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Wu WD, Wang Y, Fu XY, Zhang JH, Zhang CY, Mao XL, Li SW. Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses. BMC Nurs 2024; 23:431. [PMID: 38918784 PMCID: PMC11201785 DOI: 10.1186/s12912-024-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To explore the perception of good death of patients with end-stage cancer by nurses in the oncology department. METHOD In the study we used a phenomenological approach and semi-structured interviews. A total of 11 nurses from the oncology department of a Grade A hospital in Taizhou were interviewed on the cognition of good death from July 1 to September 30, 2022. Colaizzi's analysis method was used to analyse the interview data. This study followed the consolidated criteria for reporting qualitative research (COREQ). RESULT Four themes were identified: a strong sense of responsibility and mission; To sustain hope and faith; The important role of family members; Improve patients' quality of life. CONCLUSION The nurses in the department of oncology have a low level of knowledge about the "good death", and the correct understanding and view of the "good death" is the premise of the realization of " good death". The ability of nursing staff to improve the "good death", attention, and meet the needs and wishes of individuals and families, is the guarantee of the realization of "good death".
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Affiliation(s)
- Wei-Dan Wu
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Yi Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Xin-Yu Fu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Jin-Hua Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Chen-Yang Zhang
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
| | - Shao-Wei Li
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
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Liu J, Dai F, Song Q, Sun J, Liu Y. "I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors. BMC Med Ethics 2024; 25:72. [PMID: 38902648 PMCID: PMC11188161 DOI: 10.1186/s12910-024-01074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources. AIM This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it. METHOD Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method. STUDY FINDINGS This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress. CONCLUSION The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.
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Affiliation(s)
- Jiajun Liu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Fengling Dai
- School of Nursing, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Qitai Song
- Department of Emergency Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Jian Sun
- School of Nursing, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Yao Liu
- Department of Emergency Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan Province, 646000, China.
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Xu H, Yuan M. Family roles in informed consent from the perspective of young Chinese doctors: a questionnaire study. BMC Med Ethics 2024; 25:2. [PMID: 38172849 PMCID: PMC10765650 DOI: 10.1186/s12910-023-00999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient's informed consent, which creates a unique "doctor-family-patient" model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent. METHODS A questionnaire was developed including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson's chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant. RESULTS Our data shows that only 20 doctors (5.40%) stated "informing the patient alone is sufficient" when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient's medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients. CONCLUSIONS (1) Chinese doctors pay extra attention to informing the patient's family, which may not be in the patient's best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients "in the best interest of the patient," the majority choose to comply with the request, although this may cause them distress.
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Affiliation(s)
- Hanhui Xu
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Mengci Yuan
- School of Medicine, Nankai University, Tianjin, 300071, China.
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Ayalew EA, Mphuthi DD, Matlhaba KL. Patients' preferences for delivering bad news in palliative care in Ethiopia: a qualitative study. BMC Palliat Care 2023; 22:170. [PMID: 37924030 PMCID: PMC10623733 DOI: 10.1186/s12904-023-01275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND One of the major challenges for healthcare professionals relates to awareness of patients' preferences relative to how and when to break bad news and how much information should be disclosed in the eventuality of a serious medical diagnosis or prognosis. On occasions, a serious medical diagnosis or prognosis is withheld from the patient. There is a scarcity of evidence about cultural preferences regarding breaking bad news in the palliative care setting in Ethiopia. Therefore, it is necessary to understand the surrounding cultural issues to properly convey bad news. The purpose of the study was to explore Ethiopian patients' cultural preferences for receiving bad news in a palliative care setting. METHODS A qualitative research approach and nonprobability, purposive sampling method were applied. In-depth interviews were employed to collect data from eight patients who were diagnosed with cancer and cancer with HIV/AIDS during the time of data collection. Thematic analysis was applied to identify themes and subthemes. The data were transcribed verbatim and analysed using ATLAS.ti 22 computer software. RESULTS The following three themes emerged and are reported in this study: (1) Perceptions about life-threatening illness: religious values and rituals are essential for establishing perspectives on life-threatening illnesses and preferences in receiving bad news. (2) Experiences with life-threatening illness: study participants' experience with the method of breaking bad news was sad, and they were not provided with sufficient details about their medical condition. Making appropriate decisions, fulfilling the ordinance of religious faith, and avoiding unnecessary costs were outlined as benefits of receiving bad news. (3) Preferred ways of breaking bad news; the findings revealed that incremental, amiable and empathic methods for delivering bad news were preferred. It was suggested that the presence of family members is crucial when receiving bad news. CONCLUSION Patients choose to be told about their medical conditions in the presence of their family. However, the patient's needs for receiving bad news were unmet. Patients should be involved in the treatment decision process. Delivery of bad news needs to tailor the preferred methods, cultural values, and religious beliefs. Delivering bad news according to the patients' preferences helps to fulfil their wishes in palliative care.
