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Voorhees HL, Koenig Kellas J, Palmer-Wackerly AL, Gunning JN, Marsh JS, Baker J. Making Sense of Memorable Messages About Infertility: Examining Message Valence by Theme and Sender. HEALTH COMMUNICATION 2024; 39:2053-2065. [PMID: 37697443 DOI: 10.1080/10410236.2023.2254928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Fertility problems, often called infertility, have been defined as the inability to conceive or maintain pregnancy throughout one year of trying (World Health Organization, 2020). Because fertility problems can present unique medical, emotional, relational, and identity challenges, they are often difficult to talk about, and even well-intentioned messages can be perceived negatively. This study uses Communicated Sense-Making (CSM; Kellas & Kranstuber Horstman, 2015), particularly its mechanism of memorable messages, to explore what types of support-related messages people experiencing infertility find memorable. Results from semi-structured interviews (N = 54) indicate five supra-themes of memorable messages: (a) communicating solidarity; (b) attempting to minimize participants' stress; (c) communicating investment or interest in the patient's experience; (d) sharing expertise; and (e) absolving the patient of responsibility; we identify several sub-themes within each. We also explore patterns between message types, senders, and message valence: message themes were perceived as either positive, negative, or neutral based on the combination of sender and perceived intention. Theoretical and practical implications are discussed.
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Affiliation(s)
| | | | | | | | | | - Jonathan Baker
- Department of Communication, University of South Florida
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2
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Jabeen S, Zakar R, Zakar MZ, Fischer F. Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan. BMC Public Health 2024; 24:1030. [PMID: 38609905 PMCID: PMC11015732 DOI: 10.1186/s12889-024-18404-1] [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: 08/13/2023] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Patients with advanced breast cancer require consistent help and support from family caregivers. These caregivers often endure financial burdens and psychological stress, with their experiences significantly influenced by sociocultural factors. This study aims to explore the experiences of family caregivers of advanced breast cancer patients in Punjab province, Pakistan. METHODS Data was collected through in-depth interviews with fifteen family caregivers of advanced breast cancer patients in three major cities of Punjab, Pakistan. Caregivers, who had been in close contact with the patient for the last two years, were purposively sampled from five major hospitals. The data was analyzed using thematic analysis. RESULTS The study revealed that the experiences of family caregivers are deeply rooted in the sociocultural context. Key themes identified include social responsibility and cultural reciprocity norms; limited awareness and mobility options for caregivers; financial responsibility and strain; impacts of beauty myths and shyness on caregiving attitudes and decisions; the stressful and emotional nature of caregiving; treatment perspectives influenced by social groups; challenges in consulting male physicians and associated stigma; the role of religious beliefs in caregiving; and stress management, with religion often being a coping mechanism. These factors can contribute to delayed treatment decisions for patients. CONCLUSIONS Family caregivers are crucial in facilitating timely treatment decisions for advanced breast cancer patients in the Pakistani context. To minimize treatment delays and alleviate caregiver stress, addressing sociocultural barriers in care-seeking is essential. A tailored approach, considering sociocultural and religious factors, is imperative for the management and early diagnosis of breast cancer, necessitating appropriate policymaking and implementation.
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Affiliation(s)
- Sadia Jabeen
- Department of Sociology, Virtual University of Pakistan, Lahore, Pakistan
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité- Universitätsmedizin Berlin Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany.
