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Rietze LL, Stajduhar KI, Purkis ME, Cloutier D. The Challenges of Advance Care Planning for Acute Care Registered Nurses. Can J Nurs Res 2024:8445621241244532. [PMID: 38576275 DOI: 10.1177/08445621241244532] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
STUDY BACKGROUND The practice of acute care nurses is shaped by organizational factors such as lack of privacy, heavy workloads, unclear roles, lack of time, and lack of specific policies and procedures. We know little about the social and organizational structures and processes that influence nurses' uptake of valuable patient-centered discussions like advance care planning (ACP). ACP is beneficial for patients, their substitute decision makers, and healthcare providers. PURPOSE To describe the operational, organizational, and societal influences shaping nurses' ACP work in acute care settings. METHODS This ethnographic study purposively sampled 14 registered nurses and 9 administrators who worked in two acute care hospitals in Northeastern Ontario. Methods consisted of 23 open-ended, semi-structured interviews, 20 hours of observational fieldwork, and a collection of publicly available organizational documents. Data were inductively analyzed using an iterative constant comparative approach. RESULTS Nurses were challenged to meet multiple competing demands, leaving them to scramble to manage complex and critically ill acute care patients while also fulfilling organizational tasks aligned with funding metrics, accreditation, and strategic planning priorities. Such factors limited nurses' capacity to engage their patients in ACP. CONCLUSIONS Acute care settings that align patient values and medical treatment need to foster ACP practices by revising organizational policies and processes to support this outcome, analyzing the tasks of healthcare providers to determine who might best address it, and budgeting how to support it with additional resources.
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Affiliation(s)
- Lori L Rietze
- School of Nursing, Laurentian University, Sudbury, ON, Canada
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2
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Horrill TC, Bourgeois A, Kleijberg M, Linton J, Leahy K, Stajduhar KI. Services, models of care, and interventions to improve access to cancer treatment for adults who are socially disadvantaged: A scoping review protocol. PLoS One 2024; 19:e0296658. [PMID: 38408051 PMCID: PMC10896524 DOI: 10.1371/journal.pone.0296658] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 12/05/2023] [Indexed: 02/28/2024] Open
Abstract
Timely access to guideline-recommended cancer treatment is known to be an indicator of the quality and accessibility of a cancer care system. Yet people who are socially disadvantaged experience inequities in access to cancer treatment that have significant impacts on cancer outcomes and quality of life. Among people experiencing the intersecting impacts of poor access to the social determinants of health and personal identities typically marginalized from society ('social disadvantage'), there are significant barriers to accessing cancer, many of which compound one another, making cancer treatment extremely difficult to access. Although some research has focused on barriers to accessing cancer treatment among people who are socially disadvantaged, it is not entirely clear what, if anything, is being done to mitigate these barriers and improve access to care. Increasingly, there is a need to design cancer treatment services and models of care that are flexible, tailored to meet the needs of patients, and innovative in reaching out to socially disadvantaged groups. In this paper, we report the protocol for a planned scoping review which aims to answer the following question: What services, models of care, or interventions have been developed to improve access to or receipt of cancer treatment for adults who are socially disadvantaged? Based on the methodological framework of Arksey and O'Malley, this scoping review is planned in six iterative stages. A comprehensive search strategy will be developed by an academic librarian. OVID Medline, EMBASE, CINAHL (using EBSCOhost) and Scopus will be searched for peer-reviewed published literature; advanced searches in Google will be done to identify relevant online grey literature reports. Descriptive and thematic analysis methods will be used to analyze extracted data. Findings will provide a better understanding of the range and nature of strategies developed to mitigate barriers to accessing cancer treatment.
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Affiliation(s)
- Tara C Horrill
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amber Bourgeois
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | | | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Leahy
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Stajduhar KI, Giesbrecht M, Mollison A, Whitlock K, Burek P, Black F, Gerke J, Dosani N, Colgan S. "You can't die here": an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada. BMC Palliat Care 2024; 23:12. [PMID: 38200482 PMCID: PMC10782732 DOI: 10.1186/s12904-024-01340-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND One measure of quality in palliative care involves ensuring people approaching the end of life are able to receive care, and ultimately die, in the places they choose. Canadian palliative care policy directives stem from this tenet of autonomy, acknowledging that most people prefer to die at home, where they feel safe and comfortable. Limited research, however, considers the lack of 'choice' people positioned as structurally vulnerable (e.g., experiencing extreme poverty, homelessness, substance-use/criminalization, etc.) have in regard to places of care and death, with the option of dying-in-place most often denied. METHODS Drawing from ethnographic and participatory action research data collected during two studies that took place from 2014 to 2019 in an urban centre in British Columbia, Canada, this analysis explores barriers preventing people who experience social and structural inequity the option to die-in-place. Participants include: (1) people positioned as structurally