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Senger A, Venetis MK, Greene K, Catona D, Devine KA. Healthcare provider assessments of caregiver communication behaviors during gynecologic Cancer treatment appointments. PEC INNOVATION 2024; 4:100259. [PMID: 38347863 PMCID: PMC10859277 DOI: 10.1016/j.pecinn.2024.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
Objective Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes. Methods Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers. Results Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges. Conclusion HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs. Innovation HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.
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Affiliation(s)
- Angela Senger
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
| | - Maria K. Venetis
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Kathryn Greene
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Danielle Catona
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD 20742-2611, USA
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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2
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Mastropolo R, Altschuler A, Brock KE, Casperson M, Chao CR, Fisher L, Greenzang KA, Kushi LH, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Mack JW. Patient, Caregiver, and Clinician Perspectives on Core Components of Therapeutic Alliance for Adolescents and Young Adults With Advanced Cancer: A Qualitative Study. JAMA Netw Open 2023; 6:e2328153. [PMID: 37556137 PMCID: PMC10413170 DOI: 10.1001/jamanetworkopen.2023.28153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
Importance The patient-clinician therapeutic alliance is an important aspect of high-quality cancer care. However, components of the therapeutic alliance in adolescents and young adults (AYAs, aged 12-39 years) with cancer have not been defined. Objective To identify components of and barriers to the therapeutic alliance between AYAs, caregivers, and clinicians from the perspective of all key stakeholders. Design, Setting, and Participants In this qualitative study, semistructured in-depth interviews with patients, caregivers, and clinicians were conducted from 2018 to 2021 with no additional follow-up, with content analysis of resulting transcripts. Participants were recruited from Dana-Farber Cancer Institute, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and an online cancer support community (Cactus Cancer Society). Eligible participants were English- or Spanish-speaking. Eligible patients were aged 12 to 39 years with stage IV or recurrent cancer. Eligible caregivers cared for an AYA living with advanced cancer or one who had died within 5 years. Eligible clinicians routinely provided care for AYAs with cancer. Main Outcomes and Measures Perspectives on therapeutic alliance. Results Interviews were conducted with 80 participants: 23 were patients (48% were female; 78% were White), 28 were caregivers (82% were female; 50% were White), and 29 were clinicians (69% were female; 45% were White). The mean (SD) age of patients was 29 (7.3) years. Interviews identified 6 components of therapeutic alliance: (1) compassion; (2) sense of connection; (3) clinician presence; (4) information sharing; (5) shared goals; and (6) individualization of care. While some domains were represented in prior models of therapeutic alliance, a unique domain was identified related to the need for individualization of the approach to care for AYA patients and their caregivers. Interviews also identified potential barriers to building the therapeutic alliance specific to the AYA population, including managing discordant needs between patients and caregivers and communication challenges at the end of life. Conclusions and Relevance This study identified core components and barriers to building therapeutic alliance in the AYA advanced cancer population from the perspective of all the key stakeholders in the relationship. A novel component highlighting the need for individualization was identified. This model enables a deeper understanding of how to build therapeutic alliance in the AYA advanced cancer population, which may guide clinician training and facilitate improved care for this vulnerable population.