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Affiliation(s)
| | - Ditaba David Mphuthi
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Chen C, Cheng G, Chen X, Yu L. Information disclosure to cancer patients in Mainland China: A meta-analysis. Psychooncology 2023; 32:342-355. [PMID: 36582008 DOI: 10.1002/pon.6085] [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: 08/09/2022] [Revised: 12/10/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aims to systematically examine Chinese cancer patients' and families' preferences for information disclosure to the patient, patient awareness, and predictors of patient awareness. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Web of Science, Scopus, Proquest, Taylor & Francis Online, and China National Knowledge Infrastructure were searched in April 2022 and Chinese Biomedical Literature Database in July 2022 for quantitative studies. The Mixed Methods Appraisal Tool was used for quality assessment. RESULTS A total of 22 studies were included, and the average quality score was 0.65/1. Meta-analyses showed that 89.6% and 81.8% of cancer patients wanted to know their diagnosis and prognosis, respectively. Meanwhile, 50.0% and 32.4% of families prefer diagnosis disclosure and prognosis disclosure to the patient, respectively. Significantly more patients than families favored disclosure to the patient. In reality, only 59.3% of cancer patients know their diagnosis, and 19.9% know their prognosis. For predictors, while patients' gender, cancer type (breast cancer or not), treatment method (operation or other), or complications (yes or no) do not influence diagnosis awareness, being younger, being married, having higher educational attainment, having early-stage rather than late-stage cancer, and being in a higher-grade hospital all predict better chances of knowing a diagnosis. No study explored predictors of patients' prognosis awareness. The findings did not vary according to publication time or sample size. CONCLUSIONS Chinese cancer patients are eager to know their diagnosis and prognosis, but families are hesitant about disclosure to the patient, and patients' awareness is low. While cultural, legal, and medical backgrounds lay the foundation for information disclosure in Mainland China, case-by-case practical factors also make a difference.
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Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Guobin Cheng
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Xiaoying Chen
- Department of Philosophy and Science, School of Humanities, Southeast University, Nanjing, China
| | - Lingling Yu
- Department of Philosophy and Science, School of Humanities, Southeast University, Nanjing, China
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Hou Y, Chen Y, Lai S, Seery S, Wang L, Li X, Liu H, Qin C, Li W, Lu X, Liu C, Wang J, Xu T. Decision regret related to urinary diversion choices after cystectomy among Chinese bladder cancer patients. Cancer Med 2023; 12:4786-4793. [PMID: 36271485 PMCID: PMC9972133 DOI: 10.1002/cam4.5281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
AIM To explore factors associated with decision regret after cystectomy among Chinese bladder cancer patients. METHODS This cross-sectional study involved 112 patients, who had received radical bladder cancer resection. Participants were recruited from August 2021 until January 2022. The decision regret scale (DRS), decision conflict scale (DCS), and the Functional Assessment of Cancer Therapy-Bladder cancer (FACT-BL) form were used to measure decision regret, decision conflict, and quality of life. Investigator-designed items further explored perceptions involved in decision-making participation and outcomes. RESULTS The average score for decision regret was 26.21 (SD 15.886), while decision conflict was 20.27 (SD 13.375) and quality of life was 94.74 (SD 20.873). 57.1% of our participants had a little knowledge about the quality of life of patients who chose an alternate urinary diversion method; however, only 13.4% reported having a clear understanding. In addition, 8.9%, 26.8%, and 36.6% thought that quality of life related to alternate decisions was poor, average, or good, respectively. Multiple regression analysis suggested that decision regret is associated with decision conflict, quality of life, and the perceptions that others (who took alternate urinary diversion decisions) had a better quality of life. CONCLUSION Decision regret is common among Chinese bladder cancer patients, after cystectomy. The prevalence of regret appears to be much higher in Chinese bladder cancer patients compared to similar studies from other regions. Decisions in mainland China are often made by the treating physician or by family members which may cause more profound regret. However, education and economic status are positively related to higher levels of regret which creates questions around knowing, participation, and expectations, which must be explored.
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Affiliation(s)
- Yinmeng Hou
- Urology DepartmentPeking University People's HospitalBeijingChina
| | - Yiqian Chen
- Urology DepartmentPeking University People's HospitalBeijingChina
| | - Shicong Lai
- Urology DepartmentPeking University People's HospitalBeijingChina
| | - Samuel Seery
- Lancaster University, Faculty of Health and MedicineLancasterUK
| | - Ling Wang
- Office of Retirement AffairsPeking University People's HospitalBeijingChina
| | - Xiaodan Li
- Nursing DepartmentPeking University People's HospitalBeijingChina
| | - Huixin Liu
- Department of Academic ResearchPeking University People's HospitalBeijingChina
| | - Caipeng Qin
- Urology DepartmentPeking University People's HospitalBeijingChina
| | - Wei Li
- Urology DepartmentThe Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao UniversityQingdaoShandongChina
| | - Xiangyun Lu
- Department of Urology, Peking Union Medical College HospitalBeijingChina
| | - Chunxia Liu
- Peking University Third HospitalBeijingChina
| | - Jia Wang
- Urology DepartmentPeking University People's HospitalBeijingChina
| | - Tao Xu
- Urology DepartmentPeking University People's HospitalBeijingChina
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Li H, Gu H, Chi C, Jiang H, Zhou Y, Jia W, Liu Q. End-of-Life Communication Skills Training for Undergraduate Nursing Students to Address Cultural Obstacles in China. J Hosp Palliat Nurs 2023; 25:E14-E23. [PMID: 36622314 DOI: 10.1097/njh.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Nurses face many difficulties and challenges related to how patients and their families deal with communication about end-of-life (EOL) care in China because of the strong influence of traditional Chinese culture. Moreover, education and training opportunities in EOL communication skills for nursing students are rare in mainland China. This study designed a progressive case involving a common EOL communication dilemma related to traditional Chinese culture and trained 50 undergraduate nursing students in EOL communication skills. A quasi-experimental design was used to compare the training outcomes of nursing students who were divided into a standardized patient simulation group and a role-playing group. The role-playing group (23 participants) was trained via group case discussion and role-playing among classmates, while the standardized patient simulation group (27 participants) completed EOL communication training by interacting with standardized patients and their families in a high-fidelity simulation. Attitudes toward death, self-confidence in EOL communication, and communication learning were evaluated in both groups during preintervention and postintervention. The results showed that all 3 variables improved after the intervention. This study shows that EOL communication skills training has a positive effect on nursing students to a certain extent.