vulnerable on a palliative trajectory; (2) their informal support persons/family caregivers (e.g., street family); (3) community service providers (e.g., housing workers, medical professionals); and (4) key informants (e.g., managers, medical directors, executive directors). Data includes observational fieldnotes, focus group and interviews transcripts. Interpretive thematic analytic techniques were employed. RESULTS Participants on a palliative trajectory lacked access to stable, affordable, or permanent housing, yet expressed their desire to stay 'in-place' at the end of life. Analysis reveals three main barriers impeding their 'choice' to remain in-place at the end of life: (1) Misaligned perceptions of risk and safety; (2) Challenges managing pain in the context of substance use, stigma, and discrimination; and (3) Gaps between protocols, policies, and procedures for health teams. CONCLUSIONS Findings demonstrate how the rhetoric of 'choice' in regard to preferred place of death is ethically problematic because experienced inequities are produced and constrained by socio-structural forces that reach beyond individuals' control. Ultimately, our findings contribute suggestions for policy, programs and practice to enhance inclusiveness in palliative care. Re-defining 'home' within palliative care, enhancing supports, education, and training for community care workers, integrating palliative approaches to care into the everyday work of non-health care providers, and acknowledging, valuing, and building upon existing relations of care can help to overcome existing barriers to delivering palliative care in various settings and increase the opportunity for all to spend their end of life in the places that they prefer.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Piotr Burek
- Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Fraser Black
- Faculty of Medicine - Island Medical Program, University of British Columbia, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Jill Gerke
- Palliative and End of Life Care Program, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Naheed Dosani
- Palliative Care Physician, Department of Family & Community Medicine, St Michael's Hospital at Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Simon Colgan
- Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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Booker R, McLennan AIG, Beattie S, Stajduhar KI, Sawatzky R. Integrating Palliative Care in Hematopoietic Stem Cell Transplantation: A Qualitative Study Exploring Patient, Caregiver, and Clinician Perspectives. Oncol Nurs Forum 2023; 50:313-323. [PMID: 37155974 DOI: 10.1188/23.onf.313-323] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To explore patient, caregiver, and clinician perspectives on palliative care for patients undergoing hematopoietic stem cell transplantation (HSCT). PARTICIPANTS & SETTING 8 patients who had undergone or would undergo HSCT, 4 caregivers, and 16 HSCT clinicians. METHODOLOGIC APPROACH This qualitative, interpretive descriptive study used semistructured interviews conducted via telephone or videoconference. FINDINGS Responses were categorized into the following two themes: concerns and challenges during and after HSCT, and tensions with integrating palliative care into HSCT. IMPLICATIONS FOR NURSING The findings from this study highlight the unique and varied needs of patients and their caregivers during and after HSCT. More research is required to determine how to best integrate palliative care in this setting.
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Affiliation(s)
- Reanne Booker
- Alberta Blood and Marrow Transplant Program, Tom Baker Cancer Centre, Calgary, Canada
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Bourgeois A, Horrill TC, Mollison A, Lambert LK, Stajduhar KI. Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data. Int J Equity Health 2023; 22:58. [PMID: 36998035 PMCID: PMC10064679 DOI: 10.1186/s12939-023-01860-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND A key pillar of Canada's healthcare system is universal access, yet significant barriers to cancer services remain for people impacted by structural vulnerability (e.g., poverty, homelessness, racism). For this reason, cancer is diagnosed at a later stage, resulting in worse patient outcomes, a reduced quality of life, and at a higher cost to the healthcare system. Those who face significant barriers to access are under-represented in cancer control services Consequently, these inequities result in people dying from cancers that are highly treatable and preventable, however; little is known about their treatment and care course. The aim of this study was to explore barriers to accessing cancer treatment among people experiencing structural vulnerability within a Canadian context. METHODS We conducted a secondary analysis of ethnographic data informed by critical theoretical perspectives of equity and social justice. The original research draws from 30 months of repeated interviews (n = 147) and 300 h of observational fieldwork with people experiencing health and social inequities at the end-of-life, their support persons, and service providers. RESULTS Our analysis identified four themes presenting as 'modifiable' barriers to inequitable access to cancer treatment: (1) housing as a key determinant for cancer treatment (2) impact of lower health literacy (3) addressing social care needs is a pre-requisite for treatment (4) intersecting and compounding barriers reinforce exclusion from cancer care. These inter-related themes point to how people impacted by health and social inequities are at times 'dropped' out of the cancer system and therefore unable to access cancer treatment. CONCLUSION Findings make visible the contextual and structural factors contributing to inequitable access to cancer treatment within a publically funded healthcare system. Identifying people who experience structural vulnerability, and approaches to delivering cancer services that are explicitly equity-oriented are urgently needed.
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Affiliation(s)
- Amber Bourgeois
- School of Nursing, University of Victoria, Institute on Aging & Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada.
