913-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/16/2015] [Indexed: 01/06/2023]
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Abstract
OBJECTIVES Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses' accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions. DESIGN Qualitative study using semistructured interviews. SETTING Two health services with public as well as private clinical environments in a major metropolitan area of Australia. PARTICIPANTS Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care. RESULTS Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses' informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time. CONCLUSIONS The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health professionals, patients and families is required to provide a broader interdisciplinary understanding of futility and contributions to the negotiation of palliative care.
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Affiliation(s)
- Emma Kirby
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Alex Broom
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Hospital, Brisbane, Queensland, Australia
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13
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Orme J, Still D, Day R, Evans J, Perkins P. The experiences of patients undergoing blood transfusion in a day hospice. Int J Palliat Nurs 2013; 19:171-6. [PMID: 23967771 DOI: 10.12968/ijpn.2013.19.4.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore patients' views on living with anaemia and undergoing blood transfusions in a day hospice. METHODS This was a qualitative study using semi-structured interviews. Ten patients who between them had received 90 transfusions were purposively sampled from the hospice day unit. The interviews were digitially recorded, transcribed anonymously, and the transcripts analysed using a phenomenological analysis framework. FINDINGS Tiredness was the most common symptom of anaemia. Participants liked attending the day hospice instead of hospital for their transfusions owing to differences in transport, parking, waiting time, and space to ask questions. The majority had no concerns about hospice transfusion and would be happy to return for further treatment. CONCLUSIONS Haematology patients can have a good experience when undergoing blood transfusion at a day hospice. Hospices should perhaps offer this procedure more widely.
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Affiliation(s)
- Jacquie Orme
- Great Western Hospitals NHS Foundation Trust, Swindon, England
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14
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Day R, Mitchell T, Keen A, Perkins P. The experiences of patients with ascites secondary to cancer: a qualitative study. Palliat Med 2013; 27:739-46. [PMID: 23558342 DOI: 10.1177/0269216313480400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ascites secondary to cancer has a dramatic effect on all aspects of patients' lives. Healthcare professional surveys have shown that there is considerable variation in the management of ascites. AIM To explore patients' experiences of living with ascites and its management. DESIGN Qualitative research study using digitally recorded semi-structured interviews. SETTING/PARTICIPANTS Twelve adult patients with ascites who, between them, had undergone 47 paracentesis procedures in hospitals and/or specialist palliative care units in Southern England. RESULTS Symptoms were pain, discomfort and effects on appetite, digestion, breathing and mobility. All participants had experienced paracentesis in hospital or a specialist palliative care unit, and these experiences differed. They had views on what constituted a good procedure: setting, competence and pain control. They reported rapid improvement of symptoms after paracentesis. While some did not like the idea of a semi-permanent drain, those with them appreciated the convenience and not having to wait for repeated admissions or the recurrence of symptoms. The interval between ascitic taps was seen as a useful guide as to when a semi-permanent drain should be offered. Participants had mixed views on participation in a hypothetical randomised controlled trial of repeated ascitic taps versus semi-permanent drains. CONCLUSION Patients' experiences of ascites management are variable and could be improved. These experiences can inform healthcare professionals. They have views on when semi-permanent drains should be offered and future research.
