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Pattison N, O'Gara G, Thomas K, Wigmore T, Dyer J. An aromatherapy massage intervention on sleep in the ICU: A randomized controlled feasibility study. Nurs Crit Care 2024; 29:14-21. [PMID: 37533150 DOI: 10.1111/nicc.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
We conducted a feasibility randomized controlled trial exploring the effect of aromatherapy massage on sleep in critically ill patients. Patients were randomized to receive aromatherapy massage or usual care, and feasibility of recruitment and outcome data completion was captured. Sleep (depth) was assessed through Bispectral Index monitoring and self/nurse-reported Richards-Campbell Sleep Questionnaires, and the Sleep in the ICU Questionnaire. Thirty-four patients participated: 17 were randomized to aromatherapy massage and 17 to control. Five participants who received the intervention completed outcomes for analysis (alongside eight controls). A larger study was deemed unfeasible in this population, highlighting the value of testing feasibility of complex interventions, such as massage for sleep in ICU.
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Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | | | - Karen Thomas
- Intensive Care National Audit and Research Centre, London, UK
| | - Tim Wigmore
- Royal Marsden NHS Foundation Trust, London, UK
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2
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Muls A, Georgopoulou S, Hainsworth E, Hartley B, O'Gara G, Stapleton S, Cruickshank S. The psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review. Semin Oncol 2022; 49:371-382. [PMID: 36089413 PMCID: PMC9393184 DOI: 10.1053/j.seminoncol.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Global social lockdowns were instigated to reduce spread and prevent health-services from becoming overwhelmed. People having treatment for cancer are known to have heightened psychological/emotional burden. The combined impact of managing pandemic regulations alongside this may present additional burden. The purpose of this systematic review is to examine current evidence of the psychological and emotional impact of COVID-19 on people with cancer, early in the pandemic. METHODS Five electronic databases were searched (Embase, Global Health, HMIC, PsychINFO, CINAHL) from September 2019 to October 2021. Qualitative, quantitative and mixed-method primary research studies exploring emotional and psychological impacts of COVID-19 on cancer patients, limited to English language, were included. Quality appraisal was conducted using the MMAT. RESULTS Fifty-one papers, with 27,356 people from 21 countries treated for cancer, were included. 43 studies were quantitative with a survey method approach, six studies qualitative and four used a mixed methods design. MMAT score was mostly two or three. Four themes were identified: Emotional aspects and Quality of Life; Psychosocial aspects; Impact of COVID-19 on self; Impact of COVID-19 on cancer, with themes overlapping. CONCLUSION Whilst emotional/psychological impacts such as anxiety, isolation, employment fears, and uncertainty about the future were potentially universal concerns early in the pandemic, they may have been particularly acute for people living with cancer and represent complex, overlapping factors. As COVID-19 continues to impact health-services and society, it is important to focus on any ongoing impact to the experience of cancer patients. Most of the studies reviewed used tools that do not provide deeper understanding of how and why emotional states of people with cancer were affected. Further qualitative work may reveal patterns of what was unique to cancer patients during the pandemic, compared to general populations.
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O'Gara G, Wiseman T, Doyle AM, Pattison N. Chronic illness and critical care-A qualitative exploration of family experience and need. Nurs Crit Care 2022. [PMID: 35833675 DOI: 10.1111/nicc.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with chronic illnesses such as cancer and cardiovascular disease are living longer and often require the support of critical care services. Current health care provision means patients may be discharged home once clinically stable despite still having high care demands including social, emotional, or physical needs. Families are often required to assume caregiving roles. Research into family burden using quantitative methods has increased awareness, however, little qualitative work exists and the development of support interventions for families is required. AIMS To explore the experience and needs of family members of people with an existing chronic illness who are admitted to the Critical Care Unit (CCU), and to identify the desired components of a family support intervention in the form of a resource toolkit. STUDY DESIGN A qualitative exploration of family experience and need, and content development for a resource toolkit using focus group methodology. Two focus groups and one face-to-face interview were conducted involving nine adult (≥18 years) family members of adult patients with chronic illness admitted to critical care in the preceding 9 months across two specialist hospitals in the UK. These were digitally recorded, transcribed, and thematically analysed. FINDINGS Four themes were identified: importance of communication, need for support, trauma of chronic illness, and having to provide "Do-it-Yourself" care. The immense responsibility of families to provide care throughout the illness trajectory is highlighted. Understandable information is essential for a family support toolkit. CONCLUSION Family members often view a critical care episode broadly from diagnosis through to recovery/rehabilitation. Basic communication training skills within critical care should be ensured, alongside coordination of simple solutions. The potential traumatic impact on families should be highlighted early within the pathway, and positive aspects used to harness essential family support. A simple and coordinated approach to a toolkit is preferred. RELEVANCE TO CLINICAL PRACTICE This study highlights that a critical care experience may impact broadly beyond CCU, and the importance of informing patients and families of this potential experience, prior to or on admission, to aid preparation. Further highlighted is the need for contemporaneous and accurate information from clinicians involved in care. Families report a better experience when there is good collaboration across critical care services and admitting clinical teams. Early involvement of families in overall discharge planning is essential to allow patients and families to adjust and plan for recovery.