| | - Tara C Horrill
- College of Nursing, University of Manitoba, 89 Curry Place Winnipeg, R3T 2N2, Victoria, MB, Canada
| | - Ashley Mollison
- Social Dimensions of Health, University of Victoria Institute on Aging and Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada
| | - Leah K Lambert
- School of Nursing, University of British Columbia, BC Cancer Suite 500, 686 West Broadway, V5Z 1G1, Vancouver, BC, Canada
| | - Kelli I Stajduhar
- School of Nursing, University of Victoria, Institute on Aging & Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada
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Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, Howard AF, Kaur J, McKenzie M, Stajduhar KI, Thorne S. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Health 2023; 22:20. [PMID: 36709295 PMCID: PMC9883825 DOI: 10.1186/s12939-023-01829-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
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Affiliation(s)
- Leah K. Lambert
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Tara C. Horrill
- grid.21613.370000 0004 1936 9609College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Scott M. Beck
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada
| | - Amber Bourgeois
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Annette J. Browne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - A. Fuchsia Howard
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jagbir Kaur
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Michael McKenzie
- Radiation Therapy Program, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Kelli I. Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Sally Thorne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
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Seow H, Bishop VC, Myers J, Stajduhar KI, Marshall DI, Incardona NK, Levine OH, Steinberg LJ, Bainbridge DB. Outcome measures in palliative care training interventions: a systematic review of trial-based studies. Ann Palliat Med 2023; 12:399-417. [PMID: 37019643 DOI: 10.21037/apm-22-947] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The ability of health care clinicians to offer a palliative approach to care to their patients with progressive, life-limiting illness has become critical as demand for these services increases. Numerous training initiatives exist to assist clinicians who are not palliative care specialists in the development of palliative care skills, however there is little consensus on how to best measure the effectiveness of these education programs. We conducted a systematic review of palliative care training intervention trials to examine the outcomes measures used. METHODS We searched MEDLINE, CINAHL, PsycINFO, Embase, HealthSTAR, and five trial registries for studies and protocols published since 2000. Eligible studies were trials assessing palliative care training for clinicians. Interventions had to address at least two of six palliative care-related domains, based on the National Consensus Project: identification or assessment; illness understanding; symptom management; decision making (e.g., advance care planning); coping (patient and caregivers); and referral (coordination/care planning). Each article was reviewed independently by a minimum of two reviewers for inclusion and extraction of relevant data. RESULTS Of 1,383 articles reviewed, 36 studies met the inclusion criteria, 16 (44%) of which focused on palliative care communication skills. Among all the trials, 190 different measures were reported. Only 11 validated measures were used in at least 2 studies, including the End-of-Life Professional Caregiver Survey (EPCS) for clinicians and the Quality of Dying and Death Questionnaire (QODD) for caregivers. Clinician and patient/caregiver reported outcomes were measured in 75% and 42% of studies, respectively. Half of the trials employed a study-created questionnaire. Data from administrative (n=14) and/or qualitative (n=7) sources were also used. Nine studies, almost exclusively those with a communication skills focus, assessed clinician interactions as an outcome. CONCLUSIONS We found considerable diversity in outcomes among the trials reviewed. Further examination of the outcomes used in the broader literature and development of these measures is needed. This will assist towards establishing meaningful and consistent metrics for assessing the impact of palliative care education, to inform evidence-based scaling of effective programs.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Valerie C Bishop
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jeff Myers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Denise I Marshall
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Nadia K Incardona
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Oren H Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Leah J Steinberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Giesbrecht M, Mollison A, Whitlock K, Stajduhar KI. "Once you open that door, it's a floodgate": Exploring work-related grief among community service workers providing care for structurally vulnerable populations at the end of life through participatory action research. Palliat Med 2022; 37:558-566. [PMID: 36461158 PMCID: PMC10074740 DOI: 10.1177/02692163221139727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/05/2022]
Abstract
BACKGROUND At the end of life, people experiencing structural vulnerability (e.g. homelessness, poverty, stigmatization) rely on community service workers to fill gaps in access to traditional palliative services. Although high levels of burnout are reported, little is known about these workers' experiences of grief. AIM To explore community service workers' experiences of grief to identify ways of providing more tailored, meaningful, and equitable supports. DESIGN A community-based participatory action research methodology, informed by equity perspectives, was employed. SETTING/PARTICIPANTS In an urban center in western Canada, community service worker (primary) participants (n = 18) were engaged as members of an action team. A series of 18 action cycles took place, with secondary participants (n = 48) (e.g. palliative, social care, housing support, etc.) being recruited throughout the research process. Focus groups (n = 5) and evaluative interviews (n = 13) with participants were conducted. Structured observational field notes (n = 34) were collected during all team meetings and community interventions. Interpretive thematic analysis ensued through a collaborative and iterative process. RESULTS During initial meetings, action team participants described experiences of compounding distress, grief, and multiple loss. Analysis showed workers are: (1) grieving as family, not just providers; (2) experiencing complex layers of compounded grief; and (3) are fearful to open the "floodgates" to grief. CONCLUSIONS Findings contribute to our understanding on the inequitable distribution of grief across society. A collective and material response is needed, including witnessing, acknowledging and valuing the grief process; facilitating community wellness, collective grieving, and advocacy; and providing training and tools in a palliative approach to care.
