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Baliga MS, Marakala V, Madathil LP, George T, D'souza RF, Palatty PL. Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:145. [PMID: 38784285 PMCID: PMC11114567 DOI: 10.4103/jehp.jehp_1048_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/02/2023] [Indexed: 05/25/2024]
Abstract
The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.
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Affiliation(s)
- Manjeshwar S. Baliga
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka, India
| | - Vijaya Marakala
- Department of Biochemistry, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Lal P. Madathil
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, New York, USA
| | - Russell F. D'souza
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
| | - Princy L. Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
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Alsolami FN, Alharbi IM, Alsulami JN, Albohassan NS, Alfraidi LS, Alfares FA, Alsayafi SI, Abu Hajar MI, Alsheikh TY, Asad FM. Assessment of Knowledge and Attitudes Toward Palliative Care and End-of-Life Decision-Making in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e45781. [PMID: 37872898 PMCID: PMC10590645 DOI: 10.7759/cureus.45781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Palliative care in Saudi Arabia has witnessed significant recent progress through the establishment of the Saudi Society for Palliative Care and the National Palliative Care Program. The objective of this study was to assess knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces among individuals residing in these regions. METHODS Utilizing a cross-sectional survey-based research design, we assessed knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces. Participants were recruited through purposive sampling via social media. Data collection included demographic information, palliative care knowledge, attitudes toward palliative care, and cultural influences on end-of-life decisions. RESULTS A total of 710 participants completed the survey, resulting in a response rate of 85%, with a balanced gender distribution, predominantly aged 25-54. Over half were healthcare providers, many possessing more than 15 years of healthcare experience. A substantial proportion had received formal palliative care training and had personal involvement in end-of-life decisions. While most participants demonstrated a good understanding of palliative care, knowledge gaps, especially regarding its timing, persisted. Generally, participants felt at ease discussing end-of-life care and believed in palliative care's effectiveness. Cultural influences on end-of-life decisions were perceived both positively and negatively, with some facing cultural challenges in palliative care. CONCLUSIONS This study underscores a promising understanding of palliative care in Saudi Arabia alongside persistent misconceptions. It highlights the necessity for targeted education to rectify misperceptions, particularly concerning the initiation timing of palliative care. Cultural factors strongly impact end-of-life decisions, emphasizing the need for culturally sensitive healthcare discussions and provider training.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Farah M Asad
- Public Health, Primary Health Care Center, Hofuf, SAU
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Gursahani R, Salins N, Bhatnagar S, Butola S, Mani RK, Mehta D, Simha S. Advance Care Planning in India: Current status and future directions. A short narrative review. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:64-67. [PMID: 37353428 DOI: 10.1016/j.zefq.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 06/25/2023]
Abstract
India is undergoing economic, demographic and epidemiologic transitions. The healthcare industry is expanding rapidly as the burden of non-communicable diseases increases. The Indian Supreme Court [1] has recently enabled Advance Medical Directives (AMD). Implementation of Advance Care Planning (ACP) will depend on civil society and the palliative care sector until government support is available.
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Affiliation(s)
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sushma Bhatnagar
- National Cancer Institute and Institute Rotary Cancer Hospital; Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India; Indian Association of Palliative Care
| | - Savita Butola
- Sector Hospital, Border Security Force, Tripura, India; Indian Association of Palliative Care
| | - Raj K Mani
- Yashoda Hospital, Kaushambi, Ghaziabad, UP, India
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PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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Ghoshal A, Muckaden MA, Garg C, Iyengar J, Ganpathy KV, Damani A, Deodhar J, Vora T, Chinnaswamy G. Parents’ experiences with prognosis communication in advanced pediatric cancers. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2152169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A. Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - M. A. Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - C. Garg
- Village Mosaic, Fontbonne Ministries, Sisters of St. Joseph, Toronto, Canada
| | - J. Iyengar
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - K. V. Ganpathy
- JASCAP (JEET ASSOCIATION FOR SUPPORT TO CANCER PATIENTS), Mumbai, India
| | - A. Damani
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - J. Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - T. Vora
- Division of Paediatric Oncology, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - G. Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
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Chawak S, Chittem M, Dhillon H, Huilgol N, Butow P. Treatment-related communication experiences and expectations among Indian cancer patients receiving radiation therapy and their family members: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:2913-2922. [PMID: 35597700 DOI: 10.1016/j.pec.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore Indian cancer patients' and their primary family caregivers' (PFC) experiences and expectations of treatment-related communication with their physician while undergoing radiation therapy. METHODS Participants, comprising patient-PFC dyads (n = 32), patients only (n = 33) and PFC only (n = 7), were recruited from one hospital in Mumbai, India. Semi-structured interviews explored participants' perceived role in cancer-related decision-making, diagnosis and prognosis communication experiences with the physician, communication expectations of their treating physician, and information needs. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. RESULTS Main themes included: (i) patients' passive role in treatment communication, (ii) family as an integral part of the medical consultation, and (iii) dyads' expectations and beliefs about the role of the physician. CONCLUSION Indian cancer patients played a passive role in treatment decision-making while physicians were seen as primary medical decision-makers. Further, PFCs provided the final consent for the treatment plan and acted as a mediator/moderator between the patient-physician. PRACTICE IMPLICATIONS These findings suggest the need for (i) interventions such as question prompt lists that may improve patient activation and caregiver preparedness, and (ii) triadic communication training interventions for optimal communication between the three stakeholders (i.e., patient, physician and PFC).
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India.
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nagraj Huilgol
- Chief Radiation Oncologist, Department of Radiation Oncology, Dr Balabhai Nanavati Hospital, Mumbai, India
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Chittem M, Sridharan SG, Pongener M, Maya S, Epton T. Experiences of barriers to self-monitoring and medication-management among Indian patients with type 2 diabetes, their primary family-members and physicians. Chronic Illn 2022; 18:677-690. [PMID: 34259058 DOI: 10.1177/17423953211032251] [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: 11/15/2022]
Abstract
OBJECTIVES This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. METHODS Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. RESULTS Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. DISCUSSION Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management.
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Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, India
| | | | | | - Sravannthi Maya
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, India
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, University of Manchester, Manchester, UK
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Kashyap K, Gielen J. Improving Access and Health Outcomes in Palliative Care through Cultural Competence: An exploration of opportunities and challenges in India. Indian J Palliat Care 2022; 28:331-337. [DOI: 10.25259/ijpc_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/06/2022] [Indexed: 11/04/2022] Open
Abstract
People who belong to ethnic, racial and cultural minorities often have less access to healthcare and have poorer health outcomes when compared to the majority population. In the COVID pandemic, too, health disparities have been observed. Similar disparities have been noted in patients with advanced disease and suffering from pain, with minority patients having less access to or making less use of palliative care. In the US, a range of solutions has been proposed to address the issue of inequality in access to healthcare, with cultural competence figuring prominently among them. This study explores whether and how cultural competence may be applied to palliative care in India to improve access and health outcomes. In the literature, it is argued that, in diverse societies, cultural competence is an essential part of the solution towards equitable healthcare systems. Solutions to problems of healthcare disparities must go beyond an increase in financial resources as more financial resources will not necessarily make the healthcare system more equitable. A culturally competent system recognises and integrates at all levels the culture as a significant component of care, which is particularly relevant at the end of life. If efficiently implemented, cultural competence will lead to higher patient satisfaction, better follow-up and patient compliance and an improved reputation of palliative care among minorities. This may help to reduce inequalities in access and health outcomes in palliative care.