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Affiliation(s)
- Rosemarie Mastropolo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Katharine E. Brock
- Department of Pediatric Oncology, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Mallory Casperson
- Divisions of Pediatric Oncology and Palliative Care, Cactus Cancer Society, Oakland, California
| | - Chun R. Chao
- Department of Research and Evaluation (C.R.C.), Kaiser Permanente Southern California, Pasadena
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Joshua R. Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey M. Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland
| | - Dov M. Shalman
- Department of Palliative Care, Kaiser Permanente Southern California, Pasadena
| | - Catherine B. Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Yadav S, Jayaseelan V, Pandjatcharam J, Roy G, Susindran B, Ravel V. Facilitators and Challenges in Patient's Satisfaction with Quality of Cervical Cancer Care in a Tertiary Care Hospital, Puducherry, India: A Qualitative Study. South Asian J Cancer 2023; 12:250-255. [PMID: 38047055 PMCID: PMC10691913 DOI: 10.1055/s-0043-1761283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Shikha YadavBackground Chronic diseases require more attention in terms of patient satisfaction due to their physically and mentally exhausting nature. Cancer burden in India for 2021 was 26.7 million disability-adjusted life years (DALYs), and is projected to rise to 29.8 million by 2025. The second most common cause of cancer DALYs among females was cervix uteri (98.6 per 100,000). Evaluation of factors that influence satisfaction can assist in finding solutions to improve the quality of services provided. Methods This study was conducted in the Regional Cancer Centre, Puducherry. One focused group discussion (FGD) was conducted among seven cervical cancer patients and eight key informant interviews (KII) with their healthcare providers (HCPs). The details collected included perceptions of patient satisfaction, difficulties they faced in achieving patient satisfaction, and possible recommendations for improvement. Thematic analysis was done after preparing transcripts. Results The major facilitating factors reported were proper information exchange, the approachability of staff, and assisting patients with transportation concession certificates. Obstacles highlighted by patients included lack of family support, side effects of treatment, inability to do routine work, and long travel time. HCP reported misalignment between and within departments, overworked staff, lack of equipment for smooth telemedicine services, and inadequate space for OPD, counseling, and waiting as barriers to providing satisfactory services to patients. Conclusions Most challenges were attributed to overworked staff, inequitable distribution of cancer center, and patients' knowledge and understanding of disease. Therefore, it is important to make patients aware of the disease, treatment, and value of the quality of life. It can enable them to make better use of resources, in addition to improvements in the health system.
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Affiliation(s)
- Shikha Yadav
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Venkatachalam Jayaseelan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jagadesan Pandjatcharam
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balaji Susindran
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vanessa Ravel
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kroll L, Mathew A, Baldini G, Hosch R, Koitka S, Kleesiek J, Rischpler C, Haubold J, Fuhrer D, Nensa F, Lahner H. CT-derived body composition analysis could possibly replace DXA and BIA to monitor NET-patients. Sci Rep 2022; 12:13419. [PMID: 35927564 PMCID: PMC9352897 DOI: 10.1038/s41598-022-17611-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Patients with neuroendocrine tumors of gastro-entero-pancreatic origin (GEP-NET) experience changes in fat and muscle composition. Dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) are currently used to analyze body composition. Changes thereof could indicate cancer progression or response to treatment. This study examines the correlation between CT-based (computed tomography) body composition analysis (BCA) and DXA or BIA measurement. 74 GEP-NET-patients received whole-body [68Ga]-DOTATOC-PET/CT, BIA, and DXA-scans. BCA was performed based on the non-contrast-enhanced, 5 mm, whole-body-CT images. BCA from CT shows a strong correlation between body fat ratio with DXA (r = 0.95, ρC = 0.83) and BIA (r = 0.92, ρC = 0.76) and between skeletal muscle ratio with BIA: r = 0.81, ρC = 0.49. The deep learning-network achieves highly accurate results (mean Sørensen-Dice-score 0.93). Using BCA on routine Positron emission tomography/CT-scans to monitor patients’ body composition in the diagnostic workflow can reduce additional exams whilst substantially amplifying measurement in slower progressing cancers such as GEP-NET.
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Affiliation(s)
- Lennard Kroll
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. .,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
| | - Annie Mathew
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, Essen, Germany
| | - Giulia Baldini
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Sven Koitka
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | | | - Johannes Haubold
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Harald Lahner
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, Essen, Germany
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Fringer A, Stängle S, Bischofberger I, Büche D, Praxmarer R, Ch Ott S, Schnepp W. Experiences of relatives with outpatient palliative care: a cross-sectional study. Int J Palliat Nurs 2021; 26:230-237. [PMID: 32584687 DOI: 10.12968/ijpn.2020.26.5.230] [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: 11/11/2022]
Abstract
AIM The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN A cross-sectional survey. METHODS A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.