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Affiliation(s)
- Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada.,School of Nursing, University of Victoria, Victoria, BC, Canada
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Donald EE, Whitlock K, Dansereau T, Sands DJ, Small D, Stajduhar KI. A codevelopment process to advance methods for the use of patient-reported outcome measures and patient-reported experience measures with people who are homeless and experience chronic illness. Health Expect 2022; 25:2264-2274. [PMID: 35411709 PMCID: PMC9615092 DOI: 10.1111/hex.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction People who experience social disadvantage including homelessness suffer from numerous ill health effects when compared to the general public. Use of patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) enables collection of information from the point of view of the person receiving care. Involvement in research and health care decision‐making, a process that can be facilitated by the use of PROMs and PREMs, is one way to promote equity in care. Methods This article reports on a codevelopment and consultation study investigating the use of PROMs and PREMs with people who experience homelessness and chronic illness. Data were analysed according to interpretative phenomenological analysis. Results Committee members with lived experience identified three themes for the role of PROMs and PREMs in health care measurement: trust and relationship‐building; health and quality of life; and equity, alongside specific recommendations for the design and administration of PROMs and PREMs. The codevelopment process is reported to demonstrate the meaningful investment in time, infrastructure and relationship‐building required for successful partnership between researchers and people with lived experience of homelessness. Conclusion PROMs and PREMs can be meaningful measurement tools for people who experience social disadvantage, but can be alienating or reproduce inequity if they fail to capture complexity or rely on hidden assumptions of key concepts. Patient or Public Contribution This study was conducted in active partnership between researchers and people with experience of homelessness and chronic illness, including priority setting for study design, data construction, analysis and coauthorship on this article.
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Affiliation(s)
- Erin E Donald
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Faculty of Human and Social Development, School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Horrill TC, Browne AJ, Stajduhar KI. Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology. Curr Oncol 2022; 29:186-192. [PMID: 35049692 PMCID: PMC8774995 DOI: 10.3390/curroncol29010018] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.
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Affiliation(s)
- Tara C. Horrill
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Correspondence:
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kelli I. Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8P 5C2, Canada;
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Schick-Makaroff K, Sawatzky R, Cuthbertson L, Öhlén J, Beemer A, Duquette D, Karimi-Dehkordi M, Stajduhar KI, Suryaprakash N, Terblanche L, Wolff AC, Cohen SR. Knowledge translation resources to support the use of quality of life assessment tools for the care of older adults living at home and their family caregivers. Qual Life Res 2021; 31:1727-1747. [PMID: 34664161 PMCID: PMC9098582 DOI: 10.1007/s11136-021-03011-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
Purpose To support the use of quality of life (QOL) assessment tools for older adults, we developed knowledge translation (KT) resources tailored for four audiences: (1) older adults and their family caregivers (micro), (2) healthcare providers (micro), (3) healthcare managers and leaders (meso), and (4) government leaders and decision-makers (macro). Our objectives were to (1) describe knowledge gaps and resources and (2) develop corresponding tailored KT resources to support use of QOL assessment tools by each of the micro-, meso-, and macro-audiences. Methods Data were collected in two phases through semi-structured interviews/focus groups with the four audiences in Canada. Data were analyzed using qualitative description analysis. KT resources were iteratively refined through formative evaluation. Results Older adults and family caregivers (N = 12) wanted basic knowledge about what “QOL assessment” meant and how it could improve their care. Healthcare providers (N = 13) needed practical solutions on how to integrate QOL assessment tools in their practice. Healthcare managers and leaders (N = 14) desired information about using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in healthcare programs and quality improvement. Government leaders and decision-makers (N = 11) needed to know how to access, use, and interpret PROM and PREM information for decision-making purposes. Based on these insights and evidence-based sources, we developed KT resources to introduce QOL assessment through 8 infographic brochures, 1 whiteboard animation, 1 live-action video, and a webpage. Conclusion Our study affirms the need to tailor KT resources on QOL assessment for different audiences. Our KT resources are available: www.healthyqol.com/older-adults.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, 4-116 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada. .,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, 588- 1081 Burrard Street, Vancouver, V6Z 1Y6, Canada. .,Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, Box 400, 405 30, Gothenburg, Sweden.
| | - Lena Cuthbertson
- Office of Patient Centred Measurement, British Columbia, Ministry of Health, 1190 Hornby Street, 341F, Vancouver, BC, V6Z 2K5, Canada
| | - Joakim Öhlén
- Institute of Health and Care Sciences, and Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital, Västra Götaland Region, Gothenburg, Sweden
| | - Autumn Beemer
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Dominique Duquette
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Mehri Karimi-Dehkordi
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, 1-198 Clinical Sciences Building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada
| | - Kelli I Stajduhar
- School of Nursing, Institute on Aging and Lifelong Health, University of Victoria, STN CSC, PO Box 1700, Victoria, BC, V8W 2Y2, Canada
| | - Nitya Suryaprakash
- Center for Clinical Epidemiology and Evaluation, University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Landa Terblanche
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada
| | - Angela C Wolff
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada
| | - S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montreal, QC, H4A 3T2, Canada.,Lady Davis Research Institute of the Jewish General Hospital, Montreal, QC, H3T 1E2, Canada
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Wu EX, Collins A, Briggs S, Stajduhar KI, Kalsi A, Hilliard N. Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada. Am J Hosp Palliat Care 2021; 39:361-369. [PMID: 34259023 PMCID: PMC8847765 DOI: 10.1177/10499091211030442] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. METHODS A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. RESULTS Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. CONCLUSION The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief.