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Affiliation(s)
- Rebecca Day
- Research Department, Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
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D’Angelo D, Vellone E, Alvaro R, Chiara M, Casale G, Stefania L, Latina R, Matarese M, De Marinis MG. Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis. Int J Palliat Nurs 2013; 19:110-5. [DOI: 10.12968/ijpn.2013.19.3.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Roberto Latina
- School of Public Health, La Sapienza University, Rome, Italy
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Psychological impact of working with patients with cystic fibrosis at end-of-life, pre-transplant stage. Palliat Support Care 2012; 11:111-21. [PMID: 23234801 DOI: 10.1017/s147895151200079x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Multidisciplinary staff who work with end-of-life, pre-transplant patients with cystic fibrosis (CF) have to juggle two seemingly opposing care approaches; active care to maintain their patients' health and condition in anticipation of a transplant, and sensitive palliative care that takes their end-of-life wishes into consideration should they not receive a transplant. Little is known about the psychological impact on staff working within this care dichotomy. The aim of this study is to explore staff's experiences and understand more about the psychological impact of this work on them professionally and personally, and how this affects their ability to provide appropriate care for their patients. METHOD A qualitative explorative research design was used. Ten semistructured interviews with multidisciplinary staff working in cystic fibrosis centers and units across the United Kingdom were analyzed using interpretative phenomenological analysis (IPA). RESULTS Two superordinate themes emerged from the analysis: factors contributing to the "juggle" of active and palliative care, and extent of emotional impact on staff. SIGNIFICANCE OF RESULTS The study indicates that there is an emotional impact on staff working with patients with CF at end-of-life, pre-transplant stages. Specifically, it reveals the extent of the unpredictability that staff work with, and the range of emotions that staff experience, including uncertainty about professional identity and anxiety about working practices. The depth and intimacy of professional-patient relationships is highlighted, particularly for staff in close contact with and similar in age to their patients. Additionally, the strength of staff's commitment and desire to care for patients within broader humanistic terms that mesh with their own personal values is brought to light. Despite the difficulties with their work, the majority of staff adopted numerous coping strategies to manage their emotions, many of which emphasized the link between their professional and personal values in undertaking their roles.
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Broom A, Kirby E, Good P, Wootton J, Adams J. The art of letting go: referral to palliative care and its discontents. Soc Sci Med 2012; 78:9-16. [PMID: 23219848 DOI: 10.1016/j.socscimed.2012.11.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 11/03/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break 'bad news' to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process.
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Affiliation(s)
- Alex Broom
- School of Social Science, University of Queensland, St. Lucia, QLD 4072, Australia.
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Affiliation(s)
| | - Sally Hayes
- Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
| | - Rebecca Day
- Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
| | - Asha Johny
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Paul Perkins
- Sue Ryder Leckhampton Court Hospice and Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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19
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Stajduhar KI, Thorne SE, McGuinness L, Kim-Sing C. Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs 2011; 19:2039-47. [PMID: 20920030 DOI: 10.1111/j.1365-2702.2009.03158.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? BACKGROUND Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. DESIGN Secondary analysis of qualitative interview data. METHODS Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. RESULTS Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase - respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. CONCLUSIONS Communication is an important element in the provision of advanced cancer care. RELEVANCE TO CLINICAL PRACTICE Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication.
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Affiliation(s)
- Kelli I Stajduhar
- University of Victoria School of Nursing, Vancouver, British Columbia, Canada.
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20
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Duggleby WD, Penz KL, Goodridge DM, Wilson DM, Leipert BD, Berry PH, Keall SR, Justice CJ. The transition experience of rural older persons with advanced cancer and their families: a grounded theory study. BMC Palliat Care 2010; 9:5. [PMID: 20420698 PMCID: PMC2876144 DOI: 10.1186/1472-684x-9-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 04/26/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz's constructivist grounded theory approach. RESULTS Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of "Navigating Unknown Waters". This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population.
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Affiliation(s)
- Wendy D Duggleby
- Faculty of Nursing, University of Alberta, 3rd floor Clinical Sciences Building, Edmonton Alberta, T6G 2G3, Canada
| | - Kelly L Penz
- Nursing Division, Saskatchewan Institute of Applied Science and Technology, 4500 Wascana Parkway, Regina Saskatchewan, S4P 3A3, Canada
| | - Donna M Goodridge