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Affiliation(s)
- André Fringer
- Professor for Family-Centered Care; Co-Head MSc Nursing and Co-Head Research Unit Nursing, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Sabrina Stängle
- Research Associate, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Iren Bischofberger
- Professor for Applied Research and Clinical Excellence in Nursing, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
| | - Daniel Büche
- Head Physician Palliative Care Centre, Cantonal Hospital St.Gallen, St. Gallen, Switzerland
| | - Renate Praxmarer
- Co-Head of Palliative Bridge Service, Cancer League of Eastern Switzerland, Bern, Switzerland
| | - Stefan Ch Ott
- Professor of Economics, FHS St.Gallen University of Applied Sciences, Department of Economics, St.Gallen, Switzerland
| | - Wilfried Schnepp
- Head of the Department for Family-Oriented and Community Care, Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
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6
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Melis P, Galletta M, Aviles Gonzalez CI, Contu P, Jimenez Herrera MF. Experiencing communication related to knowing the cancer diagnosis and prognosis: A multi-perspective interpretative phenomenological study. Eur J Oncol Nurs 2021; 51:101904. [PMID: 33578333 DOI: 10.1016/j.ejon.2021.101904] [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: 05/03/2020] [Revised: 12/12/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the phenomenon of communication related to knowing the diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses. METHODS Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) -who were linked by a carer-cared relationship-were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants' narratives. RESULTS Two overarching themes were identified: The first theme "the «what is it?» and the «what will happen to me?»" illustrates the two different paths of communication of diagnosis and prognosis. The second theme "Matching and mismatching in identifying the others as speakers" shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions. CONCLUSIONS Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses' perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
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Affiliation(s)
- Paola Melis
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | | | - Paolo Contu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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7
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Mitchell KAR, Brassil KJ, Rodriguez SA, Tsai E, Fujimoto K, Krause KJ, Shay LA, Springer AE. Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences. Psychooncology 2020; 29:1723-1733. [PMID: 32715542 PMCID: PMC7901502 DOI: 10.1002/pon.5500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Efficiently addressing patient priorities and concerns remains a challenge in oncology. Systematic operationalization of patient-centered care (PCC) can support improved assessment and practice of PCC in this unique care setting. This review aimed to synthesize the qualitative empirical literature exploring the National Academy of Medicine (NAM)'s PCC constructs of values, needs, and preferences among patients' during their cancer treatment experiences. METHODS A systematic review of qualitative studies published between 2002 and 2018 addressing adult patient values, needs, and preferences during cancer treatment was conducted. Medline, EMBASE, PsycINFO, and SCOPUS databases were searched on September 10, 2018. Methodological rigor was assessed using a modified version of the Evaluation Tool for Qualitative Studies. Included study findings were analyzed using line-by-line coding; and the emergent themes were compared to the National Academy of Medicine (NAM)'s PCC dimensions. RESULTS Twenty-nine primary studies were included in the synthesis. Descriptive themes for values (autonomy, being involved, family, hope, normality, and sincerity), needs (care coordination, information, privacy, support of physical well-being, emotional support (family/friends, peer, provider), and self-support), and preferences (care coordination, decision-making, information delivery, source of social support, and treatment) were identified. "Cancer care context" emerged as an important domain in which these constructs are operationalized. This thematic framework outlines PCC attributes that oncology care stakeholders can evaluate to improve patient experiences. CONCLUSIONS These findings build on previous PCC research and may contribute to the systematic assessment of patient priorities and the improvement of oncology care quality from the patient perspective.