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Affiliation(s)
- Elizabeth X Wu
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Collins
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Shelley Briggs
- Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Kelli I Stajduhar
- School of Nursing & Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Asha Kalsi
- Health Information Science University of Victoria, Victoria, British Columbia, Canada
| | - Neil Hilliard
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
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Cloutier D, Stajduhar KI, Roberts D, Dujela C, Roland K. 'Bare-bones' to 'silver linings': lessons on integrating a palliative approach to care in long-term care in Western Canada. BMC Health Serv Res 2021; 21:610. [PMID: 34183002 PMCID: PMC8238377 DOI: 10.1186/s12913-021-06606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background ‘Whole-person’ palliative approaches to care (PAC) are important for enhancing the quality of life of residents with life-limiting conditions in long-term care (LTC). This research is part of a larger, four province study, the ‘SALTY (Seniors Adding Life to Years)’ project to address quality of care in later life. A Quality Improvement (QI) project to integrate a PAC (PAC-QI) in LTC was implemented in Western Canada in four diverse facilities that varied in terms of ownership, leadership models, bed size and geography. Two palliative ‘link nurses’ were hired for 1 day a week at each site over a two-year time frame to facilitate a PAC and support education and training. This paper evaluates the challenges with embedding the PAC-QI into LTC, from the perspectives of the direct care, or front-line team members. Sixteen focus groups were undertaken with 80 front-line workers who were predominantly RNs/LPNs (n = 25), or Health Care Aides (HCAs; n = 32). A total of 23 other individuals from the ranks of dieticians, social workers, recreation and rehabilitation therapists and activity coordinators also participated. Each focus group was taped and transcribed and thematically analyzed by research team members to develop and consolidate the findings related to challenges with embedding the PAC. Results Thematic analyses revealed that front-line workers are deeply committed to providing high quality PAC, but face challenges related to longstanding conditions in LTC notably, staff shortages, and perceived lack of time for providing compassionate care. The environment is also characterized by diverse views on what a PAC is, and when it should be applied. Our research suggests that integrated, holistic and sustainable PAC depends upon access to adequate resources for education, training for front-line care workers, and supportive leadership. Conclusions The urgent need for integrated PAC models in LTC has been accentuated by the current COVID-19 pandemic. Consequently, it is more imperative than ever before to move forwards with such models in order to promote quality of care and quality of life for residents and families, and to support job satisfaction for essential care workers.
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Affiliation(s)
- Denise Cloutier
- Department of Geography, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada. .,Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.,School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Della Roberts
- Palliative & End of Life Care, Island Health, 1952 Bay Street, Victoria, BC, V8R 1 J8, Canada
| | - Carren Dujela
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Kaitlyn Roland
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.,School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
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14
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Stajduhar KI, Giesbrecht M, Mollison A, Dosani N, McNeil R. Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life. Palliat Med 2020; 34:946-953. [PMID: 32340556 PMCID: PMC7787672 DOI: 10.1177/0269216320917875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/03/2022]
Abstract
BACKGROUND People experiencing structural vulnerability (e.g. homelessness, poverty, racism, criminalization of illicit drug use and mental health stigma) face significant barriers to accessing care at the end-of-life. 'Family' caregivers have the potential to play critical roles in providing care to these populations, yet little is known regarding 'who' caregivers are in this context and what their experiences may be. AIM To describe family caregiving in the context of structural vulnerability, to understand who these caregivers are, and the unique challenges, burdens and barriers they face. DESIGN Critical ethnography. SETTING/PARTICIPANTS Twenty-five family caregivers participated. Observational fieldnotes and semi-structured interviews were conducted in home, shelter, transitional housing, clinic, hospital, palliative care unit, community-based service centre and outdoor settings. RESULTS Family caregivers were found to be living within the constraints of structural vulnerability themselves, with almost half being street family or friends. The type of care provided varied greatly and included tasks associated with meeting the needs of basic survival (e.g. finding food and shelter). Thematic analysis revealed three core themes regarding experiences: Caregiving in the context of (1) poverty and substance use; (2) housing instability and (3) challenging relationships. CONCLUSION Findings offer novel insight into the experiences of family caregiving in the context of structural vulnerability. Engaging with family caregivers emerged as a missing and necessary palliative care practice, confirming the need to re-evaluate palliative care models and acknowledge issues of trust to create culturally relevant approaches for successful interventions. More research examining how 'family' is defined in this context is needed.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada.,School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | | | - Ryan McNeil
- BC Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Affiliation(s)
- Kelli I. Stajduhar
- School of Nursing, Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
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16
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Funk LM, Stajduhar KI, Giesbrecht M, Cloutier D, Williams A, Wolse F. Applying the concept of structural empowerment to interactions between families and home-care nurses. Nurs Inq 2019; 27:e12313. [PMID: 31336409 DOI: 10.1111/nin.12313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
Interpretations of family carer empowerment in much nursing research, and in home-care practice and policy, rarely attend explicitly to families' choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home-care nurses' interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses visiting 16 families) and interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed.
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Affiliation(s)
- Laura M Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada.,Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Denise Cloutier
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Department of Geography, University of Victoria, Victoria, British Columbia, Canada
| | - Allison Williams
- School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Faye Wolse
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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17
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Abstract
This ethnographic study examined the social context of home-based palliative caregiving. Data were composed of observation field notes, interviews, and textual documents, and were analyzed using constant comparative methods. Findings show that home-based palliative caregiving resulted in life-enriching experiences for many caregivers. However, assumptions about dying at home and health care reforms resulted in some caregivers feeling “pressured” to provide home care, and consequently, left them feeling their obligations to care were exploited by the health care system. Shifts toward providing care closer to home not only changed caregivers, but also changed the home setting where palliative care was provided. Findings indicate a need for interventions designed to improve support for caregivers at home, and to explore how assumptions influence and sometimes drive the provision of home health care.