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Zhu T, Liu D, van der Heide A, Korfage IJ, Rietjens JAC. Preferences and Attitudes Towards Life-Sustaining Treatments of Older Chinese Patients and Their Family Caregivers. Clin Interv Aging 2023; 18:467-475. [PMID: 36994430 PMCID: PMC10042169 DOI: 10.2147/cia.s395128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose The family plays a major role in medical decision-making in China. Little is known about whether family caregivers understand patients' preference for receiving life-sustaining treatments and are able to make decisions consistent with them when patients are incapable of making medical decisions. We aimed to compare preferences and attitudes concerning life-sustaining treatments of community-dwelling patients with chronic conditions and their family caregivers. Patients and Methods We conducted a cross-sectional study among 150 dyads of community-dwelling patients with chronic conditions and their family caregivers from four communities in Zhengzhou. We measured preferences for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, tube feeding, hemodialysis, chemotherapy), who should decide, the timing of making decisions, and their most important consideration. Results The consistency of preferences for life-sustaining treatments between patients and family caregivers was poor to fair, with kappa values ranging from 0.071 for mechanical ventilation to 0.241 for chemotherapy. Family caregivers more frequently preferred each life-sustaining treatment for the patients than the patients themselves. More family caregivers than patients preferred the patient to make their own decisions about life-sustaining treatments (29% of patients and 44% of family caregivers). The most important considerations when deciding on life-sustaining treatments are family burden and the patient's comfort and state of consciousness. Conclusion There is a poor to fair consistency between community-dwelling older patients and their family caregivers in their preferences and attitudes towards life-sustaining treatments. A minority of patients and family caregivers preferred that patients make their own medical decisions. We recommend healthcare professionals to encourage discussions between patients and their families on future care to improve the mutual understanding within the family about medical decision-making.
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Affiliation(s)
- Tingting Zhu
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, People’s Republic of China
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dongling Liu
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, People’s Republic of China
- Correspondence: Dongling Liu, Email
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Hu RH, Zhang HB, Yuan B, Zhang KH, Xu JY, Cui XM, Du T, Song C, Zhang S, Jiang XH. Quality and accuracy of gastric cancer related videos in social media videos platforms. BMC Public Health 2022; 22:2025. [PMID: 36335401 PMCID: PMC9636631 DOI: 10.1186/s12889-022-14417-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Gastric cancer is a major public health problem worldwide. Social media has affected public's daily lives in ways no one ever thought possible. Both TikoTok and its Chinese version Douyin are the most popular short video posting platform. This study aimed to evaluate the quality, accuracy, and completeness of videos for gastric cancer on TikTok and Douyin. METHODS The terms "gastric cancer" was searched on TikTok in both English and Japanese, and on Douyin in Chinese. The first 100 videos in three languages (website's default setting) were checked. QUality Evaluation Scoring Tool (QUEST) and DISCERN as the instrument for assessing the quality of the information in each video. Content was analysed under six categories (aetiology, anatomy, symptoms, preventions, treatments, and prognosis). The educational value and completeness were evaluated with a checklist developed by the researchers. RESULTS A total of 78 videos in English, 63 in Japanese, and 99 in Chinese were analyzed. The types of sources were as follows: 6.4% in English, 4.8% in Japanese, and 57.6% in Chinese for health professionals; 93.6% in English, 95.2% in Japanese, and 3.0% in Chinese for private users; none in English and Japanese, but 39.4% in Chinese for other sources. In all, 20.5% in English, 17.5% in Japanese, and 93.9% in Chinese of videos had useful information about gastric cancer. Among the useful videos, the videos published in Chinese had the highest QUEST(p < 0.05) and DISCERN scores(p < 0.05), followed by those published in Japanese. Among the educational videos, prognosis in English (37.5%), symptoms in Japanese (54.5%), and prevention in Chinese (47.3%) were the most frequently covered topic. CONCLUSIONS TikTok in English and Japanese might not fully meet the gastric cancer information needs of public, but Douyin in Chinese was the opposite.
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Affiliation(s)
- Ren-Hao Hu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Hai-Bin Zhang
- Center of Digestive Endoscopy, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Biao Yuan
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Ke-Hui Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jia-Yi Xu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xi-Mao Cui
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tao Du
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chun Song
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Shun Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.
| | - Xiao-Hua Jiang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.