- College of Nursing, University of Saskatchewan, Health Sciences Building, 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, 3rd floor Clinical Sciences Building, Edmonton Alberta, T6G 2G3, Canada
| | - Beverly D Leipert
- School of Nursing, University of Western Ontario, Health Sciences Addition, London, Ontario, N6A 5C1, Canada
| | - Patricia H Berry
- Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Utah, 10 South 2000 East Front, Salt Lake City, 84112-5880, USA
| | - Sylvia R Keall
- Five Hills Health Region, 1000 Albert Street, Moose Jaw, Saskatchewan, S6H 2Y2, Canada
| | - Christopher J Justice
- Department of Anthropology University of Victoria, 3800 Finnerty Road Victoria British Columbia V8W 3P5, Canada
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LEUNG D, ESPLEN M. Alleviating existential distress of cancer patients: can relational ethics guide clinicians? Eur J Cancer Care (Engl) 2010; 19:30-8. [DOI: 10.1111/j.1365-2354.2008.00969.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Nelson ML, Schrader SL, Eidsness LM. “South Dakota's Dying to Know”: Personal Experiences with End-of-Life Care. J Palliat Med 2009; 12:905-13. [DOI: 10.1089/jpm.2009.0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margot L. Nelson
- Department of Nursing, Augustana College, Sioux Falls, South Dakota
| | - Susan L. Schrader
- Department of Sociology, Augustana College, Sioux Falls, South Dakota
| | - LuAnn M. Eidsness
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
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Pavlish C, Ceronsky L. Oncology Nurses' Perceptions of Nursing Roles and Professional Attributes in Palliative Care. Clin J Oncol Nurs 2009; 13:404-12. [DOI: 10.1188/09.cjon.404-412] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marsella A. Exploring the literature surrounding the transition into palliative care: a scoping review. Int J Palliat Nurs 2009; 15:186-9. [PMID: 19430414 DOI: 10.12968/ijpn.2009.15.4.41967] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article explores the current literature surrounding transitions into palliative care. Transitions in care have become more frequent and complex in the Canadian healthcare system. Plagued with difficulty, fear and misunderstanding, the transition into palliative care is one of the most confusing and traumatic transitions a patient and family can face. Despite this, however, transitions into palliative care have been commonly overlooked in transitional research. A scoping review of the existing literature on transitions and palliative care was conducted and three key areas complicating the transition into palliative care were noted: the intrinsic nature of the transitions, the timing of the transition, and the lack of information surrounding this transition. This article highlights a need for further research into the complicated area of transitions into palliative care.
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Affiliation(s)
- Amanda Marsella
- Graduate Department of Rehabilitation Science, University of Toronto, Ontario, Canada.
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25
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Walker G, Andrew Maiden J. Understanding patients' lived experience following photodynamic therapy for the treatment of advanced cancer. Int J Palliat Nurs 2009; 15:80-5. [PMID: 19247224 DOI: 10.12968/ijpn.2009.15.2.39805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To gain an understanding of patients' lived experience following photodynamic therapy (PDT) for the treatment of advanced cancer. BACKGROUND Existing literature on PDT tends to be predominantly grounded in basic science and mainly associated with the effect of PDT on the cancer rather than the individual's experience. An appreciation of the impact on patients' day-to-day life may enhance the support and advice offered to patients undergoing this treatment. METHOD A Heideggerian hermeneutic phenomenological approach was used as the philosophical framework. Semi-structured interviews were conducted with a purposive sample of six participants. Thematic content analysis was adopted to analyse the data, which yielded six themes. FINDINGS Analysis of the data yielded six themes: the impact on day-to-day life; existential meaning; the physical effects of treatment; kaleidoscope of emotions; information gap; and family burden. CONCLUSION PDT offers palliation of symptoms for some participants while offering hope of enhanced quality of life. Patients and their families have to be willing and well-informed of the need to comply with the guidance provided by healthcare professionals and information leaflets to avoid any photosensitive reaction. There is a need for education for healthcare professionals as PDT is not well recognized or understood as a treatment for advanced cancer.
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Affiliation(s)
- Gail Walker
- Macmillan Day Care Unit, Royal Victoria Hospital, Dundee, Scotland, UK.
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Kusajima E, Kawa M, Miyashita M, Kazuma K, Okabe T. Prospective Evaluation of Transition to Specialized Home Palliative Care in Japan. Am J Hosp Palliat Care 2009; 26:172-9. [DOI: 10.1177/1049909108330029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to clarify patients' characteristics and the level of symptom management in the transition to specialized home palliative care, and to examine prospectively real-time evaluation of both terminal cancer patients and their families. This study was conducted at one of the largest institutions offering specialized home palliative care in Japan. We asked both the patient's and the family's health status at the initial assessment and 2 weeks later. One hundred sets of patients and their families were included in this study. Regarding patient characteristics at the time of referral to the specialized home palliative care service, patients referred from outpatient settings had more severe physical symptoms than patients referred from inpatient settings. The specialized home palliative care service could contribute to patients' symptom and families' psychosocial status.