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Affiliation(s)
- Komal Kashyap
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - Joris Gielen
- Center for Global Health Ethics, Duquesne University, Pittsburgh, Pennsylvania, USA,
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Srivastava R, Srivastava S. Bibliometric Analysis of Indian Journal of Palliative Care from 1995 to 2022 using the VOSviewer and Bibliometrix Software. Indian J Palliat Care 2022; 28:338-353. [DOI: 10.25259/ijpc_30_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction:
The Indian Journal of Palliative Care (IJPC) is an open-source, interdisciplinary and peer-reviewed journal started in 1994 that publishes high-quality articles in the field of palliative care in India. The purpose of this study is to analyse the bibliometric data of its publications using bibliometric analysis to understand the key bibliometric factors affecting the journal and its contribution to the field of palliative care research.
Material and Methods:
A software-assisted bibliometric analysis of the IJPC was conducted. The dimensions database was used to mine the bibliometric data of the journal from 1995 to 2022. A total of 1046 records were analysed using the VOSviewer and Biblioshiny by Bibliometrix software.
Results:
The analysis represented a vivid and graphically elaborate picture of the journal. It gives insight into the most productive and influential authors, countries, affiliations, sources and documents along with a picture of the network among them.
Conclusion:
This study highlights a gradual upward trend in the annual production of the journal. A strong connection of the IJPC could be seen with leading journals publishing in the field of palliative care globally.
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Affiliation(s)
- Rajashree Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
| | - Shikha Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
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Srivastava R, Srivastava S. Parental Perspective in Paediatric Palliative Care: A Systematic Review of Literature Using the PRISMA Method. Indian J Palliat Care 2022; 28:199-215. [PMID: 35673689 PMCID: PMC9168285 DOI: 10.25259/ijpc_37_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022] Open
Abstract
Research in Parental Perspectives are pivotal in gaining understanding of parents’ experiences, issues, concerns and attitude in pediatric palliative care which affects their decision making. However only a limited number of such studies have included the first-person perspective of Parents. The aim of this article is to understand the contribution of previous research on parental perspectives in pediatric palliative care through a systematic review of literature. Nine articles that met the inclusion criteria were accessed and seven key themes emerged; Psychological perspective, parental concerns, parental needs, parental attitude, spiritual perspective, cultural perspective and financial perspective. This review highlights requirement of more research into parental perspective if possible, covering all key aspects along with additional research in cultural perspective and development of validated tools, checklists and psychometric questionnaires for the assessment of these perspectives in various domains: spiritual, financial, psychological, cultural and social.
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Affiliation(s)
- Rajashree Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
| | - Shikha Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
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Cartmell KB, Kenneson SAE, Roy R, Bhattacharjee G, Panda N, Kumar G, Qanungo S. Feasibility of a Palliative Care Intervention Utilizing Community Health Workers to Facilitate Delivery of Home-based Palliative Care in India. Indian J Palliat Care 2022; 28:21-27. [PMID: 35673377 PMCID: PMC9165458 DOI: 10.25259/ijpc_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives:
The purpose of this study was to evaluate the feasibility of a home-based palliative care program delivered by community health workers (CHW) in rural areas outside of Kolkata, India. The specific aims were to assess CHWs’ ability to implement the intervention protocol and maintain records of care, to characterize patient problems and CHW activities to assist patients, and to assess change in patient pain scores over the course of the intervention.
Materials and Methods:
Four CHWs were hired to facilitate delivery of home-based palliative care services. CHWs were trained using the Worldwide Hospice and Palliative Care Alliance’s Palliative Care Toolkit. CHWs provided care for patients for 3-months, making regular home visits to monitor health, making and implementing care plans, and referring patients back to the cancer center team for serious problems.
Results:
Eleven patients enrolled in the intervention, with ten of these patients participating in the intervention and one patient passing away before starting the intervention. All ten participants reported physical pain, for which CHWs commonly recommended additional or higher dose medication and/or instructed patients how to take medication properly. For two patients, pain levels decreased between baseline and end of study, while pain scores did not decrease for the remaining patients. Other symptoms for which CHWs provided care included gastro-intestinal, bleeding, and respiratory problems.
Conclusion:
The study findings suggest that utilization of CHWs to provide palliative care in low-resource settings may be a feasible approach for expanding access to palliative care. CHWs were able to carry out the study visit protocol and assess and document patient problems and their activities to assist. They were also able to alleviate many common problems patients experienced with simple suggestions or referrals. However, most patients did not see a decrease in pain levels and more emphasis was needed on the emotional aspects of palliative care, and so CHWs may require additional training on provision of pain management and emotional support services.
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Affiliation(s)
- Kathleen B. Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States,
| | - Sarah Ann E. Kenneson
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States,
| | - Rakesh Roy
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Gautam Bhattacharjee
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Nibedita Panda
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Gaurav Kumar
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India,
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, Clemson, South Carolina, United States,
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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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Al-Johani WM, AlShamlan NA, AlGhamdi MF, AlAbdulkader AM, Aljohani WM, AlGhamdi RF, Alrefae M, Alshehabi M, AlOmar RS, Abdel Wahab MM. Breaking Bad News of a Cancer Diagnosis: A Mixed-Methods Study of Patients' Perspectives. Patient Prefer Adherence 2022; 16:3357-3369. [PMID: 36573225 PMCID: PMC9789710 DOI: 10.2147/ppa.s394170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE A cancer diagnosis is an overwhelming process for both patients and doctors. Many studies have addressed doctors' opinions and knowledge regarding breaking bad news (BBN). However, scarce knowledge exists regarding patients' perspectives for communicating bad news. Therefore, the current study aims to assess cancer patient preferences and satisfaction about BBN. PATIENTS AND METHODS This is a mixed methods study consisting of two phases; an in-depth interview and cross-sectional quantitative analysis. Thematic analysis was used for the qualitative data to explore patients' satisfaction and preferences about BBN. For quantitative analyses, the overall satisfaction was calculated as satisfaction percent. Bivariate analyses were performed, and statistical significance was set as p < 0.05. Quality function deployment was used to effectively define patient requirements of highest priority. RESULTS Thematic analysis revealed two main themes. Theme 1; patients' requirements for BBN and theme 2; patients' reaction at the time of diagnosis with their categories. For the quantitative part, a total of 222 patients responded to the survey, females made up 70% of the sample. Satisfaction score percent ranged from 25.5 to 100%, with a mean of 82.7±11.9%. The most preferred items were mainly concerned with the doctor being honest and encouraging, good listener and interacting giving simple smooth explanations without using medical terms, and empathetic (average score 4.8/5). Also, providing the diagnosis in a calm and private environment (4.7/5). Analysis also found that the requirements for improvement included providing a written summary after receiving the diagnosis and patient perception assessed by the doctor before telling the diagnosis. CONCLUSION Communicating bad news effectively is crucial in the management of cancer patients. The process of BBN should be patient-centered, focusing on patients' needs. Thus, the current study has demonstrated the patients' preferences and the requirements, which should be incorporated into BBN protocols.