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3
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Parreiras FC, Drummond-Lage AP, de Souza Brandão MPA, Silva LN, Geo LS, Andrade BB, de Melo AC, Wainstein AJA. What could be Improved at Melanoma Patients' Welfare Death? End of Life Perception of Caregivers. INTERNATIONAL JOURNAL OF CANCER MEDICINE 2024; 7:28-34. [PMID: 39193355 PMCID: PMC11349044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Despite enormous recent advances in stage IV melanoma treatment, it continues to have a significant mortality. Five-years survival is below 50% even when granted full access to effective therapeutic regimens. Considering the real world, mostly with low or medium-income countries like Brazil, where 75% of population depends on public health system receiving ineffective Dacarbazine chemotherapy, more than 95% of stage IV patients are dead before 5 years. Knowing the survival process of melanoma end-of-life time is imperative to help physicians to establish better symptoms control and improve the quality of death of these patients. METHODS Relative caregiver of melanoma end of life patients were invited to participate in a specific interview answering questions for the purpose of gathering information regarding symptoms and patients' complaints at the last 30 days, 7 days and at the day of death. RESULTS Although melanoma has a highest propensity for brain dissemination, seizure and focal neurological deficits were not a major complaint. Most of dying melanoma symptoms are shared among other solid terminality tumor process and get worse from 30 days to 7 days, but the majority of symptoms kept unchanged from 7 days till time to death. Wound bleeding and bad odor were the only complaints that got worse during the whole terminality process and could be improved with better commitment of assistant team. CONCLUSIONS although a strong effort is made to control brain metastasis, local and regional open wound metastasis represents a major remediable complaint that should receive more attention at end-of-life melanoma patients.
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Hammer K, Højgaard HS, Á Steig B, Wang AG, Bergenholtz HM, Rosted EE. Hope pictured in drawings by patients newly diagnosed with advanced cancer. J Clin Nurs 2023; 32:1262-1275. [PMID: 35277902 DOI: 10.1111/jocn.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hope is an integral part of a dying person's needs and an important phenomenon that has not been satisfactorily explored. The tension between hope for a cure and the reality of being terminally ill is a paradox, which in the context of palliative cancer care, nurses and health care professionals must take into consideration. OBJECTIVE The purpose of this study was to elucidate the phenomenon of hope and to investigate the lived experiences of hope among newly diagnosed patients with advanced cancer. METHOD The study used a phenomenological-visual method where drawings and post-drawing interviews were used. The participants were six patients who recently had been offered specialised palliative care treatment. They were five women and one man with different cancer diagnoses and between 30 and 82 years of age (median 65 years). The data consisted of six drawings and individual post-drawing interviews with the participants. The study was reported using the COREQ checklist. RESULTS The study revealed one main concern 'Being in hope' and hope appeared in four different dimensions; internal, external, relational and transcendental. Hopelessness was present at all times. CONCLUSION Hope pictured in drawings was expressed through colour, shape, lines, symbols and metaphors, and hope incorporated internal, external, relational and transcendental aspects. Hope was constantly fighting against hopelessness and hope integrated with past, present and future. RELEVANCE TO CLINICAL PRACTICE Drawings, as well as other visual representations, are suitable tools when trying to understand an ineffable phenomenon such as hope experienced by people newly diagnosed with cancer.
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Affiliation(s)
- Kristianna Hammer
- Department of Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Bjarni Á Steig
- Department of Hematology and Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - August G Wang
- Faculty of Health, University of Faroe Islands, Tórshavn, Faroe Islands.,Centre of Psychiatry, Copenhagen University Hospital Amager, Copenhagen S, Denmark
| | - Heidi M Bergenholtz
- Department of Surgery, Holbaek Hospital, Holbaek, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, UK
| | - Elizabeth E Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.,University of Southern Denmark, Odense, Denmark
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Durieux BN, Berrier A, Catzen HZ, Gray TF, Lakin JR, Cunningham R, Morris SE, Tulsky JA, Sanders JJ. " I think that she would have wanted. . .": Qualitative interviews with bereaved caregivers reveal complexity in measuring goal-concordant care at the end of life. Palliat Med 2022; 36:742-750. [PMID: 35164612 DOI: 10.1177/02692163221078472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. AIM To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. DESIGN Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. SETTING/PARTICIPANTS Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. RESULTS Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. CONCLUSIONS Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer.