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Affiliation(s)
- Kelli I. Stajduhar
- Centre on Aging, University of Victoria, and Vancouver Island Health Authority, Victoria, British Columbia, Canada
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18
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Abstract
This study explored the day-to-day experiences of family members providing care at home for their dying loved one with HIV/AIDS. In-depth interviews with seven caregivers were analyzed using grounded theory qualitative methods. A conceptualization of the family caregiving experience portrays HIV/AIDS caregiving as an intense, emotional, and powerful experience filled with pride and enrichment, and conversely, with anger and disillusionment. Findings reflected a significant need for interventions designed to provide direct and effective support for family members caring for a loved one with HIV/AIDS.
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Affiliation(s)
- Kelli I. Stajduhar
- Doctoral Student, University of British Columbia School of Nursing, British Columbia, Canada
| | - Betty Davies
- University of British Columbia School of Nursing and British Columbia Research Institute for Child and Family Health, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Affiliation(s)
- Kelli I. Stajduhar
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Betty Davies
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Stajduhar KI, Funk L, Cohen SR, Williams A, Bidgood D, Allan D, Norgrove L, Heyland D. Bereaved Family Members’ assessments of the quality of End-Of-Life Care: What is Important? J Palliat Care 2018. [DOI: 10.1177/082585971102700402] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of patients are well poised to comment on the end-of-life (EOL) care received by those patients and can provide feedback to care providers and decision makers. To better understand family-member evaluations of the quality of in-patient EOL care, this study draws on qualitative interview data (n=24) to identify core aspects of EOL care that are important for family members. Based on this analysis, a conceptual framework of family members’ assessments of their experiences with EOL health care services is developed. Findings suggest the need to distinguish between perceived substantive or tangible features of received care, interpretations of the causes and symbolic meanings of that care, and personal and affective outcomes. Practitioners are encouraged to reflect on how behaviours and communications may be interpreted by families. Attention also needs to be given to the changes in practice and organizational decision making that can facilitate more positive experiences for families and patients.
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Affiliation(s)
- Kelli I. Stajduhar
- KI Stajduhar (corresponding author) School of Nursing and Centre on Aging, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, Canada V8W 2Y2
| | - Laura Funk
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
| | - S. Robin Cohen
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Allison Williams
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Darcee Bidgood
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Diane Allan
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Leah Norgrove
- Department of Community Health and Epidemiology, Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Daren Heyland
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
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21
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Abstract
Toby died 5 October 2015. [...]
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Affiliation(s)
- K I Stajduhar
- School of Nursing, University of Victoria.,Institute on Aging and Lifelong Health, University of Victoria, and
| | - A Mollison
- Institute on Aging and Lifelong Health, University of Victoria, and
| | - D Gleave
- Victoria Cool Aid Society, Victoria, BC; and
| | - S W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON
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22
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Stajduhar KI, Tayler C. Helene Hudson Lecture: Taking an “upstream” approach in the care of dying cancer patients: The case for a palliative approach. Can Oncol Nurs J 2014. [DOI: 10.5737/1181912x241144148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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23
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Stajduhar KI, Tayler C. Prix de conférence à la mémoire de Helene Hudson : L’adoption d’une approche « en amont » dans les soins aux patients mourant du cancer : les mérites d’une approche palliative. Can Oncol Nurs J 2014. [DOI: 10.5737/1181912x243149153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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24
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Stajduhar KI, Tayler C. Taking an "upstream" approach in the care of dying cancer patients: the case for a palliative approach. Can Oncol Nurs J 2014; 24:144-153. [PMID: 25189052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Advances in technology and drug therapy have resulted in cancer patients living longer with malignant disease. However, most of these patients will face the end of life much sooner than the general population. Adopting a "palliative approach" is one innovation that has the potential to promote anticipatory planning and promote enhanced end-of-life care. Yet, in much of the western world, this upstream orientation has rarely been achieved. An emphasis on providing palliative care late in the illness trajectory has resulted in many challenges for the care of people with advanced cancer. We highlight a nursing research initiative, The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (iPANEL), that aims to develop evidence to inform the integration of a palliative approach into the care of people with advancing chronic life-limiting conditions. Oncology nurses have an important role to play in facilitating a palliative approach, transforming the ways in which cancer patients are cared for within our health care system.
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Shadd JD, Burge F, Stajduhar KI, Cohen SR, Kelley ML, Pesut B. Defining and measuring a palliative approach in primary care. Can Fam Physician 2013; 59:1149-50. [PMID: 24235182 PMCID: PMC3828085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Joshua D Shadd
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, London, ON N6A 3K7.