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Perceptions of the meaning of life among Korean patients with advanced cancer: A mixed-methods study. Palliat Support Care 2022:1-12. [PMID: 36017653 DOI: 10.1017/s1478951522000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to explore perceptions of the meaning of life among Korean patients living with advanced cancer. METHOD The study employed a mixed-methods design, and 16 participants were included in the analysis. Qualitative data gathered from in-depth interviews were analyzed using Colaizzi's phenomenological method. Quantitative survey data were analyzed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, and Spearman's ρ correlation. RESULTS Participants experienced both the existence of meaning and the will to find meaning in terms of four categories: "interpersonal relationships based on attachment and cohesion" (three themes - family as the core meaning of one's life, supportive and dependent interconnectedness with significant others, and existential responsibility embedded in familism), "therapeutic relationships based on trust" (one theme - communication and trust between the patient and medical staff), "optimism" (two themes - positivity embodied through past experiences and a positive attitude toward the current situation), and "a sense of purpose with advanced cancer" (two themes - the will to survive and expectations for the near future). The meaning in life questionnaire (MLQ) and the purpose in life scale (PIL) showed a significant positive correlation tendency with the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). The patient health questionnaire (PHQ-9) showed significant negative correlation tendency with both the MLQ-presence of meaning (MLQ-PM) and PIL-Initiative (PIL-I) questionnaires. SIGNIFICANCE OF RESULTS Finding meaning in life helps advanced cancer patients realize their will to live. It also acts as a coping mechanism that palliates negative experiences in the fight against the disease. In particular, among advanced cancer patients in the Korean culture, the dynamics of relationships with family and medical staff was a key axis that instilled optimism and will to live. These results suggest that considering the meaning of life in advanced cancer patients by reflecting Korean culture in the treatment process improves the quality of care.
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Hahne J, Wang X, Liu R, Zhong Y, Chen X, Liu X, Khoshnood K, Li X. Chinese physicians' perceptions of palliative care integration for advanced cancer patients: a qualitative analysis at a tertiary hospital in Changsha, China. BMC Med Ethics 2022; 23:17. [PMID: 35246107 PMCID: PMC8895637 DOI: 10.1186/s12910-022-00750-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
Background Little previous research has been conducted outside of major cities in China to examine how physicians currently perceive palliative care, and to identify specific goals for training as palliative care access expands. This study explored physicians’ perceptions of palliative care integration for advanced cancer patients in Changsha, China. Methods We conducted semi-structured qualitative interviews with physicians (n = 24) specializing in hematology or oncology at a tertiary hospital. Results Most physicians viewed palliative care as equivalent to end-of-life care, while a minority considered it possible to integrate palliative care with active treatment. Almost all physicians maintained separate conversations about palliative care with family members and patients, communicating more directly with family members than with patients about prognosis and goals of care. Physicians described experiencing ethical tension between the desire of family members to protect the patient from knowing they have advanced cancer, and the patient’s “right to decide” about palliative treatment. Physicians varied overall regarding perceptions of the role they should have in discussions about goals of care. Conclusions As palliative care access expands in China, medical training should encourage earlier integration of palliative care for advanced cancer, address ethical issues faced by physicians communicating about palliative care, and establish guidance on the role of the physician in discussions about goals of care.
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Affiliation(s)
| | - Xiaomin Wang
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China.,Center for Medical Ethics, Central South University, Changsha, 410013, People's Republic of China
| | - Rui Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China
| | - Yuqiong Zhong
- School of Public Administration, Central South University, Changsha, 410075, People's Republic of China
| | - Xin Chen
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China
| | - Xing Liu
- Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | | | - Xin Li
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China.
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Li C, Lu X, Wong CL, Gao F, Chan CW. Cross-cultural adaptation and validation of a Chinese Preventive Health Model instrument for measuring the psychosocial factors in hepatocellular carcinoma screening among patients with hepatitis B. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:94-105. [DOI: 10.1016/j.anr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 03/13/2022] [Indexed: 11/02/2022] Open
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Sutar R, Chaudhary P. Prognostic disclosure in cancer care: a systematic literature review. Palliat Care Soc Pract 2022; 16:26323524221101077. [PMID: 35693193 PMCID: PMC9178750 DOI: 10.1177/26323524221101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Collusion in cancer care is the diplomatic concealment of information between a triad of the health care professional (HCP), patient, and caregiver. Free and expressive communication is determined by multiple factors, which establishes a healthy balance between ‘patient-centric’ and ‘family-centric’ decision making. The lack of a universal approach to prognostic disclosure techniques emphasizes the need for a systematic review of contemporary practice. Methods: A systematic review of the literature was conducted till June 2020 using themes based on cancer, communication, prognostic disclosure, and collusion by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Fifty-three studies involving 10,569 subjects were studied for their utility on prognostic disclosure using different communication methods and interfaces. Twenty-three studies used a face-to-face interview with subjects while in-person telephonic interviews were conducted in two studies, 16 studies implicated semi-structured questionnaires, and 6 studies mentioned the development of a new technique/tool for disclosure. The duration of a session for prognosis-disclosure ranged from 22 min to 1 h. The involvement of palliative care specialists and mental health professionals was limited during the disclosure of the prognosis. Conclusion: The findings of the review indicate that patients in cancer care are aware of their diagnosis and to a certain extent of prognosis despite nondisclosure by their family members and treating teams. This review emphasizes the assessment of ‘disclosure wishes’ among patients and caregivers in separate interviews rather than simply relying on one specific method of interviewing. The nonconfrontational approach and training among HCPs are of utmost importance to build therapeutic resilience among the treating team involved in cancer care. Since many factors such as family wishes, cultural dissonance, medical model, and patient perception could become barriers to prognostic disclosure, there is a need to develop a universal approach to prognostic disclosure and handling associated collusion.
