1
|
Bovero A, Cotardo F, Tuberosa E, Carletto S, Oliva F. End-Of-Life Cancer Patients' Dignity Perception Before and During COVID-19 Pandemic. Am J Hosp Palliat Care 2024:10499091241267878. [PMID: 39045782 DOI: 10.1177/10499091241267878] [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: 07/25/2024] Open
Abstract
Background: The safety and restriction regulations implemented to contain the COVID-19 pandemic significantly impacted people's quality of life compromising the perception of dignity. Preserving dignity for end-of-life patients remains a paramount objective in palliative care. This study aimed to compare dignity levels in terminal cancer patients between pre- and during-pandemic periods. Methods: Dignity was assessed by the Italian version of the Patient Dignity Inventory (PDI-IT) in both pre- and during-pandemic groups of terminal cancer inpatients (hospitalized or admitted in hospice). The 2 groups were compared using non-parametric tests and a multivariate logistic regression analysis to estimate the association of the different dimensions of dignity with COVID-19 period, adjusting for other confounders. The study involved 2 groups of end-of-life cancer patients with a Karnofsky Performance Status (KPS) index less than 50. The first group included 506 patients before COVID-19, and the second group consisted of 156 patients enrolled during pandemic. Results: Existential Distress, Loss of Purpose and Meaning, Physical Symptoms and Dependency, Social Support PDI subscales and PDI Total score were higher in the during-pandemic group. The multivariate regression model partially supported the previous results as Loss of Purpose and Meaning, Social Support, and Existential Distress PDI subscales were associated with during-pandemic period, whereas PDI Physical Symptoms and Dependency and PDI Psychological Distress were not. Conclusion: Social isolation and other restrictions put in place to contain the COVID-19 pandemic may have had a negative impact on the perception of dignity in cancer patients at the end of life.
Collapse
Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Torino, Italy
| | - Francesca Cotardo
- Clinical Psychology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Torino, Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Erika Tuberosa
- Clinical Psychology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Torino, Italy
| | - Sara Carletto
- Clinical Psychology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Torino, Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Francesco Oliva
- Clinical Psychology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Torino, Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| |
Collapse
|
2
|
Gotlib Conn L, Coburn NG, Di Prospero L, Hallet J, Legere L, MacCharles T, Slutsker J, Tagger R, Wright FC, Haas B. Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100147. [PMID: 35937964 PMCID: PMC9344808 DOI: 10.1016/j.ssmqr.2022.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
Early in the COVID-19 pandemic restricted family presence in hospitals was a widespread public health intervention to preserve critical resources and mitigate the virus's spread. In this study, we explore the experiences of surgical care providers and family members of hospitalized surgical patients during the period of highly restricted visiting (March 2020 to April 2021) in a large Canadian academic hospital. Thirty-four interviews were completed with hospital providers, family members and members of the hospital's visitor task force. To understand hospital providers' experiences, we highlight the ethical tensions produced by the biomedical and public health ethics frameworks that converged during COVID-19 in hospital providers' bedside practice. Providers grappled with mixed feelings in support of and against restricted visiting, while simultaneously experiencing gaps in resources and care and acting as patient gatekeepers. To understand family members' experiences of communication and care, we use the theory of institutional betrayal to interpret the negative impacts of episodic and systemic communication failures during restricted visiting. Family members of the most vulnerable patients (and patients) experienced short- and long-term effects including anxiety, fear, and refusal of further care. Our analysis draws attention to the complex ways that hospital care providers and families of hospitalized surgical patients sought to establish and reconfigure how trust and patient-centeredness could be achieved under these unprecedented conditions. Practical learnings from this study suggest that if family presence in hospitals must be limited in the future, dedicated personnel for communication and emotional support for patients, families and staff must be prioritized.
Collapse
Affiliation(s)
- Lesley Gotlib Conn
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Corresponding author. Sunnybrook Research Institute, 2075 Bayview Avenue, Suite K3W-13, Toronto, ON, M4N3M5, Canada
| | - Natalie G. Coburn
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Julie Hallet
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Laurie Legere
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Tracy MacCharles
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Jessica Slutsker
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Ru Tagger
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Frances C. Wright
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Barbara Haas
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| |
Collapse
|
3
|
Bovero A, Pidinchedda A, Clovis F, Berchialla P, Carletto S. Psychosocial factors associated with complicated grief in caregivers during COVID-19: Results from a preliminary cross-sectional study. DEATH STUDIES 2021; 46:1433-1442. [PMID: 34957925 DOI: 10.1080/07481187.2021.2019144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has changed how end-of-life ceremonies are performed, affecting grief processing and bereavement experiences. In this study, caregivers of patients who died with COVID-19 during the first wave of the pandemic were asked to complete an online survey designed to detect psychosocial factors associated with the presence of complicated grief (CG). The results show CG present in 48.4% of caregivers. The marital and cohabitant status during lockdown, the perceived sense of guilt and depression levels were significantly associated with the presence of CG, whereas attendance at the funeral and social support were found to be significant protective factors.
Collapse
Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Alexa Pidinchedda
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Federica Clovis
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Sara Carletto
- Clinical Psychology Unit, University Hospital sA.O.U. Città della Salute e della Scienza di Torino", Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| |
Collapse
|