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26
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Stajduhar KI, Funk L, Outcalt L. Family caregiver learning--how family caregivers learn to provide care at the end of life: a qualitative secondary analysis of four datasets. Palliat Med 2013; 27:657-64. [PMID: 23695826 DOI: 10.1177/0269216313487765] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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 Family caregivers are assuming growing responsibilities in providing care to dying family members. Supporting them is fundamental to ensure quality end-of-life care and to buffer potentially negative outcomes, although family caregivers frequently acknowledge a deficiency of information, knowledge, and skills necessary to assume the tasks involved in this care. AIM The aim of this inquiry was to explore how family caregivers describe learning to provide care to palliative patients. DESIGN Secondary analysis of data from four qualitative studies (n = 156) with family caregivers of dying people. DATA SOURCES Data included qualitative interviews with 156 family caregivers of dying people. RESULTS Family caregivers learn through the following processes: trial and error, actively seeking needed information and guidance, applying knowledge and skills from previous experience, and reflecting on their current experiences. Caregivers generally preferred and appreciated a supported or guided learning process that involved being shown or told by others, usually learning reactively after a crisis. CONCLUSIONS Findings inform areas for future research to identify effective, individualized programs and interventions to support positive learning experiences for family caregivers of dying people.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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27
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Abstract
A patient’s ability to be cared for and to die at home is heavily dependent upon the efforts of family caregivers. Considerable stresses are associated with such caregiving, including physical, psychosocial and financial burdens. Research has shown that unmet needs and dissatisfaction with care can lead to negative outcomes for caregivers. While many family caregivers also report caregiving as life-enriching, some report that they would prefer alternatives to care at home, primarily because of these associated burdens. Little is known about which interventions are most effective to support family caregivers ministering palliative care at home. Well-designed studies to test promising interventions are needed, followed by studies of the best ways to implement the most effective interventions. Clinically effective practice support tools in palliative home care are warranted to identify family caregiver needs and to ensure that patients and their family caregivers have a choice about where care is provided.
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28
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Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: cancer patient perspectives. Patient Educ Couns 2013; 90:291-296. [PMID: 22464665 DOI: 10.1016/j.pec.2012.02.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients' perspectives. METHODS Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients. RESULTS Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care. CONCLUSION In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities. PRACTICE IMPLICATIONS Shared decision-making as a practice standard must be balanced against individual patient preferences.
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Affiliation(s)
- Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, Canada.
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29
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Abstract
Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health-care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi-structured interviews with Canadian family caregivers, care recipients and nurses, the intersection of language, place and health-care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as 'guests'; home environments facilitate the development of nurse-client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health-care. We conclude by discussing the importance of considering the language-place-healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice.
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Affiliation(s)
- Melissa D Giesbrecht
- Department of Geography, Simon Fraser University, Burnaby, BC, CanadaSchool of Nursing and Centre on Aging, University of Victoria, Victoria, BC, Canada
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Funk LM, Stajduhar KI, Robin Cohen S, Heyland DK, Williams A. Legitimising and rationalising in talk about satisfaction with formal healthcare among bereaved family members. Sociol Health Illn 2012; 34:1010-1024. [PMID: 22384989 DOI: 10.1111/j.1467-9566.2011.01457.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
While there is a fair amount of knowledge regarding substantive features of end of life care that family members desire and appreciate, we lack full understanding of the process whereby family members formulate care evaluations. In this article we draw on an analysis of interview data from 24 bereaved family members to explicate how they interpret their experiences and formulate evaluations of end of life care services. Most participants wove between expressing and legitimising dissatisfaction, and qualifying or diffusing it. This occurred through processes of comparisons against prior care experiences and expectations, personalising (drawing on personal situations and knowledge), collectivising (drawing on conversations with and observations of others) and attempting to understand causes for their negative care experiences and to attribute responsibility. The findings suggest that dissatisfaction might be diffused even where care is experienced negatively, primarily through the acknowledgement of mitigating circumstances. To a lesser extent, some participants attributed responsibility to the 'system' (policy and decision-makers) and individual staff members. The findings are discussed in relation to the theoretical understanding of satisfaction and evaluation processes and how satisfaction data might inform improvements to care quality.
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Affiliation(s)
- Laura M Funk
- Department of Sociology, University of Manitoba, Winnipeg, Canada.
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Molzahn A, Sheilds L, Bruce A, Stajduhar KI, Makaroff KS, Beuthin R, Shermak S. Perceptions regarding death and dying of individuals with chronic kidney disease. Nephrol Nurs J 2012; 39:197-204. [PMID: 22866359] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This research explores perceptions regarding death and dying among people with chronic kidney disease. The methodology for the study was narrative inquiry informed by social constructivism. In-depth narrative interviews were conducted on two occasions with 14 participants. The participants included 10 men and 4 women (mean age of 66) who were treated in a mid-size Canadian city. Four themes relating to death and dying emerged from the data: awareness of death as a consequence of kidney failure, close calls, contemplation of suicide and/or withdrawal from dialysis, and preparing for death while living life. From the findings, it appeared that participants were very aware of the risk of dying from their illness, experienced serious health crises, and planned for their deaths. They were comfortable in discussing death and dying and acknowledged withdrawal from dialysis as an option.