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Affiliation(s)
- Wejdan M Al-Johani
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia
- Correspondence: Wejdan M Al-Johani, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 34224, Saudi Arabia, Tel +966599721175, Email
| | - Nouf A AlShamlan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia
| | - Manar F AlGhamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M AlAbdulkader
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia
| | - Waleed M Aljohani
- Supply Chain Department, Security Forces Hospital, Dammam, Saudi Arabia
| | - Rehab F AlGhamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Munir Alrefae
- Department of Internal medicine, King Fahad Hospital of University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muna Alshehabi
- Palliative Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia
| | - Moataza M Abdel Wahab
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia
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14
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Abraha Woldemariam A, Andersson R, Munthe C, Linderholm B, Berbyuk Lindström N. Breaking Bad News in Cancer Care: Ethiopian Patients Want More Information Than What Family and the Public Want Them to Have. JCO Glob Oncol 2021; 7:1341-1348. [PMID: 34491813 PMCID: PMC8423395 DOI: 10.1200/go.21.00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study explores the preferences of patients with cancer, family caregivers, and the general public regarding breaking bad news in an Ethiopian oncology setting. METHODS The study was conducted at Tikur Anbessa (Black Lion) Specialized Hospital. The sample consists of patients with a confirmed cancer diagnosis, their family caregivers, and representatives from the general public with 150 subjects per cohort. The study used a comparative cross-sectional design and multivariable data analysis. RESULTS The patients would like to be informed, which contradicts the preferences of family caregivers. This creates an ethical dilemma for staff in terms of how much they involve their patients in clinical decision making. The patients also indicate that information should not be withheld from them. By contrast, the general public prefers information about poor life expectancy to be communicated to family only, which may reflect a widespread public perception of cancer as a deadly disease. CONCLUSION The findings indicate the complexity of communication-related preferences concerning breaking bad news in oncology care in Ethiopia. It requires oncologists to probe patient attitudes before information disclosure to find a balance between involving patients in communication at the same time as keeping a constructive alliance with family caregivers.
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Affiliation(s)
- Aynalem Abraha Woldemariam
- Department of Surgery, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Ethiopia.,Deceased
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
| | - Barbro Linderholm
- Institute of Clinical Sciences, Department of Oncology, The Sahlgrenska Academy, University of Gothenburg and the Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals. Palliat Support Care 2021; 18:425-430. [PMID: 31699170 DOI: 10.1017/s1478951519000865] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients' autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled. METHODS Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals' attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis. RESULTS The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices. SIGNIFICANCE OF RESULTS Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.
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16
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Sinclair C, Sellars M, Buck K, Detering KM, White BP, Nolte L. Association Between Region of Birth and Advance Care Planning Documentation Among Older Australian Migrant Communities: A Multicenter Audit Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:109-120. [PMID: 32803263 PMCID: PMC7756686 DOI: 10.1093/geronb/gbaa127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives This study explored associations between birth region, sociodemographic predictors, and advance care planning (ACP) uptake. Methods A prospective, multicenter, cross-sectional audit study of 100 sites across 8 Australian jurisdictions. ACP documentation was audited in the health records of people aged 65 years or older accessing general practice (GP), hospital, and long-term care facility (LTCF) settings. Advance care directives (ACDs) completed by the person (“person completed ACDs”) and ACP documents completed by a health professional or other person (“health professional or someone else ACP”) were counted. Hierarchical multilevel logistic regression assessed associations with birth region. Results From 4,187 audited records, 30.0% (1,152/3,839) were born outside Australia. “Person completed ACDs” were less common among those born outside Australia (21.9% vs 28.9%, X2 (1, N = 3,840) = 20.3, p < .001), while “health professional or someone else ACP” was more common among those born outside Australia (46.4% vs 34.8%, X2 (1, N = 3,840) = 45.5, p < .001). Strongest associations were found for those born in Southern Europe: “person completed ACD” (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.36–0.88), and “health professional or someone else ACP” (OR = 1.41, 95% CI = 1.01–1.98). English-language proficiency and increased age significantly predicted both ACP outcomes. Discussion Region of birth is associated with the rate and type of ACP uptake for some older Australians. Approaches to ACP should facilitate access to interpreters and be sensitive to diverse preferences for individual and family involvement in ACP.
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Affiliation(s)
- Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, Australia.,Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia.,Advance Care Planning Australia, Austin Health, Melbourne, Australia
| | - Marcus Sellars
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.,Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Kimberly Buck
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
| | - Karen M Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Ben P White
- Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Linda Nolte
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
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17
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Chawak S, Chittem M, Maya S, Dhillon HM, Butow PN. The Question-prompt list (QPL): Why it is needed in the Indian oncology setting? Cancer Rep (Hoboken) 2021; 4:e1316. [PMID: 33295152 PMCID: PMC8451377 DOI: 10.1002/cnr2.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Mahati Chittem
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Sravannthi Maya
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phyllis N. Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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18
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Mathew B, Mohanti BK, Tewari S, Kabra V, Gulia P, Bajpai P, Munshi A. Collusion: The Facade and its Implications on Total Pain Management in Palliative Care. Indian J Palliat Care 2021; 27:176-179. [PMID: 34035636 PMCID: PMC8121215 DOI: 10.4103/ijpc.ijpc_81_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022] Open
Abstract
Collusion is an unharmonious bond between the doctor and a patient or between patients and caregivers. This case report exemplifies one such experience and highlights the hurdles we face when dealing with collusion. A 31-year-old woman was diagnosed with rectal carcinoma during her pregnancy and underwent diversion colostomy (for intestinal obstruction) followed by neoadjuvant chemoradiation after delivery. Later, she was diagnosed with metastatic disease and was under palliative care. The family always had a negative association with cancer and chose to withhold information from the patient throughout the treatment trajectory. Collusion and lack of information can be a factor for persisting total pain. While caregivers desire to protect the patient from the distress of a life-limiting diagnosis, invariably it causes more anguish than comfort. Oncology professionals need to consider collusion as part of our sociocultural fabric and develop a strategy to negotiate and improve the care.