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Affiliation(s)
- Roshan Sutar
- Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, Saket Nagar, Bhopal 462020, India
| | - Pooja Chaudhary
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, Bhopal, India
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Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety, Depression and Spiritual Well-Being: A Multi-Country Study in Asia. Clin Oncol (R Coll Radiol) 2021; 34:368-375. [PMID: 34930691 DOI: 10.1016/j.clon.2021.11.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
AIMS The associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer). MATERIALS AND METHODS In total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics. RESULTS Compared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes. CONCLUSIONS The results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness.
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Ni P, Wu B, Lin H, Mao J. Advance directives and end-of-life care preferences among adults in Wuhan, China: a cross-sectional study. BMC Public Health 2021; 21:2042. [PMID: 34749682 PMCID: PMC8574939 DOI: 10.1186/s12889-021-12046-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background Little is known about advance directives (ADs) and end-of-life (EOL) care preferences among the general population in Mainland China. This study aimed to describe knowledge and attitudes of ADs and EOL care preferences, and to explore factors related to preferences for ADs among Chinese adults. Methods The sample included 1114 adult participants in Wuhan, Mainland China. A brief message including the link to the online survey was sent to local residents who were registered at household registration management centers in Wuhan. The questionnaire included information regarding demographics, self-rated health, views on ADs and EOL care. Bivariate analyses and binary forward logistic regression were conducted to examine factors related to ADs preferences of Chinese adults. Results The average age of the sample was 48.0 years and more than half of the sample was female. 81.8% had never heard of ADs, but 86.6% indicated that they might create one after learning what ADs were. 58% would choose hospice care if they were terminally ill whereas 48.7% of the participants wanted to die at home. 92.3% would want to know their diagnosis and prognosis if ill; however, if their family members were diagnosed with an incurable disease, 50.5% would not tell their ill family member the actual diagnosis and prognosis. Those who had heard of ADs (OR = 1.567, p < 0.001), earned an associate’s degree (OR = 2.448, p < 0.001) or a bachelor’s degree or higher (OR = 2.382, p < 0.001), and self-rated their health as very poor/poor (OR = 1.002, p = 0.001) were more likely to be willing to make an AD than their counterparts. However, those who were single (OR = 0.149, p < 0.001) or widowed /divorced/separated (OR = 0.405, p = 0.001) were less likely to be willing to make an AD than the married ones. Conclusions Chinese adults showed positive attitudes towards ADs. There is an urgent need to promote more educational initiatives and raise awareness on the importance of ADs. It is important to develop more policies and legislation about ADs to improve the quality of EOL care in Mainland China.
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Affiliation(s)
- Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China.
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, 10010, USA
| | - Huijing Lin
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
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Associations Between Prognostic Awareness, Acceptance of Illness, and Psychological and Spiritual Well-being Among Patients With Heart Failure. J Card Fail 2021; 28:736-743. [PMID: 34655774 DOI: 10.1016/j.cardfail.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to (1) investigate the association of prognostic awareness with psychological (distress level and emotional well-being) and spiritual well-being among patients with heart failure, and (2) assess the main and moderating effects of illness acceptance on the relationship between prognostic awareness and psychological and spiritual well-being. METHODS AND RESULTS This study used baseline data of a Singapore cohort of patients with heart failure (N = 245) who had New York Heart Association class 3 or 4 symptoms. Patients reported their awareness of prognosis and extent of illness acceptance. Multivariable linear regressions were used to investigate the associations. Prognostic awareness was not significantly associated with psychological and spiritual well-being. Illness acceptance was associated with lower levels of distress (β [SE] = -0.9 [0.2], P < .001), higher emotional well-being (β [SE] = 2.2 [0.4], P < .001), and higher spiritual well-being (β [SE] = 5.4 [0.7], P < .001). Illness acceptance did not moderate the associations of prognostic awareness with psychological and spiritual well-being. CONCLUSIONS This study suggests that illness acceptance could be a key factor in improving patient well-being. Illness acceptance should be regularly assessed and interventions to enhance illness acceptance should be considered for those with poor acceptance.
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Huang Y, Zhou Y, Wong TKS, Luo D, Zhang G, Chen J, Smith GD. Inpatient Dignity Scale: Mandarin translation and psychometric characteristics evaluation. Nurs Open 2021; 9:500-512. [PMID: 34612614 PMCID: PMC8685866 DOI: 10.1002/nop2.1088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
Aim The aim of this paper was to translate the English version of the Inpatient Dignity Scale into Mandarin and to test the psychometric properties of the Mandarin version of the Inpatient Dignity Scale. Design This research is a cross‐sectional survey, using convenience sampling. Methods The English version of the Inpatient Dignity Scale was translated into Mandarin Chinese. From June–August 2020, 736 inpatients from 50 tertiary hospitals in Guangzhou were recruited to assess the psychometric attributes of the Inpatient Dignity Scale. Results The Mandarin version of the Inpatient Dignity Scale consists of expectation and satisfaction subscales. It differs from the English language version, as the expectation subscale includes three dimensions and the satisfaction subscale includes two dimensions. The total Cronbach alpha coefficient of the expectation subscale and the satisfaction subscale were .820 and .965, respectively, and the split‐half reliability of the expectation subscale and the satisfaction subscale were 0.740 and 0.928, respectively, indicating good internal consistency and effectiveness. Known‐groups validity was established, as 70% of the hypotheses were supported.