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Affiliation(s)
| | - Anna Berrier
- Dana-Farber Cancer Institute, Boston, MA, USA.,Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tamryn F Gray
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Joshua R Lakin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rebecca Cunningham
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sue E Morris
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Justin J Sanders
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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6
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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7
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Altınışık M, Kocabıyık B, Arıkan F, Şevik HY, Coşkun HŞ. The relationship between hope levels and unmet needs of caregivers of advanced cancer patients†. Jpn J Nurs Sci 2022; 19:e12482. [PMID: 35274446 DOI: 10.1111/jjns.12482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Abstract
AIM The effects in cultural and health provisions can lead to different unmet support needs. Hope is seen as an important support, a supportive power, and an efficient coping strategy for cancer caregivers. The purpose of this study in Turkish society is to determine supportive care needs of caregivers of cancer patients, to determine the hope levels of those caring for cancer patients and foresee how variables and hope can trigger needs. METHODS To identify the unmet needs and hope levels of caregivers of advanced cancer patients in Turkish society. Data were collected using the Supportive Care Needs of Caregivers Scale and Herth Hope Index. RESULTS More than half of the advanced cancer caregivers (56.51%) reported unmet care needs. Their unmet needs and hope levels were above average. Regression analysis showed the total score for hope was related to health care and information needs, work-social needs. CONCLUSION Hope was related to health care and information needs and work-social needs. Oncology nurses should focus on the unmet needs of caregivers, taking into account their cultural differences in order to raise their hopes.
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Affiliation(s)
- Müge Altınışık
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | | | - Fatma Arıkan
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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Gunn KM, Weeks M, Spronk KJJ, Fletcher C, Wilson C. Caring for someone with cancer in rural Australia. Support Care Cancer 2022; 30:4857-4865. [PMID: 35165761 PMCID: PMC9046138 DOI: 10.1007/s00520-022-06857-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the experiences of people caring for someone with cancer, while living in rural Australia, and the impact of the cancer-caring role on their well-being. METHOD Eighteen adults in regional or remote ('rural') Australia who cared for a person with cancer took part in semi-structured telephone interviews. Participants were aged 32-77 years and mainly female (66%). Data were analysed using thematic analysis and an essentialist approach. RESULTS Eight themes were identified: (1) travel is hard, but supports are available; (2) frustration with systems that do not demonstrate understanding of the rural context; (3) the importance of lay and peer support; (4) the impact of access to trusted, local health care services; (5) the importance of access to rurally relevant information (particularly on relevant services and what to expect); (6) living with uncertainty and balancing loss with hope; (7) reluctance to seek or accept psychological support; and (8) the gendered nature of care. CONCLUSION Rural cancer carers' roles can be made easier by improving health systems and coordination to ease the burden of travel, providing information about available support and what to expect throughout cancer treatment that is relevant to the rural context, and increasing access to quality health, community, and support services, including palliative care, in rural areas. More training on the specific needs of rural patients and their carers is needed for urban health care professionals. Peer support groups may have particular value for cancer carers in rural settings, where there are known to be multiple barriers to accessing professional sources of psychosocial support.
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Affiliation(s)
- Kate M. Gunn
- grid.1026.50000 0000 8994 5086Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, South Australia Australia ,grid.1014.40000 0004 0367 2697Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, South Australia Australia ,grid.492269.20000 0001 2233 2629Cancer Council SA, Adelaide, South Australia Australia ,grid.1010.00000 0004 1936 7304Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia Australia
| | - Melanie Weeks
- grid.1010.00000 0004 1936 7304School of Psychology, The University of Adelaide, Adelaide, South Australia Australia
| | - Kristiaan J. J. Spronk
- grid.1026.50000 0000 8994 5086Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, South Australia Australia
| | - Chloe Fletcher
- grid.1026.50000 0000 8994 5086Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, South Australia Australia
| | - Carlene Wilson
- grid.1014.40000 0004 0367 2697Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, South Australia Australia ,grid.492269.20000 0001 2233 2629Cancer Council SA, Adelaide, South Australia Australia ,grid.1018.80000 0001 2342 0938La Trobe University, Melbourne, Victoria Australia
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Almansour I, Abdel Razeq NM. Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study. J Clin Nurs 2021; 30:861-873. [PMID: 33377560 DOI: 10.1111/jocn.15630] [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: 02/25/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed. BACKGROUND Improving end-of-life care requires a focus on adequate family-professionals prognostic communication, while maintaining a realistic level of hope and family support. DESIGN A descriptive qualitative approach was applied. METHODS Semi-structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed. RESULTS Two main categories emerged from the data of this study: 'perspectives on optimistic hope' and 'approaches to prognostic communication'. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope. CONCLUSIONS Improving end-of-life care in intensive care units in Jordan requires a focus on family-professional communication. Jordanian intensive care doctors and nurses perceived honest family-professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication. RELEVANCE TO CLINICAL PRACTICE Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.