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Affiliation(s)
- Bincy Mathew
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
| | | | - Saipriya Tewari
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
| | - Vedant Kabra
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
| | - Pushpinder Gulia
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
| | - Peush Bajpai
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
| | - Anusheel Munshi
- Department of Oncology, HCMCT Manipal Hospital, New Delhi, India
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19
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Martí-García C, Fernández-Alcántara M, Suárez López P, Romero Ruiz C, Muñoz Martín R, Garcia-Caro MP. Experiences of family caregivers of patients with terminal disease and the quality of end-of-life care received: a mixed methods study. PeerJ 2020; 8:e10516. [PMID: 33362972 PMCID: PMC7745673 DOI: 10.7717/peerj.10516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to analyze the perceptions and experiences of relatives of patients dying from a terminal disease with regard to the care they received during the dying process, considering the oncological or non-oncological nature of the terminal disease, and the place where care was provided (at home, emergency department, hospital room, or palliative care unit). For this purpose, we conducted a mixed-methods observational study in which two studies were triangulated, one qualitative using semi-structured interviews (n = 30) and the other quantitative, using questionnaires (n = 129). The results showed that the perception of relatives on the quality of care was highly positive in the quantitative evaluation but more critical and negative in the qualitative interview. Experience of the support received and palliative measures was more positive for patients attended in hospital in the case of oncological patients but more positive for those attended at home in the case of non-oncological patients.
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Affiliation(s)
- Celia Martí-García
- Department of Nursing, University of Málaga, Málaga, Spain.,Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain
| | | | | | | | - Rocío Muñoz Martín
- Distrito sanitario Granada-Metropolitano de Atención Primaria, Granada, Spain
| | - Mᵃ Paz Garcia-Caro
- Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain.,Department of Nursing, University of Granada, Granada, Spain
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20
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Mailankody S, Rao SR. "PENS" approach for breaking bad news-a short and sweet way! Support Care Cancer 2020; 29:1157-1159. [PMID: 33025228 DOI: 10.1007/s00520-020-05807-0] [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: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
India has a distinct pattern of cancer care delivery, with unique sociocultural milieu and patient characteristics. In the current era of patient-centered and personalized care, there is an unmet need for an abbreviated protocol for breaking bad news to cancer patients suitable for the Indian outpatient setting. We propose a short four-step protocol for breaking bad news effectively and caringly, in the outpatient department of oncology clinics.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India. .,Department of Medical Oncology, Manipal Comprehensive Cancer Care Centre, Shirdi Sai Baba Cancer Block, Kasturba Medical College, Madhavnagar, Eshwarnagar, Manipal, 576104, Karnataka, India.
| | - Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Network, Singapore, Singapore.,School of Medicine, Cardiff, UK
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21
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Huang YL, Yates P, Thorberg FA, Wu CJ(J. Application of social ecological model to Taiwanese end-of-life communication and healthcare planning. Collegian 2020. [DOI: 10.1016/j.colegn.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Chawak S, Chittem M, Butow P, Huilgol N. Indian Cancer Patients' Needs, Perceptions of, and Expectations from their Support Network: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:462-469. [PMID: 30715673 DOI: 10.1007/s13187-019-1483-4] [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] [Indexed: 06/09/2023]
Abstract
Psycho-oncology research in India reveals that family caregivers and oncologists are primary medical decision-makers frequently acting on behalf of the patient. Thus, patients are rarely asked about their wants and needs. This study aimed to understand Indian cancer patients' needs and expectations from their support network. Twenty-six cancer patients participated in semi-structured interviews exploring patients' needs, perceptions of their support network and the type of support they would prefer, and their experiences of receiving this support. The interviews were analyzed using Interpretive Phenomenological Analysis. Emergent themes included: (i) role of the oncologist: being the primary medical decision-maker, communicating in a style consistent with patient preferences; (ii) role of the immediate family: being emotionally available, helping with navigating the hospital system, aiding in medical adherence; (iii) role of relatives and friends: giving advice and providing tangible aid and services; and (iv) role of other cancer patients: helping with coping with the illness. The study highlights Indian patients' ability to define their supportive network and assign specific roles to them. The study implies the need to develop communication training programs and peer-to-peer support groups to address patients' unmet communication needs and aid in coping.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India.
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Nagraj Huilgol
- Division of Radiation Oncology, Nanavati Super Specialty Hospital, Mumbai, Maharasthra, 400056, India
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23
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Ruby NS, Vijayakumar C, Sundaramurthi S, Sureshkumar S, Kumbhar U, Balasubramanian G. Knowledge and Attitude of Newly Diagnosed Breast Cancer Patients and Their Accompanying Attendants About Multimodality Treatment for Breast Cancer. Cureus 2020; 12:e7915. [PMID: 32494529 PMCID: PMC7263706 DOI: 10.7759/cureus.7915] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction This study was done to estimate the level of knowledge and attitude about the multimodality treatment (MMT) of breast cancer among the newly diagnosed breast cancer patients and accompanying attendants. Apart from the lack of knowledge, it is equally important to consider their accompanying attendant's knowledge, which changes the patient's attitude. Methodology This was a cross-sectional analytic study, including all newly diagnosed breast cancer patients of age above 18 years. The initial questionnaire one (Q1) was about their overall knowledge of carcinoma breast treatment options. Subsequent questionnaire two (Q2) were asked about MMT for breast cancer at eliciting their attitudes about MMT. After explaining about MMT for breast cancer, they were asked to indicate if they had a positive/negative attitude about MMT by questionnaire three (Q3). Results A total of 84 patients was included in the study. The results indicate a significant association between the relation of the attendant to the patient and their level of knowledge of MMT (p<0.001). Approximately 62% of study patients preferred a passive role in making their treatment decisions of MMT, with nearly 26.2% preferring their treating doctor to make all decisions while 36.7% preferred decisions by accompanying attendants. None of the patients had a negative attitude about MMT. Conclusion The treating surgeon should analyse the patient's knowledge of MMT and their attitude toward involving their accompanying attendants in making MMT decisions. It is necessary to administer adequate knowledge regarding MMT and discuss the various treatment options for breast cancer with the ailing patient, along with the accompanying attendants.