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Affiliation(s)
- Etsuko Kusajima
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
| | - Masako Kawa
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Kazuma
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Saint-Pierre M, Sévigny A. Approche individuelle et collective sur la continuité des soins. SANTÉ PUBLIQUE 2009. [DOI: 10.3917/spub.093.0241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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28
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Sanjo M, Miyashita M, Morita T, Hirai K, Kawa M, Ashiya T, Ishihara T, Miyoshi I, Matsubara T, Nakaho T, Nakashima N, Onishi H, Ozawa T, Suenaga K, Tajima T, Hisanaga T, Uchitomi Y. Perceptions of specialized inpatient palliative care: a population-based survey in Japan. J Pain Symptom Manage 2008; 35:275-82. [PMID: 18222630 DOI: 10.1016/j.jpainsymman.2007.04.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Revised: 04/20/2007] [Accepted: 04/30/2007] [Indexed: 11/19/2022]
Abstract
This study aimed to clarify and compare the awareness and perceptions of the specialized inpatient palliative care service. A cross-sectional questionnaire survey was performed on the general population selected by stratified two-stage random sampling (n=2,548) and bereaved families who actually received specialized inpatient palliative care at 12 palliative care units (PCUs) in Japan (n=513). The respondents reported their awareness and perceptions of PCUs. Thirty-eight percent of the general population answered that they had "considerable" or "moderate" knowledge of PCUs, but 24% answered that they had "no" knowledge. Bereaved families who received PCU care (PCU-bereaved families) were likely to have better perceptions of PCUs than the general population: "alleviates pain" (68% of the general population and 87% of PCU-bereaved families agreed), "provides care for families" (67% and 86%, respectively), and "provides compassionate care" (67% and 87%, respectively). Both groups, however, expressed concerns about PCUs: "a place where people only wait to die" (30% and 40%, respectively) and "shortens the patient's life" (8% and 17%, respectively). These perceptions were associated with overall satisfaction with received care, and differed among the 12 PCUs. In conclusion, public awareness of PCUs was insufficient in Japan. Although PCU-bereaved families were generally likely to have better perceptions of PCUs than the general population, both groups shared concerns that a PCU was a place where people only wait to die. To facilitate appropriate use of specialized palliative care services, more efforts to inform the general population about the actual palliative care system are needed. In addition, the role of PCUs might be reconsidered in terms of the continuum of cancer care.
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Affiliation(s)
- Makiko Sanjo
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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29
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Abstract
PURPOSE/OBJECTIVES To explore oncology nurses' perceptions about palliative care. RESEARCH APPROACH Descriptive study with narrative data analysis. SETTING Oncology units in three midwestern hospitals. PARTICIPANTS 33 actively practicing oncology nurses. METHODOLOGIC APPROACH Oncology nurses participated in focus groups that elicited concrete experiences and reflections about palliative care. Researchers identified subtexts by which to sort data, worked inductively in each subtext to identify categories, resorted the text according to the categories, carefully examined the category narratives, and established narrative descriptors that captured the essence of each category. Data matrices were constructed to examine the emerging categories more closely. MAIN RESEARCH VARIABLE Oncology nurses' perceptions about palliative care. FINDINGS Narratives revealed 14 descriptors about palliative care. Considerable agreement occurred in nurses' descriptions about the nature of palliative care. Divergent viewpoints were evident as nurses described how palliative care intersects with other practice areas. Three descriptors of the healthcare context in which palliative care occurs were identified: limited time for addressing complex palliative care issues, health care's emphasis on prolonging life, and the challenge of coordinating care across disciplines. CONCLUSIONS Participants clearly comprehend palliative care goals. However, divergent perspectives about the intersections of palliative care with oncology nursing may limit timely consultation with specialty palliative care teams. The current acute care context poses challenges to implementing palliative care. INTERPRETATION Palliative care teams and oncology nurses need to develop partnership models that clearly illustrate how both partners contribute to palliative care across the continuum of oncology care. Furthermore, the partnership models must address barriers that the acute care context poses to quality palliative care.
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Affiliation(s)
- Carol Pavlish
- School of Nursing, University of California, Los Angeles, USA.