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Affiliation(s)
- Yao Huang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | | | - Dongyi Luo
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Gangna Zhang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Jiani Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Graeme D Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong SAR, China
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18
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Liu X, Liu Z, Zheng R, Li W, Chen Q, Cao W, Li R, Ying W. Exploring the needs and experiences of palliative home care from the perspectives of patients with advanced cancer in China: a qualitative study. Support Care Cancer 2021; 29:4949-4956. [PMID: 33569672 DOI: 10.1007/s00520-021-06037-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/29/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The needs and experiences of palliative home care for patients with advanced cancer have received little research attention. We aimed to explore the needs and experiences of palliative home care among patients with advanced cancer in China. METHODS This qualitative study was conducted using semi-structured interviews with patients with advanced cancer. Participants (n = 15) were recruited from an oncology palliative care unit and a hospice outpatient unit, and were selected using purposive sampling from October 2019 to March 2020. Interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 and developed major themes and subthemes by inductive and constant comparison. RESULTS Five themes were identified: (1) physical need; (2) psychological experience; (3) spiritual need; (4) social need; and (5) information need. Patients need to manage their symptoms (especially cancer pain), prolong life as long as possible, reconstruct their attitudes to adapt to their roles, be socially supported, be respected, maintain spiritual peace, and obtain more information about illness and home care. CONCLUSIONS The current palliative home care services are imperfect, and patients face substantial challenges, including physical symptoms, psychological/spiritual distress, and inadequate social support and information. Our findings may provide evidence and a reference for the development of palliative home care in China.
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Affiliation(s)
- Xiaocheng Liu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Zhili Liu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Ruihua Zheng
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Wenyuan Li
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Qiudi Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Weihua Cao
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Ruina Li
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Wenjuan Ying
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
- Nursing Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
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Abdel-Hafeez A, Abdel-Aziz HI, Hassan A, Farag DE, El-Sherief WA, Abdel-Aal HH, Alsirafy SA. Diagnosis Disclosure Preferences of Cancer Patients in Egypt: A Multi-Institutional Cross-Sectional Study. Am J Hosp Palliat Care 2021; 39:779-784. [PMID: 34427118 DOI: 10.1177/10499091211041082] [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: 12/21/2022] Open
Abstract
BACKGROUND Although diagnosis disclosure to cancer patients has important roles in cancer care, it is not a routine practice in countries like Egypt. Respecting patients' autonomy and responding to their preferences are among the factors that should guide the practice of cancer diagnosis disclosure. OBJECTIVES To assess the preferences of Egyptian cancer patients regarding the disclosure of cancer diagnosis and to determine factors that may affect their preferences. METHODS The study included 295 patients aware of their cancer diagnosis from 3 cancer care facilities in Egypt. Patients were asked if they would have preferred to be informed of the diagnosis or not, whom they would have preferred to receive the diagnosis information from, and if they would have preferred to tell their families or not. RESULTS The vast majority (91%) of the included patients preferred to be informed about their diagnosis, 59% preferred to disclose the diagnosis to their families and 66% preferred to receive the diagnosis information from a physician. In univariate analysis, male gender, higher education level and employment were significantly associated with the preference for disclosure. None of the studied variables associated significantly with the preferences in multivariate analysis. CONCLUSION The majority of Egyptian cancer patients in our study preferred to be informed about their diagnosis, which should be respected. The results may help in changing the diagnosis disclosure practice of health care professionals and refuting the misconception of family caregivers about cancer diagnosis disclosure in Egypt and countries with similar culture.
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Affiliation(s)
- Ahmed Abdel-Hafeez
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hadeer I Abdel-Aziz
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.,Damietta Cancer Institute, Damietta, Egypt
| | - Ahmad Hassan
- Clinical Oncology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina E Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wessam A El-Sherief
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hesham H Abdel-Aal
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Master JF, Wu B, Ni P, Mao J. The Compliance of End-of-Life Care Preferences Among Older Adults and Its Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc 2021; 22:2273-2280.e2. [PMID: 34087224 DOI: 10.1016/j.jamda.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/11/2021] [Accepted: 05/03/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the compliance of end-of-life (EOL) care preferences, and the facilitators and barriers of promoting quality of EOL care among older adults. DESIGN A scoping review was used to identify key themes in the compliance of EOL care preferences among older adults. SETTING AND PARTICIPANTS Studies published between 2009 and 2020 were identified from the Medline and Cochrane libraries. Eligible articles containing components related to the compliance of EOL care preferences among older adults were selected. MEASURES The eligible articles were thematically synthesized. Factors that affected the compliance of EOL care preferences among older adults were identified from the key components. RESULTS In total, 35 articles were included to identify the key components in the compliance of EOL care preferences: (1) supportive policy, (2) supportive environment, (3) cultural characteristics, (4) advance care planning (ACP), (5) the concordance of EOL care preferences between patients and surrogate decision makers, (6) prognosis awareness, and (7) patient's health status and the type of disease. Facilitators for the compliance of EOL care preferences included enactment of relevant policy, sufficient care institutions, the utilization of ACP, and poor health status. Barriers included lack of supportive policy, different culture, and low utilization of ACP. CONCLUSIONS/IMPLICATIONS The compliance of EOL care preferences was low among older adults. The compliance of EOL care preferences can be improved through relevant policy development and the utilization of ACP.