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Affiliation(s)
- Nahan Siddique Ruby
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Sudharsanan Sundaramurthi
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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24
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Faruqui N, Joshi R, Martiniuk A, Lowe J, Arora R, Anis H, Kalra M, Bakhshi S, Mishra A, Santa A, Sinha S, Siddaiahgari S, Seth R, Bernays S. A health care labyrinth: perspectives of caregivers on the journey to accessing timely cancer diagnosis and treatment for children in India. BMC Public Health 2019; 19:1613. [PMID: 31791308 PMCID: PMC6889559 DOI: 10.1186/s12889-019-7911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cure rates for children with cancer in India lag behind that of high-income countries. Various disease, treatment and socio-economic related factors contribute to this gap including barriers in timely access of diagnostic and therapeutic care. This study investigated barriers to accessing care from symptom onset to beginning of treatment, from perspectives of caregivers of children with cancer in India. Methods Semi-structured in-depth interviews were conducted with caregivers of children (< 18 years) diagnosed with cancer in seven tertiary care hospitals across New Delhi and Hyderabad. Purposive sampling to saturation was used to ensure adequate representation of the child’s gender, age, cancer type, geographical location and socioeconomic status. Interviews were audio recorded after obtaining informed consent. Thematic content analysis was conducted and organised using NVivo 11. Results Thirty-nine caregivers were interviewed, where three key themes emerged from the narratives: time intervals to definitive diagnosis and treatment, the importance of social supportive care and the overall accumulative impacts of the journey. There were two phases encapsulating the experiences of the family: referral pathways taken to reach the hospital and after reaching the hospital. Most caregivers, especially those from distant geographical areas had variable and inconsistent referral pathways partly due to poor availability of specialist doctors and diagnostic facilities outside major cities, influence from family or friends, and long travel times. Upon reaching the hospital, families mostly from public hospitals faced challenges navigating the hospital facilities, finding accommodation, and comprehending the diagnosis and treatment pathway. Throughout both phases, financial constraint was a recurring issue amongst low-income families. The caregiver’s knowledge and awareness of the disease and health system, religious and social factors were also common barriers. Conclusion This qualitative study highlights and explores some of the barriers to childhood cancer care in India. Our findings show that referral pathways are intrinsically linked to the treatment experience and there should be better recognition of the financial and emotional challenges faced by the family that occur prior to definitive diagnosis and treatment. This information would help inform various stakeholders and contribute to improved interventions addressing these barriers.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,George Institute for Global Health, Sydney, NSW, Australia.
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ramandeep Arora
- Cankids…Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Manas Kalra
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Ayyagari Santa
- Basavatarakam Indo American Cancer Hospital, Hyderabad, India
| | | | | | | | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
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25
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Pinto N, Bhola P, Chandra PS. "End-of-Life Care is more than Wound Care": Health-Care Providers' Perceptions of Psychological and Interpersonal needs of Patients with Terminal Cancer. Indian J Palliat Care 2019; 25:428-435. [PMID: 31413460 PMCID: PMC6659520 DOI: 10.4103/ijpc.ijpc_26_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim People diagnosed with cancer and in end-of-life care may have a range of needs. These needs may be inadequately expressed, recognized, or responded to by family members and health-care providers. The present study aimed at exploring health-care providers' perceptions of the interpersonal needs, psychological needs, and unfinished business among terminally ill cancer patients during the end-of-life care. Methods The sample consisted of 11 health-care providers, including physicians, counselors, social workers, and nurses from the end-of-life care settings in Bengaluru, India. A cross-sectional qualitative design was used and involved semi-structured interviews and focus group discussions. Results Thematic analysis identified themes related to health-care providers' perceptions of patients' prominent interpersonal needs, psychological needs, and expressions of "unfinished business" and their perspectives and experiences. There were three themes related to psychological needs and concerns: (i) experience and expression of negative emotions, (ii) mental health concerns, and (iii) confronting mortality. Three themes emerged in the domain of interpersonal connections: (i) support and closer connections with family, (ii) disconnection from family relationships, and (iii) building new connections at the hospice. Two themes were identified related to unfinished business: (i) types of unfinished business and (ii) addressing unfinished business. The findings also highlighted health-care providers' perspectives and experiences: (i) need for expanded end-of-life care training and (ii) experiences of emotional labor. Conclusions The findings have implications for comprehensive training of health-care providers and for assessment, support, and care services in palliative care settings in India.
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Affiliation(s)
- Nishal Pinto
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Poornima Bhola
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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26
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Fernando GVMC, Prathapan S. What do young doctors know of palliative care; how do they expect the concept to work? : A 'palliative care' knowledge and opinion survey among young doctors. BMC Res Notes 2019; 12:419. [PMID: 31311576 PMCID: PMC6636058 DOI: 10.1186/s13104-019-4462-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/09/2019] [Indexed: 01/12/2023] Open
Abstract
Objectives Discipline of palliative care is still evolving in developed parts of the world while it remains at an infantile stage in Sri Lanka which has not been formally assessed as of today. We aimed at evaluating the level of palliative care knowledge and opinions among young medical graduates. A descriptive cross-sectional study was carried out among pre-residency medical graduates of Sri Lanka through a social media based online survey. The pre-tested questionnaire assessed the level of knowledge on general principles, service organization, clinical management and ethical considerations while it also evaluated their opinions. Results Response rate was 35.8% (n = 351). The average score among the respondents was 37.25% [standard deviation (SD) = 11.975]. Specific knowledge on “general principles” was adequate (score ≥ 50%) with an average of 62.61%, SD = 24.5 while “ethics” was observed to be the area with the poorest knowledge (average score = 19.55%, SD = 22). Average scores for “service organization” and “managerial aspects” were 34.54%, SD = 17.6 and 32.26%, SD = 22.3, respectively. The majority (> 90%) believed that de-novo establishment of hospice, hospital and community-based palliative services would sustainably improve holistic patient care. Measures must be taken to optimize basic palliative care knowledge among the undergraduates in view of achieving Universal Health Coverage in the long term. Electronic supplementary material The online version of this article (10.1186/s13104-019-4462-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G V M C Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka. .,Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
| | - S Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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Collusion in palliative care: an exploratory study with the Collusion Classification Grid. Palliat Support Care 2019; 17:637-642. [PMID: 30968807 DOI: 10.1017/s1478951519000142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Collusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research. METHOD Situations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG. RESULT 1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion. SIGNIFICANCE OF RESULTS This case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.
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Sutar R, Chandra PS, Seshachar P, Gowda L, Chaturvedi SK. A Qualitative Study to Assess Collusion and Psychological Distress in Cancer Patients. Indian J Palliat Care 2019; 25:242-249. [PMID: 31114111 PMCID: PMC6504745 DOI: 10.4103/ijpc.ijpc_146_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Collusion is frequently encountered but least studied entity in palliative care services in India. Impact of collusion is manifold and identifying it requires good communication skills. Once identified, it gives an indication for existing healthy versus developing unhealthy collusion to be dealt within families. Objective: The objective of this study was to identify the prevalence of collusion and its clinical and psychological correlates among patients and caregivers in a palliative cancer care. Materials and Methods: We describe systematic identification and unraveling of collusion across multiple levels in a palliative cancer care eventually drafting an algorithm to unravel the collusion. Patients and families were recruited from in-patient palliative care services after obtaining written informed consent. Qualitative interviews were conducted using collusion questionnaire, EQ5D, Visual Analog Scale, and NIMHANS psychiatric morbidity screen. Results: Among 62 cancer families interviewed, we identified that 71% collusion exists between doctor and patient, 61.3% between doctor and caregiver, and 75.83% between patient and caregiver. Around 50% collusions were unraveled systematically. Collusion was more prevalent in patients with rapid progression of illness (<6 months), patients with poor coping skills, and preference of being interviewed alone. Conclusion: This statistics suggests that collusion goes unnoticed in terminal illnesses and communication skills play a major role in identifying and dealing with collusion. This also unearths need to formulate interview techniques and structured assessment tools or questionnaire in palliative cancer care which are sparse.