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Affiliation(s)
- Kerri-Anne R. Mitchell
- Department of Health Behavior and Policy, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Tsai
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, Missouri
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences,
The University of Texas Health Science Center at Houston (UTHealth) School of Public
Health, Houston, Texas
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD
Anderson Cancer Center, Houston, Texas
| | - L. Aubree Shay
- Department of Health Promotion & Behavioral Sciences,
UTHealth School of Public Health, San Antonio, Texas
| | - Andrew E. Springer
- Michael & Susan Dell Center for Healthy Living,
Department of Health Promotion & Behavioral Sciences, UTHealth School of Public
Health, Austin, Texas
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Sibeoni J, Verneuil L, Manolios E, Révah-Levy A. A specific method for qualitative medical research: the IPSE (Inductive Process to analyze the Structure of lived Experience) approach. BMC Med Res Methodol 2020; 20:216. [PMID: 32847514 PMCID: PMC7449004 DOI: 10.1186/s12874-020-01099-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper reports the construction and use of a specific method for qualitative medical research: The Inductive Process to Analyze the Structure of lived Experience (IPSE), an inductive and phenomenological approach designed to gain the closest access possible to the patients' experience and to produce concrete recommendations for improving care. This paper describes this innovative method. METHODS IPSE has five steps: 1) set up a research group, 2) ensure the originality of the research, 3) organize recruitment and sampling intended to optimize exemplarity, 4) collect data that enable entry into the subjects' experience, and 5) analyze the data. This final stage is composed of one individual descriptive phase, followed by two group phases: i) structure the experience, and ii) translate the findings into concrete proposals that make a difference in care. RESULTS This innovative method has provided original findings that have opened up new avenues of research and have important practical implications, including (1) the development of patient-reported outcomes, (2) clinical recommendations concerning assessment and treatment, (3) innovative ways to improve communication between patients and doctors, and (4) new insights for medical pedagogy. CONCLUSIONS IPSE is a qualitative method specifically developed for clinical medical research to reach concrete proposals, easily combined with quantitative research within a mixed-method study design and then directly integrated within evidence-based medicine.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France. .,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Anne Révah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prud'hon, 95107 ARGENTEUIL Cedex, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
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9
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Melis P, Galletta M, Gonzalez CIA, Contu P, Herrera MFJ. Ethical perspectives in communication in cancer care: An interpretative phenomenological study. Nurs Ethics 2020; 27:1418-1435. [PMID: 32406310 DOI: 10.1177/0969733020916771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In cancer care, many clinical contexts still lack a good-quality patient-health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. OBJECTIVE To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. METHODS A qualitative study using interpretative phenomenological analysis was performed. PARTICIPANTS AND RESEARCH CONTEXT Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. ETHICAL CONSIDERATIONS Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. RESULTS Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. CONCLUSION The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them 'to choose with dignity and being aware of it'. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
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Affiliation(s)
- Paola Melis
- 3111University of Cagliari, Italy.,16777Universitat Rovira i Virgili, Spain
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10
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Mitchell KAR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:351-361. [PMID: 32197731 PMCID: PMC7086403 DOI: 10.1016/j.jval.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/26/2019] [Accepted: 10/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To increase the understanding of patient-centered care (PCC) and address the need for cross-cutting quality cancer care measures that are relevant to both patients and providers. METHODS An exploratory factor analysis (EFA) was performed on a short version of the Patients and the Cancer Care Experience Survey, a patient-reported measure of perceived importance of social, emotional, physical, and informational aspects of care, administered to adult patients (n = 104) at a National Cancer Institute-designated comprehensive cancer center. Relationships between PCC dimensions and patient characteristics were also assessed. Principal axis factoring was applied and bivariate analyses were performed using Wilcoxon rank-sum tests. RESULTS Most of our sample was over 60 years old (63.4%), female (57.4%), and white (74.2%), with either breast (41.2%) or prostate cancer (27.5%). A 5-factor model was identified: (1) quality of life (α = .91), (2) provider social support (α = .83), (3) psychosocial needs (α = .91), (4) nonprovider social support (α = .79), and (5) health information and decision-making support (α = .88). No statistically significant associations were found between these factors and patients' characteristics. CONCLUSIONS A preliminary factor structure for a cancer PCC measure was identified. Our findings reinforce the interrelated nature of PCC dimensions. The lessons learned from this study may be used to develop a single PCC measure that identifies patient priorities across the cancer care continuum. Data collected from such a measure can be used to support patient engagement in treatment planning and decision-making.