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Affiliation(s)
- Jie Fu Master
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, USA
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Bongelli R, Bertolazzi A, Piccioni L, Burro R. Italian onco-haematological patients' preferences in bad news communication: a preliminary investigation. BMC Cancer 2021; 21:555. [PMID: 34001021 PMCID: PMC8127256 DOI: 10.1186/s12885-021-08181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The manner in which bad news is communicated in oncological contexts can affect patients' engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients' experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. METHODS In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). RESULTS While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients' preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. CONCLUSIONS The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients' preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.
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Affiliation(s)
- Ramona Bongelli
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy.
| | - Alessia Bertolazzi
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Ludovica Piccioni
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Roberto Burro
- Department of Human Sciences, University of Verona, Verona, Italy
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22
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Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care 2021; 11:128-132. [PMID: 33762267 DOI: 10.1136/bmjspcare-2020-002700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/04/2022]
Abstract
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed. METHODOLOGY In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation. RESULTS Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution. CONCLUSION Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
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Affiliation(s)
| | - Jan Illing
- Royal College of Surgeons in Ireland, Dublin, Ireland
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23
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Cheng Q, Duan Y, Wang Y, Zhang Q, Chen Y. The physician-nurse collaboration in truth disclosure: from nurses' perspective. BMC Nurs 2021; 20:38. [PMID: 33676508 PMCID: PMC7937200 DOI: 10.1186/s12912-021-00557-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Collaboration between physicians and nurses is critical. However, a limited number of studies have provided insights into the status of physician-nurse collaboration in truth disclosure. METHODS A cross-sectional survey was conducted using an electronic questionnaire among Chinese nurses who attended a provincial conference. The Nurse-Physician Collaboration Scale was administered to nurses to assess the collaboration in truth disclosure from their perspective. A multiple-choice question was asked to assess the perceived difficulties in truth disclosure. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to evaluate physician-nurse collaboration in truth disclosure. RESULTS A total of 287 nurses completed the survey, and 279 of them reported that they had carried out truth disclosures among patients. The average score for physician-nurse collaboration in truth disclosure was 3.98 ± 0.72. The majority of nurses (73.1-81%) responded positively to different dimensions of collaboration in truth disclosure. The results of multiple stepwise regression analysis showed that seniority (B = - 0.111, 95% confidence interval [CI] = - 0.167-- 0.055, p < 0.001) and frequency of truth disclosure (B = 0.162, 95%CI = 0.076-0.249, p < 0.001) were the only two factors associated with collaboration in truth disclosure between physicians and nurses. The most common barrier perceived by nurses was fear of patients' negative emotions or their suicide attempts after truth telling. CONCLUSIONS Most nurses responded positively to physician-nurse collaboration in truth disclosure. Various difficulties existed in the practice of truth-telling collaboration. Further studies are required to test the potential interventions to promote cooperation between nurses and physicians in truth disclosure.
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Affiliation(s)
- Qinqin Cheng
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yinglong Duan
- The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ying Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qinghui Zhang
- Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yongyi Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China.
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Wu J, Wang Y, Jiao X, Wang J, Ye X, Wang B. Differences in practice and preferences associated with truth-telling to cancer patients. Nurs Ethics 2020; 28:272-281. [PMID: 32959721 DOI: 10.1177/0969733020945754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China. OBJECTIVE The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling. RESEARCH DESIGN A quantitative survey with three closed-ended questionnaires was conducted. PARTICIPANTS In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure. ETHICAL CONSIDERATIONS This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement. FINDINGS A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis (p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients. DISCUSSION The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed. CONCLUSION Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient's willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient's care team, especially nurses, could be integrated in the process of truth-telling.
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Affiliation(s)
- Jing Wu
- Naval Medical University, China
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Zhang Z, Min X. The Ethical Dilemma of Truth-Telling in Healthcare in China. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:337-344. [PMID: 32394322 DOI: 10.1007/s11673-020-09979-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and culture are also discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations.
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Affiliation(s)
- Zanhua Zhang
- Department of Emergency Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China
| | - Xiaoyan Min
- Department of Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China.
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Hahne J, Liang T, Khoshnood K, Wang X, Li X. Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients. PATIENT EDUCATION AND COUNSELING 2020; 103:286-291. [PMID: 31455567 DOI: 10.1016/j.pec.2019.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis. METHODS We conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis. RESULTS Doctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient's "right to know" and respecting the family's interest in protecting the patient. CONCLUSIONS Doctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient's "right to know." Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China's cultural value of family decision-making. PRACTICE IMPLICATIONS Future training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.
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Affiliation(s)
- Jessica Hahne
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Ting Liang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China
| | | | - Xiaomin Wang
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China; Center for Medical Ethics, Central South University, Changsha 410013, PR China.
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China; Center for Medical Ethics, Central South University, Changsha 410013, PR China.