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Affiliation(s)
- Geraldine O'Gara
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Theresa Wiseman
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Anne-Marie Doyle
- Department of Psychological Medicine, Royal Brompton Hospital, London, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire/East and North Herts NHS Trust, Hertfordshire, UK
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O'Gara G, Murray L, Georgopoulou S, Anstiss T, Macquarrie A, Wheatstone P, Bellman B, Gilbert P, Steed A, Wiseman T. SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting? BMJ Open 2022; 12:e047626. [PMID: 35144943 PMCID: PMC8845220 DOI: 10.1136/bmjopen-2020-047626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life. DESIGN A two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews. SETTING A specialist cancer centre, UK. PARTICIPANTS 11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care. PRIMARY AND SECONDARY OUTCOME Primary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions. SECONDARY OUTCOMES impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA). RESULTS Twenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1-z=2.846, p≤0.01; VR 2-z=2.501, p≤0.01; VR 3-z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development. CONCLUSION The intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings.
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Affiliation(s)
- Geraldine O'Gara
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK Geraldine.O'
| | - Lisa Murray
- Department of Research and Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | | | - Andrew Macquarrie
- School of Computing and Mathematical Sciences, University of Greenwich, London, UK
| | - Pete Wheatstone
- Patient and Public Representative, Royal Marsden NHS Foundation Trust, London, UK
| | - Barbie Bellman
- Patient and Public Representative, Royal Marsden NHS Foundation Trust, London, UK
| | - Paul Gilbert
- Mental Health Research Unit, Derbyshire Healthcare NHS Foundation Trust, Derby, Derbyshire, UK
| | - Anthony Steed
- Department of Computer Science, University College London, London, UK
| | - Theresa Wiseman
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
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McNair HA, Joyce E, O'Gara G, Jackson M, Peet B, Huddart RA, Wiseman T. Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role. Radiography (Lond) 2021; 27:1085-1093. [PMID: 34006442 PMCID: PMC8497277 DOI: 10.1016/j.radi.2021.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. METHOD A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. RESULTS Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. CONCLUSION Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. IMPLICATIONS FOR PRACTICE Role development and changes in education for therapeutic radiographers.
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Affiliation(s)
- H A McNair
- Royal Marsden NHS Foundation Trust, United Kingdom; Institute of Cancer Research, United Kingdom.
| | - E Joyce
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - G O'Gara
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - M Jackson
- St George's University of London, United Kingdom
| | - B Peet
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - R A Huddart
- Institute of Cancer Research, United Kingdom
| | - T Wiseman
- Royal Marsden NHS Foundation Trust, United Kingdom
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Pattison N, Arulkumaran N, O'Gara G, Connolly B, Humphreys S, Walsh T, Hopkins P, Dark P. Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure. BMJ Open 2019; 9:e030815. [PMID: 31871255 PMCID: PMC6937020 DOI: 10.1136/bmjopen-2019-030815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Conducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity. AIM To identify variability in the research infrastructure of UK intensive care units and their ability to conduct research and recruit patients into clinical trials. DESIGN We evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analyses of two datasets (one dataset had been analysed previously) were undertaken in the thematic analysis. FINDINGS The synthesis yielded an overarching core theme of normalising research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: organisational, human, study, practical resources, clinician and patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined. CONCLUSIONS The central and transferable tenet of normalising research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is a requisite for all healthcare individuals from organisational to direct patient contact level.