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Affiliation(s)
- Roshan Sutar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabha Seshachar
- Department of Palliative Medicine, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Linge Gowda
- Department of Palliative Medicine, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Sankar SD, Dhanapal B, Shankar G, Krishnaraj B, Karra S, Natesan V. Desire for Information and Preference for Participation in Treatment Decisions in Patients With Cancer Presenting to the Department of General Surgery in a Tertiary Care Hospital in India. J Glob Oncol 2018; 4:1-10. [PMID: 30241243 PMCID: PMC6223434 DOI: 10.1200/jgo.17.00144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Providing appropriate information to patients about their illness helps them to cope with the diagnosis. Shared decision making is a key concept in managing patients with cancer. There are no data available about the desire for information and preference for participation in treatment decisions among Indian patients with cancer. The objective of this study was to estimate the proportion of patients who have information needs and to study the patient preference for participation in treatment decisions and the factors associated with them. METHODS A cross-sectional survey was conducted among patients with cancer older than 18 years. They were interviewed with a questionnaire after signing an informed consent. The association of sex, educational level, residence, diagnosis (type of cancer), Eastern Cooperative Oncology Group performance status, and treatment status with information needs and decision-making preference was analyzed using χ2 test. RESULTS Approximately 81% of patients said that they had an absolute need to know if the illness was cancer, and > 70% of patients either had an absolute need to know or would like to know about the prognosis, treatment options, and adverse effects. Regarding the decision-making preferences, 97% wanted their treating physicians to make the decision regarding their treatment, and 66% preferred to share decision making with their family. CONCLUSION The majority of the patients with cancer expressed a need for knowing whether they had cancer. When it comes to treatment decisions, most of them preferred a passive role, and the majority wanted to involve their families in the decision-making process. We recommend that the treating physician should elicit the patient's preference in participating in treatment decisions and their preference about involving their family in making treatment decisions.
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Affiliation(s)
| | | | - Gomathi Shankar
- Corresponding author: Gomathi Shankar V, MS, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvanthri nagar, Pondicherry, 605006, India; e-mail:
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Hernández-Marrero P, Fradique E, Pereira SM. Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis. Nurs Ethics 2018; 26:1680-1695. [PMID: 29807491 DOI: 10.1177/0969733018774610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. OBJECTIVES To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices. DESIGN Qualitative secondary analysis. PARTICIPANTS/CONTEXT Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. ETHICAL CONSIDERATION Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. FINDINGS All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. DISCUSSION Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients' preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. CONCLUSION While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses' involvement and practices in end-of-life decision-making.
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Affiliation(s)
| | - Emília Fradique
- Hospital de Santa Maria, Portugal; Instituto S. João de Deus, Portugal
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31
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Vinayagamoorthy V, Suguna E, Dongre AR. Evaluation of Community-based Palliative Care Services: Perspectives from Various Stakeholders. Indian J Palliat Care 2017; 23:425-430. [PMID: 29123350 PMCID: PMC5661346 DOI: 10.4103/ijpc.ijpc_80_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background As a part of Memorandum of Understanding with Tamil Nadu Institute of Palliative Medicine, community-based palliative care services have been initiated 2 years back in our urban field practice areas. Aim The aim of this study was to evaluate the home care service, a major component of our community-based palliative care, with a view to identify the unmet needs of the services rendered for decision-making about the program. Materials and Methods It was a descriptive qualitative design carried out by the authors trained in qualitative research methods. In-depth interviews were done among four patients, seven caregivers, two social workers, six nursing staffs, and six medical interns for a minimum of 20 min. Interviews were audiorecorded, transcribed verbatim, and content analysis was done manually. Ethical principles were adhered throughout the study. Results Descriptive coding of the text information was done; later, similar codes were merged together to form the categories. Five categories under the theme of strengths and five codes under the theme of challenges of the home care services emerged out. Categories under strengths were physical management, psychological care, social support, efficient teamwork, and acceptance by the community. Codes for felt challenges were interdisciplinary collaboration, volunteer involvement, training enhancement, widening the services, and enhancing the community support. Conclusions This review revealed the concerns of various stakeholders. There is a need for more interprofessional collaborations, where team members understand each other's roles for effective teamwork, as evident from the framework analysis.
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Affiliation(s)
- Venugopal Vinayagamoorthy
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Elayaperumal Suguna
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Amol R Dongre
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Martin ASH, Costello J, Griffiths J. Communication in palliative care: the applicability of the SAGE and THYME model in Singapore. Int J Palliat Nurs 2017. [PMID: 28648130 DOI: 10.12968/ijpn.2017.23.6.288] [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: 11/11/2022]
Abstract
BACKGROUND Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. AIM To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. RESULTS The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.
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Affiliation(s)
| | - John Costello
- Associate Professor, University of Manchester, United Kingdom
| | - Jane Griffiths
- Senior Lecturer, University of Manchester, United Kingdom
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Lazenby S, Edwards A, Samuriwo R, Riley S, Murray MA, Carson‐Stevens A. End-of-life care decisions for haemodialysis patients - 'We only tend to have that discussion with them when they start deteriorating'. Health Expect 2017; 20:260-273. [PMID: 26968338 PMCID: PMC5354044 DOI: 10.1111/hex.12454] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Haemodialysis patients receive very little involvement in their end-of-life care decisions. Issues relating to death and dying are commonly avoided until late in their illness. This study aimed to explore the experiences and perceptions of doctors and nurses in nephrology for involving haemodialysis patients in end-of-life care decisions. METHODS A semi-structured qualitative interview study with 15 doctors and five nurses and thematic analysis of their accounts was conducted. The setting was a large teaching hospital in Wales, UK. RESULTS Prognosis is not routinely discussed with patients, in part due to a difficulty in estimation and the belief that patients do not want or need this information. Advance care planning is rarely carried out, and end-of-life care discussions are seldom initiated prior to patient deterioration. There is variability in end-of-life practices amongst nephrologists; some patients are felt to be withdrawn from dialysis too late. Furthermore, the possibility and implications of withdrawal are not commonly discussed with well patients. Critical barriers hindering better end-of-life care involvement for these patients are outlined. CONCLUSIONS The study provides insights into the complexity of end-of-life conversations and the barriers to achieving better end-of-life communication practices. The results identify opportunities for improving the lives and deaths of haemodialysis patients.