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Zheng Y, Lei F, Liu B. Cancer Diagnosis Disclosure and Quality of Life in Elderly Cancer Patients. Healthcare (Basel) 2019; 7:healthcare7040163. [PMID: 31847309 PMCID: PMC6956195 DOI: 10.3390/healthcare7040163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Informed consent and patient autonomy rights require an optimal cancer diagnosis disclosure strategy to be used to update the patients and caregivers with the bad news. However, a cancer diagnosis disclosure may arouse anxiety and distress which increase patients’ and caregivers’ psychological burden. This study aims to explore the influence of cancer diagnosis disclosure on the quality of life in elderly cancer patients and their caregivers, and to introduce an effective way to disclose cancer diagnosis. A total of 120 participants were randomly selected in the study. The Medical Coping Modes Questionnaire was used to select informed person. The SPIKES was used to guide the disclosure procedures. The informed patients’ or caregivers’ quality of life were evaluated by the Generic Quality of Life Inventory-74 or Caregiver Quality of Life Scale before and after the cancer diagnosis disclosure and at the discharge time. After cancer diagnosis disclosure, no significant change was found on the quality of life of the informed person. With multiple psychological interventions implemented, a significant increase was noticed on the quality of life of the informed person. Applying the cancer diagnosis disclosure strategies and psychological intervention were essential to improve cancer patients’ and caregivers’ quality of life.
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Affiliation(s)
- Ying Zheng
- School of Public Health, Fudan University, Shanghai 200032, China; (Y.Z.); (B.L.)
| | - Fang Lei
- School of Nursing, University of California, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-733-0963
| | - Bao Liu
- School of Public Health, Fudan University, Shanghai 200032, China; (Y.Z.); (B.L.)
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Jie B, Zhou YH, Qiu Y, Yang GY, Feng ZZ. Impact of the disclosure of diagnosis on posttraumatic stress and growth and quality of life in Chinese patients with hepatocellular carcinoma. Support Care Cancer 2019; 28:3371-3379. [DOI: 10.1007/s00520-019-05141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022]
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Liu Y, Yang J, Song L, Yang X, Yin Y, Yan L. Nurses' experiences and attitudes toward diagnosis disclosure for cancer patients in China: A qualitative study. Psychooncology 2019; 28:2415-2421. [PMID: 31702852 DOI: 10.1002/pon.5273] [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: 08/23/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To qualitatively investigate and explore oncology nurses' perceptions of cancer diagnosis disclosure (CDD) for cancer patients. METHODS Purposive sampling led to the inclusion of 25 nurses with diverse characteristics from four inpatient oncology nursing wards in two tertiary hospitals. Semistructured, one-on-one, in-depth interviews were conducted. Colaizzi's analysis method was performed with NVivo software to develop categories and themes. RESULTS Four themes were identified: (a) impact of CDD, including advantages and disadvantages for patients and nurse distress; (b) barriers to CDD, including requests from family members, patients themselves, and communication skills; (c) strategies for CDD, including communication with family members, physician-nurse collaboration, and patient education; and (d) nurses' roles in CDD, including active participants and promoters and advocates. CONCLUSIONS More channels of information and education on cancer, cancer diagnosis, life, and death will be needed in the future. Nurses should actively participate in cancer diagnosis delivery, and more collaboration between nurses and physicians must occur.
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Affiliation(s)
- Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Jinhong Yang
- Oncology Department, Weifang People's Hospital, Weifang, China
| | - Lei Song
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yanling Yin
- School of Nursing, Weifang Medical University, Weifang, China
| | - Liping Yan
- Hospital Administration Office, Weifang People's Hospital, Weifang, China
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Preoperative anxiety in Chinese colorectal cancer patients: The role of social support, self-esteem and coping styles. J Psychosom Res 2019; 121:81-87. [PMID: 30928212 DOI: 10.1016/j.jpsychores.2019.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Relatively little is known about preoperative anxiety and its associated factors with colorectal cancer, which is one of the most prevalent cancers. We aimed to investigate preoperative anxiety and its associated social, psychological and coping factors based on the disclosure/nondisclosure of cancer diagnosis. METHODS A cross-sectional study was conducted in consecutive colorectal cancer inpatients (N = 434), whose anxiety was assessed based on semi-structured interview, demographic-clinical variables, social support, self-esteem and coping styles (acceptance-resignation, confrontation, avoidance). Hierarchical regression analyses were conducted to explore the relationships between social, psychological, coping factors and preoperative anxiety. RESULTS There was no significant difference in preoperative anxiety (χ2 = 1.031, p = .31) between the disclosure and nondisclosure groups. Social, psychological and coping factors together accounted for an additional variance of preoperative anxiety (disclosure: 22%; nondisclosure: 20.8%). Social support (β = -0.17, p = .004), self-esteem (β = -0.22, p = .001) and coping styles (acceptance-resignation: β = 0.32, p < .001; confrontation: β = 0.13, p = .06; avoidance: β = -0.17, p = .04) were associated with preoperative anxiety in the nondisclosure group. For the disclosure group, acceptance-resignation was the only significantly associated factor of preoperative anxiety (β = 0.37, p < .001). CONCLUSIONS Coping styles, such as acceptance-resignation and confrontation, could aggravate preoperative anxiety. Avoidance, social support and self-esteem might be helpful in preventing preoperative anxiety. These findings highlight the importance of providing psychological interventions for cancer patients by integrating social support, self-esteem and coping styles when disclosing a cancer diagnosis.
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Yun JH, Ryu E, Lee SY. Text Network Analysis Related to Disclosure of Cancer Diagnosis among Korea and other Countries. ASIAN ONCOLOGY NURSING 2018. [DOI: 10.5388/aon.2018.18.3.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jin Hui Yun
- Dongjak Branch Office, National Health Insurance Corporation, Seoul, Korea
| | - Eunjung Ryu
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - So Young Lee
- Department of Nursing, Graduate School of Chung-Ang University, Seoul, Korea
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