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Affiliation(s)
- Natalie Pattison
- School of Health and Social Work, University of Hertfordshire and East & North Hertfordshire NHS Trust, Hertfordshire, UK
- East and North Herts NHS Foundation Trust, Hertfordshire, United Kingdom
| | | | | | | | - Sally Humphreys
- Critical Care, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, UK
| | - Tim Walsh
- Critical Care, University of Edinburgh Royal Infirmary Edinburgh, Edinburgh, UK
| | | | - Paul Dark
- Intensive Care Unit, University of Manchester, Salford, Greater Manchester, UK
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Kane PM, Murtagh FEM, Ryan KR, Brice M, Mahon NG, McAdam B, McQuillan R, O'Gara G, Raleigh C, Tracey C, Howley C, Higginson IJ, Daveson BA. Strategies to address the shortcomings of commonly used advanced chronic heart failure descriptors to improve recruitment in palliative care research: A parallel mixed-methods feasibility study. Palliat Med 2018; 32:517-524. [PMID: 28488925 PMCID: PMC5788074 DOI: 10.1177/0269216317706426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recruitment challenges contribute to the paucity of palliative care research with advanced chronic heart failure patients. AIM To describe the challenges and outline strategies of recruiting advanced chronic heart failure patients. DESIGN A feasibility study using a pre-post uncontrolled design. SETTING Advanced chronic heart failure patients were recruited at two nurse-led chronic heart failure disease management clinics in Ireland Results: Of 372 patients screened, 81 were approached, 38 were recruited (46.9% conversion to consent) and 25 completed the intervention. To identify the desired population, a modified version of the European Society of Cardiology definition was used together with modified New York Heart Association inclusion criteria to address inter-study site New York Heart Association classification subjectivity. These modifications substantially increased median monthly numbers of eligible patients approached (from 8 to 20) and median monthly numbers recruited (from 4 to 9). Analysis using a mortality risk calculator demonstrated that recruited patients had a median 1-year mortality risk of 22.7 and confirmed that the modified eligibility criteria successfully identified the population of interest. A statistically significant difference in New York Heart Association classification was found in recruited patients between study sites, but no statistically significant difference was found in selected clinical parameters between these patients. CONCLUSION Clinically relevant modifications to the European Society of Cardiology definition and strategies to address New York Heart Association subjectivity may help to improve advanced chronic heart failure patient recruitment in clinical settings, thereby helping to address the paucity of palliative care research this population.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Fliss E M Murtagh
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Karen R Ryan
- 2 St Francis Hospice, Dublin, Ireland.,3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall G Mahon
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Regina McQuillan
- 2 St Francis Hospice, Dublin, Ireland.,5 Beaumont Hospital, Dublin, Ireland
| | | | | | - Cecelia Tracey
- 3 Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Cicely Saunders International, King's College London, London, UK
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Kane PM, Ellis-Smith CI, Daveson BA, Ryan K, Mahon NG, McAdam B, McQuillan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Murtagh FE, Koffman J. Understanding how a palliative-specific patient-reported outcome intervention works to facilitate patient-centred care in advanced heart failure: A qualitative study. Palliat Med 2018; 32:143-155. [PMID: 29154724 DOI: 10.1177/0269216317738161] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care needs of patients with chronic heart failure are poorly recognised. Policy makers advise a patient-centred approach to holistically assess patients' needs and care goals. Patient-reported outcome measures are proposed to facilitate patient-centred care. AIM To explore whether and how a palliative care-specific patient-reported outcome intervention involving the Integrated Palliative care Outcome Scale influences patients' experience of patient-centred care in nurse-led chronic heart failure disease management clinics. DESIGN A feasibility study using a parallel mixed-methods embedded design was undertaken. The qualitative component which examined patients and nurses experience of the intervention is reported here. Semi-structured interviews were conducted and analysed using framework analysis. SETTING/PARTICIPANTS Eligible patients attended nurse-led chronic heart failure disease management clinics in two tertiary referral centres in Ireland with New York Heart Association functional class II-IV. Nurses who led these clinics were eligible for inclusion. RESULTS In all, 18 patients and all 4 nurses involved in the nurse-led clinics were interviewed. Three key themes were identified: identification of unmet needs, holistic assessment and patient empowerment. The intervention impacted on processes of care by enabling a shared understanding of patients' symptoms and concerns, facilitating patient-nurse communication by focusing on these unmet needs and empowering patients to become more involved in clinical discussions. CONCLUSION This Integrated Palliative care Outcome Scale-based intervention empowered patients to become more engaged in the clinical consultation and to highlight their unmet needs. This study adds to the evidence for the mechanism of action of patient-reported outcome measures to improve patient-centred care and will help inform outcome selection for future patient-reported outcome measure research.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Clare I Ellis-Smith