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Affiliation(s)
- Kerri-Anne R Mitchell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Aubree Shay
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
| | - Andrew E Springer
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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Hannum SM, Dy SM, Smith KC, Kamal AH. Proposed Criteria for Systematic Evaluation of Qualitative Oncology Research. J Oncol Pract 2019; 15:523-529. [PMID: 31386609 DOI: 10.1200/jop.19.00125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oncology has made significant advances in standardizing how clinical research is conducted and reported. The advancement of such research that improves oncology practice requires an expansion of not only our research questions but also the research methods we deploy to address them. In particular, there is increasing recognition of the value of qualitative research methods to develop more comprehensive understandings of phenomena of interest and to describe and explain underlying motivations and potential causes of specific outcomes. However, qualitative researchers in oncology have lacked guidance to produce and evaluate methodologically rigorous qualitative publications. In this review, we highlight characteristics of high-quality, methodologically rigorous reports of qualitative research, provide criteria for readers and reviewers to appraise such publications critically, and proffer guidance for preparing publications for submission to Journal of Oncology Practice. Namely, the quality of qualitative research in oncology practice is best assessed according to key domains that include fitness of purpose, theoretical framework, methodological rigor, ethical concerns, analytic comprehensives, and the dissemination/application of findings. In particular, determinations of rigor in qualitative research in oncology practice should consider definitions of the appropriateness of qualitative methods for the research objectives against the setting of current literature, use of an appropriate theoretical framework, inclusion of a rigorous and innovative measurement plan, application of appropriate analytic techniques, and clear explanation and dissemination of the research findings.
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Affiliation(s)
- Susan M Hannum
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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12
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Sibeoni J, Manolios E, Verneuil L, Chanson P, Revah-Levy A. Patients' perspectives on acromegaly diagnostic delay: a qualitative study. Eur J Endocrinol 2019; 180:339-352. [PMID: 30939451 DOI: 10.1530/eje-18-0925] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 12/27/2022]
Abstract
Context Acromegaly has a substantial diagnostic delay associated with an increased risk of comorbidities and psychosocial deterioration. Qualitative methods which focus on the ways that individuals understand and relate to what they are experiencing are the best methods for exploring patients' perspectives. To the best of our knowledge, they have not been developed in the context of acromegaly. Objectives This study aimed to explore the experience of the diagnostic pathway of patients with acromegaly. Design We conducted a qualitative study, based on 20 face-to-face unstructured interviews in a third referral Endocrinology center. Participants, purposively selected until data saturation, were patients with acromegaly with diverse disease durations, types of treatment or associated comorbidities. The data were examined by thematic analysis. Results Our analysis found four themes: (i) what happened for patients before the diagnosis; (ii) what happened after; (iii) the style or type of doctor involved and (iv) patients' suggestions for limiting diagnostic delay. Our findings underlined the direct associations between diagnostic delay and the doctor-patient encounter, and the truly catastrophic experience of this disease, both before and after the diagnosis. Conclusions Diagnosis of acromegaly requires active medical involvement and awareness. Intervention of patient-experts in medical schools may help to be more aware of this disease. Endocrinologists caring for patients with acromegaly should also address the catastrophic dimension of the patient's experience and initiate the narrative to help them to put it into words for preventing harmful consequences such as social isolation and QoL impairment, but also anxiety or depression.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cité, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cité, France
- Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cité, France
| | - Philipe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Le Kremlin Bicêtre, France
- UMR S 1185, Fac Med Paris Sud, Univ Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cité, France
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