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Affiliation(s)
- Issa Almansour
- Clinical Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
| | - Nadin M Abdel Razeq
- Maternal and Child Health Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
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Chen J, Xiao H, Chen Y, Sun H, Chen S, Zheng J. Effect of reminiscence therapy based on positive psychology theory (RTBPPT) on the positive feelings of the spousal caregivers of elderly patients with advanced cancer in China. Eur J Cancer Care (Engl) 2020; 29:e13324. [PMID: 32885518 DOI: 10.1111/ecc.13324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/21/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Elderly patients with advanced cancer often experience various symptoms and need a great amount of care. However, their spousal caregivers are prone to negative emotions because of old age, poor health and the heavy burden of care. OBJECTIVE To examine the effect of a reminiscence therapy (RT) intervention on the spousal caregivers of elderly patients with advanced cancer. METHODS This study was a randomised controlled trial. Fifty-six spousal caregivers were randomly assigned to the control group (N = 29) receiving usual care and the experimental group (N = 27) receiving the RT intervention. The caregivers' caregiving burden, positive feelings towards caregiving and hope were measured before and immediately after the intervention. RESULTS The experimental group showed a significant reduction in the burden of spousal care compared to the control group (p < .01). The experimental group also had higher levels of positive feelings and hope than did the control group (p < .01). CONCLUSION RT is an effective approach to reducing the care burden of spouses of elderly patients with advanced cancer and enhancing the spouses' positive feelings and hope.
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Affiliation(s)
- Jingjing Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Haiyan Sun
- Department of Oncology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shaohua Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Jianjing Zheng
- Department of Oncology, Fujian Provincial Hospital, Fuzhou, China
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Poyser CA, Tickle A. Exploring the experience of the disclosure of a dementia diagnosis from a clinician, patient and carer perspective: a systematic review and Meta-ethnographic synthesis. Aging Ment Health 2019; 23:1605-1615. [PMID: 30430858 DOI: 10.1080/13607863.2018.1506747] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The objective of this review was to identify, appraise and synthesise qualitative research that explores the experience of the disclosure of a dementia diagnosis from the perspectives of clinicians, patients and carers. Method: A systematic search of four databases, grey literature and reference lists identified 13 studies, which met the required criteria to be included in the review. All were appraised using a quality appraisal tool. Data were extracted and synthesised using a meta-ethnographic approach. Results: Five key themes were developed from an interpretation of the results: the clinician's approach; how to tell people the diagnosis is dementia; the importance of the clinician offering hope; level of understanding; and who should attend the disclosure meeting. The process can be improved through a compassionate clinician offering hope, answers to patient and carer questions, and written and/or visual information to support understanding of the diagnosis. These features could be included in guidance to clinicians. There was a large amount of variance in the quality of the studies. Future qualitative research could focus on clinician compassion, giving hope, the management of dynamics within sessions, supporting information and follow-up sessions. Conclusion: Clinical practice can be informed by a body of literature but there is much work to be done to develop evidence-based detailed guidance for improving the dementia diagnosis experience for all parties, and supporting clinicians to manage inherent tensions in this process. Further research is required on this topic to addresses the shortcomings highlighted in this review.
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Affiliation(s)
- Charlotte A Poyser
- Trent DClinPsy Programme, Division of Psychiatry & Applied Psychology, University of Nottingham , Nottingham , UK
| | - Anna Tickle
- Trent DClinPsy Programme, Division of Psychiatry & Applied Psychology, University of Nottingham , Nottingham , UK
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12
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Norouzadeh R, Anoosheh M, Ahmadi F. Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:426-445. [PMID: 31188718 DOI: 10.1177/0030222819854909] [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: 11/15/2022]
Abstract
Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.