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Karen Ryan
- 2 Palliative Medicine, St Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall G Mahon
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brendan McAdam
- 4 Department of Cardiology, Beaumont Hospital, Dublin, Ireland
| | - Regina McQuillan
- 5 Department of Palliative Medicine, St Francis Hospice and Beaumont Hospital, Dublin, Ireland
| | - Cecelia Tracey
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christine Howley
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,6 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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O'Gara G, Tuddenham S, Pattison N. Haemato-oncology patients' perceptions of health-related quality of life after critical illness: A qualitative phenomenological study. Intensive Crit Care Nurs 2017; 44:76-84. [PMID: 29056247 DOI: 10.1016/j.iccn.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Haemato-oncology patients often require critical care support due to side-effects of treatment. Discharge can mark the start of an uncertain journey due to the impact of critical illness on health-related quality of life. Qualitatively establishing needs is a priority as current evidence is limited. AIMS To qualitatively explore perceptions of haemato-oncology patients' health-related quality of life after critical illness and explore how healthcare professionals can provide long-term support. METHODS Nine in-depth interviews were conducted three to eighteen months post-discharge from critical care. Phenomenology was used to gain deeper understanding of the patients' lived experience. SETTING A 19-bedded Intensive Care Unit in a specialist cancer centre. FINDINGS Five major themes emerged: Intensive care as a means to an end; Rollercoaster of illness; Reliance on hospital; Having a realistic/sanguine approach; Living in the moment. Haemato-oncology patients who experience critical illness may view it as a small part of a larger treatment pathway, thus health-related quality of life is impacted by this rather than the acute episode. CONCLUSIONS Discharge from the intensive care unit can be seen as a positive end-point, allowing personal growth in areas such as relationships and living life to the full. The contribution of health-care professionals and support of significant others is regarded as critical to the recovery experience.
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Affiliation(s)
- Geraldine O'Gara
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom. Geraldine.O'
| | | | - Natalie Pattison
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom.
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10
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Kane PM, Daveson BA, Ryan K, Ellis-Smith CI, Mahon NG, McAdam B, McQuilllan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Koffman J, Murtagh FEM. Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure. BMJ Support Palliat Care 2017; 7:470-479. [PMID: 28864449 DOI: 10.1136/bmjspcare-2017-001355] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 11/04/2022]
Abstract
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF. OBJECTIVES To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF. METHODS A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability. RESULTS Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable. CONCLUSIONS A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
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Affiliation(s)
- Pauline M Kane
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karen Ryan
- Palliative Care, St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clare I Ellis-Smith
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Niall G Mahon
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Cecelia Tracey
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Christine Howley
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
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Kane PM, Murtagh FEM, Ryan K, Mahon NG, McAdam B, McQuillan R, Ellis-Smith C, Tracey C, Howley C, Raleigh C, O'Gara G, Higginson IJ, Daveson BA. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure. Heart Fail Rev 2016; 20:673-87. [PMID: 26435042 PMCID: PMC4608978 DOI: 10.1007/s10741-015-9508-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
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Affiliation(s)
- P M Kane
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - K Ryan
- St. Francis Hospice, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - N G Mahon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B McAdam
- Beaumont Hospital, Dublin, Ireland
| | - R McQuillan
- St. Francis Hospice, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - C Ellis-Smith
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - C Tracey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Howley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - G O'Gara
- Beaumont Hospital, Dublin, Ireland
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - B A Daveson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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12