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30
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Educating RNs Regarding Palliative Care in Long-Term Care Generates Positive Outcomes for Patients With End-Stage Chronic Illness. J Hosp Palliat Nurs 2007. [DOI: 10.1097/01.njh.0000299316.45256.f3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Sanjo M, Miyashita M, Morita T, Hirai K, Kawa M, Akechi T, Uchitomi Y. Preferences regarding end-of-life cancer care and associations with good-death concepts: a population-based survey in Japan. Ann Oncol 2007; 18:1539-47. [PMID: 17660496 DOI: 10.1093/annonc/mdm199] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aims of this study were to clarify end-of-life cancer care preferences and associations with good-death concepts. METHODS The general population was sampled using a stratified random sampling method (N = 2548; response rate = 51%) and bereaved families from 12 certified palliative care units ('PCU-bereaved families') were surveyed (N = 513; response rate = 70%). The respondents reported their end-of-life care preferences and good-death concepts. RESULTS Regarding place of end-of-life care, approximately 50% of the general population preferred 'Home', while 73% of PCU-bereaved families preferred 'PCU'. The concepts of 'Maintaining hope and pleasure' and 'Dying in a favorite place' were associated with the preference for 'Home'. Regarding prognostic disclosure, approximately 50% of the participants preferred some level of negotiation with the physician. The concept of 'Control over the future' was associated with this preference. Regarding treatment of severe refractory physical distress, 75% of the general population and 85% of the PCU-bereaved families preferred palliative sedation therapy. The concepts of 'Physical and psychological comfort' and 'Unawareness of death' were associated with this preference. CONCLUSIONS End-of-life care preferences were associated with good-death concepts. It would be useful for health-care workers to discuss patients' good-death concepts to support subsequent treatment decisions.
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Affiliation(s)
- M Sanjo
- Department of Adult Nursing/Palliative Care Nursing, Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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32
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Agren Bolmsjö I, Nilstun T, Löfmark R. From cure to palliation: agreement, timing, and decision making within the staff. Am J Hosp Palliat Care 2007; 24:366-70. [PMID: 17601832 DOI: 10.1177/1049909107300213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Important issues in the transition from curative treatment to palliative care are agreement, timing, and decision making. A survey of 309 nurses and 415 physicians in Sweden showed that 61% of the nurses and 83% of the physicians thought agreement was current practice. None said that the decisions were made too early, but 19% of the nurses and 14% of the physicians thought that they often were made too late. Very few respondents stated that such decisions are changed, 0% and 1%, respectively. More than half of the informants made detailed comments on such transitions indicating that awareness and flexibility are desirable to make well-informed decisions. Three themes that emerged from the analysis concerning the decision to stop curative treatment and focus on palliative care were that the staff members should (if possible) make such decisions in agreement and should sometimes make the decisions earlier and that well-based reasons are required to make changes.
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33
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Perkins P, Moughton M, Grove S, Thornton S, Vowler SL. Can the use of videos of people who have had a positive experience of hospice help patients to make decisions about admission? Pilot study. Palliat Med 2007; 21:356-8. [PMID: 17656414 DOI: 10.1177/02692163070210040402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Canning D, Rosenberg JP, Yates P. Theraputic relationships in specialist palliative care nursing practice. Int J Palliat Nurs 2007; 13:222-9. [PMID: 17577174 DOI: 10.12968/ijpn.2007.13.5.23492] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked.
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Affiliation(s)
- Deebs Canning
- Marie Curie Cancer Care and Thames Valley University, London, UK
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35
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Abstract
Corneal donation occurs infrequently within palliative care, even though the majority of the public say they are in favour of donating organs and tissue after death. One of the roles of the health professional is to provide patients with the necessary information to make choices, and this should include the option of donating their corneas should they so wish. This literature review explores how the subject can be raised in a systematic manner within palliative care. It looks at the potential benefits and dangers of involving the patient in such discussions, and the effects on the families. Practical issues, such as when to raise the issue, are also considered. Finally, the review discusses the implications for nursing practice and research.
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Affiliation(s)
- Philip Edwards
- St Margaret's Hospice, Little Tarrant Lane, Yeovil, Somerset BA20 2HU, UK.