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Affiliation(s)
- Sophia Lazenby
- Primary Care Patient Safety (PISA) Research GroupDivision of Population MedicineSchool of MedicineCardiff UniversityCardiffWalesUK
| | - Adrian Edwards
- Division of Population MedicineSchool of MedicineCardiff UniversityCardiffWalesUK
- Primary and Emergency Care Research (PRIME) Centre WalesCardiff UniversityCardiffWalesUK
| | - Raymond Samuriwo
- School of Healthcare SciencesCardiff UniversityCardiffWalesUK
- Cardiff Institute for Tissue Engineering and RepairCardiff UniversityCardiffWalesUK
- School of HealthcareUniversity of LeedsLeedsUK
| | | | - Mary Ann Murray
- Nursing Palliative Research and Education UnitFaculty of Health SciencesUniversity of OttawaOttawaONCanada
| | - Andrew Carson‐Stevens
- Primary and Emergency Care Research (PRIME) Centre WalesCardiff UniversityCardiffWalesUK
- Department of Family PracticeUniversity of British ColumbiaVancouverBCCanada
- Institute of Healthcare Policy and PracticeUniversity of the West of ScotlandPaisleyScotland
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Stiefel F, Nakamura K, Terui T, Ishitani K. Collusions Between Patients and Clinicians in End-of-Life Care: Why Clarity Matters. J Pain Symptom Manage 2017; 53:776-782. [PMID: 28062352 DOI: 10.1016/j.jpainsymman.2016.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, unreflected behaviors, and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for both, patient and clinician. After an introductory definition of collusion, two archetypal situations of collusion-based on material from a regular supervision of a palliative care specialist by a liaison psychiatrist-and means of working through collusion are presented. The theoretical framework of collusion is then described and the conceptual shortcomings of the palliative care literature in this respect discussed, justifying the call for more clarity. Finally, cultural aspects and societal injunctions on the dying, contributing to the development of collusion in end-of-life care, are discussed.
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Affiliation(s)
- Friedrich Stiefel
- Higashi Sapporo Hospital, Sapporo, Hokkaido, Japan; University Hospital Lausanne, Lausanne, Switzerland.
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Subramaniam A. Breaking Bad News: A Review of Strategies and their Appropriateness in the Rural Indian Setting. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2017. [DOI: 10.46347/jmsh.2017.v03i01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Siddiqui S. Family Loyalty as a Cultural Obstacle to Good Care: The Case of Mrs. Indira. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017281067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rao A, Ekstrand M, Heylen E, Raju G, Shet A. Breaking Bad News: Patient Preferences and the Role of Family Members when Delivering a Cancer Diagnosis. Asian Pac J Cancer Prev 2017; 17:1779-84. [PMID: 27221852 DOI: 10.7314/apjcp.2016.17.4.1779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. MATERIALS AND METHODS Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. RESULTS Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. CONCLUSIONS While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.
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Affiliation(s)
- Abha Rao
- St. John's Research Institute Medical College Hospital, Bangalore, India E-mail :
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Datta S, Tripathi L, Varghese R, Logan J, Gessler S, Chatterjee S, Bhaumik J, Menon U. Pivotal role of families in doctor-patient communication in oncology: a qualitative study of patients, their relatives and cancer clinicians. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27430633 DOI: 10.1111/ecc.12543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- S.S. Datta
- Department of Palliative Care and Psycho-oncology; Tata Medical Center; Kolkata West Bengal India
- Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - L. Tripathi
- Department of Palliative Care and Psycho-oncology; Tata Medical Center; Kolkata West Bengal India
| | - R. Varghese
- School of Public Health; University of California; Berkeley CA USA
| | - J. Logan
- Clare College; University of Cambridge; Cambridge UK
| | - S. Gessler
- Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - S. Chatterjee
- Department of Radiation Oncology; Tata Medical Center; Kolkata West Bengal India
| | - J. Bhaumik
- Department of Gynaecological Oncology; Tata Medical Center; Kolkata West Bengal India
| | - U. Menon
- Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Oncology; Tata Medical Center; Kolkata West Bengal India
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Barthakur MS, Sharma MP, Chaturvedi SK, Manjunath SK. Experiences of Breast Cancer Survivors with Oncology Settings in Urban India: Qualitative Findings. Indian J Surg Oncol 2016; 7:392-396. [PMID: 27872525 DOI: 10.1007/s13193-016-0519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 04/19/2016] [Indexed: 10/21/2022] Open
Abstract
The experience of diagnosis and treatment of cancer leads to significant changes within an individual. In the course of survivorship trajectory, very often cancer survivors are left with the sense, improvements could be done to enhance the quality of cancer care. This article focuses on experiences of breast cancer survivors with oncology setting in urban India. Data was collected from 15 women in South and East India using in-depth interview method. Qualitative interview data was analysed using descriptive phenomenology method. Areas of importance that emerged broadly included informational and emotional categories. Findings reveal quality of cancer care in India can be improved through developing an orientation towards patient-centred style rather than doctor/disease centred approach which has major influence on physical and mental health outcomes. This would require further research and increased emphasis on training of medical as well as paramedical professionals.
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Affiliation(s)
- Michelle S Barthakur
- Manukau Community Mental Health Centre, Counties Manukau District Health Board, Auckland, New Zealand ; Department of Clinical Psychology, NIMHANS, Bangalore, India
| | | | | | - Suraj K Manjunath
- Department of Surgical Oncology, St. Johns Medical College and Hospital, Bangalore, India
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Jeba J, Jacob A, Kandasamy R, George R. The patient who 'must not be told': demographic factors associated with collusion in a retrospective study in South India. Postgrad Med J 2016; 92:659-662. [PMID: 27099298 DOI: 10.1136/postgradmedj-2015-133850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/10/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with cancer need adequate information about diagnosis, treatment options, and possible outcomes and prognosis to make therapeutic decisions. In cultures where the family plays the dominant role in healthcare decisions, doctors are often requested to collude in withholding distressing information from the patient. This challenging situation has not been well studied and there is limited knowledge on the different factors that may contribute to collusion. OBJECTIVE To study the prevalence of collusion among adult cancer patients attending a palliative care outpatient clinic and the contributing factors. METHODS The healthcare records of 306 adult cancer patients who had visited the palliative care outpatient clinic at least three times with follow-up until death were retrospectively reviewed. Details on information shared and why it was not shared were retrieved from the documentation in the communication sheet in the patient chart. The prevalence, sociodemographic and clinical factors that could contribute to collusion in doctor-patient communication were studied. RESULTS Collusion was present in 40% of cases at the time of referral to the palliative care outpatient clinic (collusion regarding diagnosis in 18%; collusion regarding prognosis in 40%). Collusion was later addressed in 35%. Collusion was significantly higher among female patients (p=0.005), manual workers (p=0.035), those not accompanied by a spouse (p=0.000) and with no oncological treatment (p=0.001). CONCLUSIONS Collusion regarding diagnosis or prognosis is common among cancer patients referred for palliative care. It was more prevalent among female patients, manual workers, patients who had not received oncological treatment, and patients not accompanied by a spouse.