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Affiliation(s)
- Reza Norouzadeh
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Monireh Anoosheh
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
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13
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Wichmann AB, van Dam H, Thoonsen B, Boer TA, Engels Y, Groenewoud AS. Advance care planning conversations with palliative patients: looking through the GP's eyes. BMC FAMILY PRACTICE 2018; 19:184. [PMID: 30486774 PMCID: PMC6263059 DOI: 10.1186/s12875-018-0868-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022]
Abstract
Background Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences. Methods Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis. Results Four themes were identified: ACP and society, the GP’s perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a ‘hot topic’. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy. Conclusions ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP’s focus on the patient’s direction and the right not to know can be difficult, ACP has to be tailored to each individual patient. Electronic supplementary material The online version of this article (10.1186/s12875-018-0868-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne B Wichmann
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands.
| | - Hanna van Dam
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
| | - Bregje Thoonsen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Theo A Boer
- Section Ethics, University Kampen, Kampen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - A Stef Groenewoud
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
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Wolf A, Garlid CF, Hyrkas K. Physicians’ Perceptions of Hope and How Hope Informs Interactions With Patients: A Qualitative, Exploratory Study. Am J Hosp Palliat Care 2018; 35:993-999. [DOI: 10.1177/1049909117751877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Today some studies of physicians’ perceptions of hope are available, but not studies of how hope informs patient care. The objectives of this qualitative study were to describe the ways physicians conceptualize hope and how these may inform interactions with their patients. Methods: Ten physicians working in a large tertiary care teaching hospital were interviewed. They represented palliative care, oncology, and 7 other specialties. Minimal amount of background information was collected. In-depth interviews were conducted during spring of 2016. Open coding and the constant comparison method were used to identify emerging themes from the transcribed data. Validation method included member checking. Results: Hope was defined as an abstract, evolving concept characterized by future-oriented wishes; offering possibilities for reframing and shaping new meaning; an attitude of positivity or optimism; an attribute of the human condition with emotional and relational roots; and as a response to the existential inevitability of suffering and death. Three themes describing hope emerged: “assessing hope,” “fostering and sustaining hope,” and “attributes and outcomes of hope.” Conclusions: The findings show how physicians conceptualize hope and how these conceptions differ in the empirical light of the study. Physicians’ perceptions of “hope” may evolve when entering into a therapeutic relationship exploring the needs and desires of patients. Physicians’ perspectives about “hope” may at times not be solely their own but are those of their patients and thus resulting in an amalgamation, or a rebuilding/rekindling of hope amidst hopelessness, that suits a particular relationship.
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Affiliation(s)
- Airin Wolf
- Clinical Pastoral Education Program, Maine Medical Center, Portland, ME, USA
| | | | - Kristiina Hyrkas
- Center for Nursing Research and Quality, Maine Medical Center, Portland, ME, USA
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15
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Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients. Support Care Cancer 2017; 26:759-766. [PMID: 28952034 DOI: 10.1007/s00520-017-3886-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients. METHODS A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning. CONCLUSIONS The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.
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Family Communication at the End of Life. Behav Sci (Basel) 2017; 7:bs7030045. [PMID: 28708107 PMCID: PMC5618053 DOI: 10.3390/bs7030045] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 02/01/2023] Open
Abstract
People often feel awkward and ill at ease when faced with the opportunity for communication at the end of life, thus the overall theme for the articles in this special issue is the creation of more awareness and knowledge regarding the depth, breadth, and importance of current research exploring family communication at the end of life. This introductory essay attempts to accomplish the following: (1) discuss the importance of talk regarding death; (2) highlight the formative role of family interactions on the death and dying process; and (3) outline the articles in this special issue. Scholars contributing to this special issue on “Family Communication at the End of Life” have provided evidence that communication is important between and for terminally ill individuals, family members, and healthcare/palliative care specialists. Overall, research exploring communication at the end of life is especially relevant because every person experiences the death and loss of loved ones, and ultimately faces the reality of their own death.
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