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36
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Duggleby W, Berry P. Transitions and shifting goals of care for palliative patients and their families. Clin J Oncol Nurs 2005; 9:425-8. [PMID: 16117209 DOI: 10.1188/05.cjon.425-428] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Terminally ill patients and their families experience many confusing and, at times, traumatic transitions. Examples of such transitions include transitions from cure to comfort care, transitions related to loss, changes in care settings, and psychosocial and spiritual transitions. The purpose of this article is to discuss the experiences of palliative patients and their families as they journey through transitions and how oncology nurses can provide support. Using a composite case study from actual clinical cases as a framework for discussion, the authors present examples of evidence-based strategies that can be used by oncology nurses. Critical points from the case study are Adjustment to death is a process and cannot be rushed. The needs of a palliative patient and family should be heard, honored, and not questioned or challenged. A patient and family should remain in control of decision making, with the hospice and palliative care team acting as guides and facilitators.
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37
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Abstract
Symptom relief in palliative care is dependent on the nurse undertaking a holistic general and symptom assessment and integrating these findings into a logical plan of care that can be evaluated against a set of negotiated goals. This article outlines the nature of the holistic assessment and how the establishment and maintenance of the therapeutic relationship can help the nurse to relieve distress, restore hope and enable the patient and family to achieve a good quality of life. Careful attention to the fundamentals of nursing practice, coupled with effective communication, will be shown to enhance the prospect of the patient, their family and the nurse feeling valued and enriched by encounters associated with symptom relief.
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Affiliation(s)
- David Maher
- Department of Nursingand Midwifery, University of Hertfordshire.
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38
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Abstract
Breathlessness is one of the commonest symptoms experienced by people receiving palliative care. However, misunderstanding of the nature of palliative care may hinder assessment, management and evaluation of care and may contribute to the fear associated with living with breathlessness in the community. Knowledge of related anatomy and physiology of breathlessness is vital in informing nursing care and interventions. Pharmacological interventions have their place, but the focus of nursing care should be on systematic holistic assessment. Using this, nurses should adopt a proactive role in supporting and helping patients to adapt to change by maximizing coping strategies.
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Affiliation(s)
- David Maher
- Department of Nursing and Midwifery, University of Hertfordshire, UK.
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39
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Abstract
Good communication with patients can be a powerful tool in palliative care. However, discussing fears and anxieties at length is also something that many nurses find difficult. This article provides an overview of one approach to using the power of communication, the end-of-life discussion. Practical issues are considered, as well as suggestions as to what to include in such a discussion. Concepts of loss and meaning for the person with advanced disease are looked at. The article also considers some of the key communication skills that are especially valuable, such as active listening, ways of encouraging disclosure and the handling of silences.
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Affiliation(s)
- Phil Edwards
- St Margaret's Hospice, Heron Drive, Bishop's Hull, Taunton, Somerset TA1 5HA, UK
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40
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Ahmed N, Bestall JC, Ahmedzai SH, Payne SA, Clark D, Noble B. Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med 2004; 18:525-42. [PMID: 15453624 DOI: 10.1191/0269216304pm921oa] [Citation(s) in RCA: 262] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the problems and issues of accessing specialist palliative care by patients, informal carers and health and social care professionals involved in their care in primary and secondary care settings. DATA SOURCES Eleven electronic databases (medical, health-related and social science) were searched from the beginning of 1997 to October 2003. Palliative Medicine (January 1997-October 2003) was also hand-searched. STUDY SELECTION Systematic search for studies, reports and policy papers written in English. DATA EXTRACTION Included papers were data-extracted and the quality of each included study was assessed using 10 questions on a 40-point scale. RESULTS The search resulted in 9921 hits. Two hundred and seven papers were directly concerned with symptoms or issues of access, referral or barriers and obstacles to receiving palliative care. Only 40 (19%) papers met the inclusion criteria. Several barriers to access and referral to palliative care were identified including lack of knowledge and education amongst health and social care professionals, and a lack of standardized referral criteria. Some groups of people failed to receive timely referrals e.g., those from minority ethnic communities, older people and patients with nonmalignant conditions as well as people that are socially excluded e.g., homeless people. CONCLUSIONS There is a need to improve education and knowledge about specialist palliative care and hospice care amongst health and social care professionals, patients and carers. Standardized referral criteria need to be developed. Further work is also needed to assess the needs of those not currently accessing palliative care services.
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Affiliation(s)
- N Ahmed
- Academic Palliative Medicine Unit, Division of Clinical Sciences (South), University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.
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