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Affiliation(s)
- Jenifer Jeba
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Annie Jacob
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ramu Kandasamy
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Reena George
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Test Construction of Caregiver Collusion Questionnaire. PSYCHOLOGICAL STUDIES 2014. [DOI: 10.1007/s12646-014-0273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chaturvedi SK, Strohschein FJ, Saraf G, Loiselle CG. Communication in cancer care: psycho-social, interactional, and cultural issues. A general overview and the example of India. Front Psychol 2014; 5:1332. [PMID: 25452741 PMCID: PMC4233911 DOI: 10.3389/fpsyg.2014.01332] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 11/03/2014] [Indexed: 12/02/2022] Open
Abstract
Communication is a core aspect of psycho-oncology care. This article examines key psychosocial, cultural, and technological factors that affect this communication. Drawing from advances in clinical work and accumulating bodies of empirical evidence, the authors identify determining factors for high quality, efficient, and sensitive communication and support for those affected by cancer. Cancer care in India is highlighted as a salient example. Cultural factors affecting cancer communication in India include beliefs about health and illness, societal values, integration of spiritual care, family roles, and expectations concerning disclosure of cancer information, and rituals around death and dying. The rapidly emerging area of e-health significantly impacts cancer communication and support globally. In view of current globalization, understanding these multidimensional psychosocial, and cultural factors that shape communication are essential for providing comprehensive, appropriate, and sensitive cancer care.
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Affiliation(s)
- Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences Bangalore, India
| | - Fay J Strohschein
- Ingram School of Nursing, McGill University Montreal, QC, Canada ; Segal Cancer Center, Jewish General Hospital Montreal, QC, Canada
| | - Gayatri Saraf
- Psychiatry, National Institute of Mental Health and Neurosciences Bangalore, India
| | - Carmen G Loiselle
- Ingram School of Nursing, McGill University Montreal, QC, Canada ; Segal Cancer Center, Jewish General Hospital Montreal, QC, Canada
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Abstract
This essay is a reflection on the multidisciplinary team in palliative care, from the perspective of a final year MBBS student from the UK spending one month with an Indian pain and palliative care team at Institute Rotary Cancer Hospital (IRCH), AIIMS, New Delhi.
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Affiliation(s)
- Liza Bowen
- St Georges University, London, UK, and Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
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Abstract
OBJECTIVES To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. DATA SOURCES Published articles, textbooks, reports, and clinical experience. CONCLUSION The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. IMPLICATIONS FOR NURSING PRACTICE Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.
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Kumar SP, D'souza M, Sisodia V. Interpersonal communication skills and palliative care: "finding the story behind the story". Indian J Palliat Care 2014; 20:62-4. [PMID: 24600187 PMCID: PMC3931247 DOI: 10.4103/0973-1075.125571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Senthil P Kumar
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation (Maharishi Markandeshwar University), Mullana-Ambala, Haryana, India
| | - Mariella D'souza
- Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, India
| | - Vaishali Sisodia
- Department of Psychiatry, Srinivas College of Physiotherapy and Research Centre, Pandeshwar, Mangalore, India
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Laxmi S, Khan JA. Does the cancer patient want to know? Results from a study in an Indian tertiary cancer center. South Asian J Cancer 2014; 2:57-61. [PMID: 24455553 PMCID: PMC3876664 DOI: 10.4103/2278-330x.110487] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The disclosure of the diagnosis of cancer is a distressing and complex issue. Families and doctors still do not tell patients when they have cancer in the belief that the patient does not want to know and telling him would lead to fear and depression. The aim of this survey was to evaluate the information needs of Indian cancer patients. MATERIALS AND METHODS A cross-sectional survey of 300 patients' views was conducted with the help of an adaptation of Cassileth's Information Needs questionnaire. RESULTS A majority of cancer patients exhibited a strong need for information about illness and treatment. Ninety-four percent wanted to know if their illness was cancer. Most patients also wanted to know the chance of cure (92%). Age, education, and type of treatment significantly affect information preferences. Gender did not have an effect on information needs. CONCLUSION This study showed that most of the patients wanted to know about their illness, treatment, side-effects, and chances of cure.
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Affiliation(s)
- Shekhawat Laxmi
- Department of Palliative Care, Bhagwan Mahaveer Cancer Hospital, JLN Marg, Malviya Nagar, Jaipur, India
| | - Joad Anjum Khan
- Department of Palliative Care, Bhagwan Mahaveer Cancer Hospital, JLN Marg, Malviya Nagar, Jaipur, India
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Nation Howard BJ, Shannon RP. Filial piety in palliative care: faithfully following family feelings. Or is it? J Palliat Med 2013; 16:584-5. [PMID: 23537195 DOI: 10.1089/jpm.2012.0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Abstract
According to Hinduism, the main religion of India, the end-of-life (EOL) deals with good and bad death. The WHO definition of palliative care stresses on improving not only the quality of life of patients facing incurable diseases but also their families by providing relief from the pain and suffering that includes the psychosocial and spiritual needs as well. The Indian Society of Palliative Care has been doing a commendable work and appreciable efforts are being done by the Kerala model of delivering the EOL care. The spiritual, ethical issues and ethical challenges raised when the patients are in terminal phase are also reviewed keeping in mind the socio-cultural norms. The Indian Penal Code (IPC) has lacunae, which hamper the physicians from taking proper decision in the EOL care. Some of the sections like IPC 309 are defunct and need to be changed. The Indian Society for Critical Care Medicine has developed a position statement on the patient management of the terminally ill patient in the Intensive Care Unit (ICU) which states that the society should move from the paternalistic model to the share based decision model of the West when deciding the fate of such patients. The literature review on the Indian research on palliative care shows very little emphatic results and the medical under graduates show illiteracy. To strengthen it Medical Council of India has included the palliative care in its curriculum by starting a PG course. Literature review revealed that more research from Indian perspective should be done in this area. This article studies the core issues of developing palliative care in Indian setting keeping in mind the ethical, spiritual and legal issues.
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Affiliation(s)
- Himanshu Sharma
- Department of Psychiatry, Pramukh Swami Medical College, Karamsad, Anand, Gujarat, India
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50
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Loiselle CG, Sterling MM. Views on death and dying among health care workers in an Indian cancer care hospice: balancing individual and collective perspectives. Palliat Med 2012; 26:250-6. [PMID: 21464118 DOI: 10.1177/0269216311400931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In providing palliative and end-of-life care, professional and lay hospice workers alike attend to patient and family needs to encourage a dignified death. However, there are few comparative inquiries documenting how differential workplace preparation affects the processes and outcomes related to being confronted to death and dying. This qualitative study explores and compares these experiences among a diverse sample of health workers (N = 25) in a grassroots cancer care hospice in Bangalore, India. Our findings underscore how personal views, socio-economic status, beliefs and values, occupational experience, and workplace interventions interact to shape 'worldviews' about death and dying. Whereas health workers report conflicting feelings of relief and sadness when confronted with the death of their patients, these mixed emotions are often lessened through open dialogue among newly trained and more experienced health workers. Moreover, experienced hospice workers wished to ensure that less experienced ones are provided with the necessary workplace support to lessen psychological 'hardening' that may occur with repeated exposure to death. In dealing with the diverse needs of hospice workers, both individual and collective needs must be considered to ensure an optimal workplace climate. Future work should study how hospice workers' views on death and dying evolve with time and experience.
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Affiliation(s)
- Carmen G Loiselle
- McGill University School of Nursing, Faculty of Medicine, Department of Oncology, Montreal Jewish General Hospital, Montreal, QC, Canada.
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