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Wiseman T, Lucas G, Sangha A, Randolph A, Stapleton S, Pattison N, O'Gara G, Harris K, Pritchard-Jones K, Dolan S. Insights into the experiences of patients with cancer in London: framework analysis of free-text data from the National Cancer Patient Experience Survey 2012/2013 from the two London Integrated Cancer Systems. BMJ Open 2015; 5:e007792. [PMID: 26482767 PMCID: PMC4611184 DOI: 10.1136/bmjopen-2015-007792] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To shed light on experiences of patients with cancer in London National Health Service (NHS) trusts that may not be fully captured in national survey data, to inform improvement action plans by these trusts. DESIGN Framework analysis of free-text data from 2012/2013 National Cancer Patient Experience Survey (NCPES) from the 2 London Integrated Cancer Systems. SETTING AND PARTICIPANTS Patients with a cancer diagnosis treated by the NHS across 27 trusts in London. MAIN OUTCOME MEASURES Free-text data received from patients categorised into what patients found good about their cancer care and what could be improved. METHODS Using Framework analysis, a thematic framework was created for 15,403 comments from over 6500 patients. Themes were identified across the London data set, by tumour group and by trust. RESULTS Two-thirds of free-text comments from patients in London were positive and one-third of those related to the good quality of care those patients received. However, the majority of comments for improvement related to quality of care, with a focus on poor care, poor communication and waiting times in outpatient departments. Additionally, 577 patients (9% of those who returned free-text data in London) commented on issues pertaining to the questionnaire itself. Some patients who experienced care from multiple trusts were unclear on how to complete the questionnaire for the single trust whose care they were asked to comment on, others said the questions did not fit their experiences. CONCLUSIONS NCPES free-text analysis can shed light on the experiences of patients that closed questions might not reveal. It further indicates that there are issues with the survey itself, in terms of ambiguities in the questionnaire and difficulties in identifying patients within specific trusts. Both of these issues have the potential to contribute to knowledge and understanding of the uses and limitations of free-text data in improving cancer services.
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Affiliation(s)
| | - Grace Lucas
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Amrit Sangha
- The Royal Marsden NHS Foundation Trust, London, UK
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Pattison N, O'Gara G. Making appropriate decisions about admission to critical care: the role of critical care outreach and medical emergency teams. Nurs Crit Care 2015; 19:4-6. [PMID: 24400603 DOI: 10.1111/nicc.12074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- N Pattison
- Royal Marsden NHS Foundation Trust, London, UK
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14
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Pattison N, O'Gara G, Rattray J. After critical care: patient support after critical care. A mixed method longitudinal study using email interviews and questionnaires. Intensive Crit Care Nurs 2015; 31:213-22. [PMID: 25748475 DOI: 10.1016/j.iccn.2014.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/06/2014] [Accepted: 12/28/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To explore experiences and needs over time, of patients discharged from ICU using the Intensive Care Experience (ICE-q) questionnaire, Hospital Anxiety and Depression Scale (HADS) and EuroQoL (EQ-5D), associated clinical predictors (APACHE II, TISS, Length of stay, RIKER scores) and in-depth email interviewing. METHODS A mixed-method, longitudinal study of patients with >48hour ICU stays at 2 weeks, 6 months, 12 months using the ICE-q, HADS, EQ-5D triangulated with clinical predictors, including age, gender, length of stay (ICU and hospital), APACHE II and TISS. In-depth qualitative email interviews were completed at 1 month and 6 months. Grounded Theory analysis was applied to interview data and data were triangulated with questionnaire and clinical data. RESULTS Data was collected from January 2010 to March 2012 from 77 participants. Both mean EQ-5D visual analogue scale, utility scores and HADS scores improved from 2 weeks to 6 months, (p=<0.001; p=<0.001), but between 6 and 12 months, no change was found in data from either questionnaire, suggesting improvements level off. These variations were reflected in qualitative data themes: rehabilitation/recovery in the context of chronic illness; impact of critical care; emotional and psychological needs (including sub-themes of: information needs and relocation anxiety). The overarching, core theme related to adjustment of normality. CONCLUSIONS Patient recovery in this population appears to be shaped by ongoing illness and treatment. Email interviews offer a convenient method of gaining in-depth interview data and could be used as part of ICU follow-up.
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Affiliation(s)
- Natalie Pattison
- The Royal Marsden NHS Foundation Trust, Fulham Road, London Sw36JJ, UK.
| | - Geraldine O'Gara
- The Royal Marsden NHS Foundation Trust, Fulham Road, London Sw36JJ, UK. geraldine.o'
| | - Janice Rattray
- The University of Dundee, School of Nursing & Midwifery, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Cubitt J, Smythe J, O'Gara G, Farquhar-Smith P. 6022 POSTER Examination of risk factors for mortality of patients with haematological malignancies admitted to intensive care. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71313-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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