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Affiliation(s)
- Anita Molzahn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Thorne SE, Stajduhar KI. Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses. J Cancer Surviv 2012; 6:229-37. [DOI: 10.1007/s11764-012-0216-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 02/16/2012] [Indexed: 12/31/2022]
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Crooks VA, Williams A, Stajduhar KI, Cohen SR, Allan D, Brazil K. Family caregivers' ideal expectations of Canada's Compassionate Care Benefit. Health Soc Care Community 2012; 20:172-180. [PMID: 21919990 DOI: 10.1111/j.1365-2524.2011.01028.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the findings of 57 interviews conducted in 2007-2008 with Canadians who have cared for a dying family member to examine their ideal expectations of the Compassionate Care Benefit (CCB) - a social programme providing job security and income support for workers caring for a dying person. Our aims are to (1) appreciate how intended users and other family caregivers view the programme's very nature; (2) identify programme challenges and improvements that emerge from considering family caregivers' ideal expectations; and (3) contribute to a larger evaluative study designed to make policy-relevant recommendations for CCB improvement. Review of transcripts across three respondent groups reveals four categories of ideal expectations: (1) eligibility, (2) informational, (3) timing and (4) financial. Ideal expectations were typically derived from respondents' experiences of care-giving, their knowledge of the programme and, for some, of applying for and/or receiving the CCB. Findings reveal that there are gaps between respondents' ideal expectations and their experienced realities. Such gaps may lead to disappointment being experienced by those who believe they should be eligible for the programme but are not, or should be entitled to receive some form of support that is not presently available. This analysis plays an important role in identifying potential changes for the CCB that may better support family caregivers, in that the ideal expectations serve as a starting point for articulating desirable programme amendments. This analysis also has wider relevance. For jurisdictions looking to create new social programmes to support caregivers based upon labour policy strategies and legislation, this analysis identifies considerations that should be made at the outset of development. For jurisdictions that already have employment-based caregiver support programmes, this analysis demonstrates that programme challenges may not always be met through legislative changes alone but also through measures such as increasing awareness.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, BC, Canada.
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Garrett DD, Tuokko H, Stajduhar KI, Lindsay J, Buehler S. Planning for end-of-life care: findings from the Canadian Study of Health and Aging. Can J Aging 2011; 27:11-21. [PMID: 18492633 DOI: 10.3138/cja.27.1.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants had thought about, discussed , or formalized their end-of-life preferences), and considered, as well, whether relations existed among the three outcomes. Canadian region of residence, female gender, and more years of education predicted having thought about preferences; region of residence, female gender, and lack of cognitive impairment predicted discussion of preferences; and region of residence and not being married predicted whether formal documents were in place. Ontario residents were most likely to have thought about, discussed, and formalized their preferences, whereas Atlantic residents were least likely to. Finally, having thought about preferences was associated with discussion, and having thought about and having discussed preferences were each associated with formalization of preferences. These findings are in keeping with the position that Advance Directives (AD) execution is a multi-stage process. A better understanding of this process may prove useful for the development of interventions to promote planning for end-of-life care.
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Stajduhar KI, Funk L, Wolse F, Crooks V, Roberts D, Williams AM, Cloutier-Fisher D, McLeod B. Core aspects of "empowering" caregivers as articulated by leaders in home health care: palliative and chronic illness contexts. Can J Nurs Res 2011; 43:78-94. [PMID: 21977727] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Home-based family caregivers are often assisted by home care services founded upon principles of health promotion, such as empowerment. Using an interpretive approach and in-depth qualitative interviews, the authors examine descriptions of family empowerment by leaders and managers in the field of home health care in the province of British Columbia, Canada. In a culture of fiscal restraint, dying at home, and self-care, participants described how home care nurses empower family caregivers to meet these objectives. This involves educating and informing caregivers, engaging them in planning and decision-making, and reassuring them that their role is manageable and worthwhile. Though some participants viewed providing supports as empowering (e.g., during times of crisis), others viewed them as disempowering (by promoting dependence). Empowered caregivers were characterized as able to provide home care, confident of their capabilities, and believing that their work is positive and beneficial. The long-term goal of empowerment was characterized as client self-care and/or family care and decreased dependence on formal services.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, British Columbia, Canada
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Stajduhar KI. Chronic illness, palliative care, and the problematic nature of dying. Can J Nurs Res 2011; 43:7-15. [PMID: 21977723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Kelli I Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, British Columbia, Canada
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Abstract
AIMS AND OBJECTIVES Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? BACKGROUND Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. DESIGN Secondary analysis of qualitative interview data. METHODS Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. RESULTS Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase - respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. CONCLUSIONS Communication is an important element in the provision of advanced cancer care. RELEVANCE TO CLINICAL PRACTICE Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication.
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Affiliation(s)
- Kelli I Stajduhar
- University of Victoria School of Nursing, Vancouver, British Columbia, Canada.
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Stajduhar KI, Funk LM, Roberts D, Cloutier-Fisher D, McLeod B, Wilkinson C, Purkis ME. Articulating the role of relationships in access to home care nursing at the end of life. Qual Health Res 2011; 21:117-131. [PMID: 20682963 DOI: 10.1177/1049732310379114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this article, we draw on data collected from two samples of home care nurses to examine how relationships between nurses and family caregivers intersected with access to palliative home care nursing services. Participants referred to relationships as important for their practical benefits and for access to care: good relationships enhanced the nurse's ability to assess clients and families and fostered the family's trust in the nurse's care. Although emphasizing the need to build and maintain relationships (often requiring time), participants simultaneously referred to beliefs about the need to control the personal emotions invoked in relationships so as to ensure appropriate access for clients and families. Future research should further explore how the organizational and resource context, and the culture of palliative care, shape nurses' beliefs about relationships in their practice, the nature and types of relationships that can develop, and both client and family caregivers' access to care.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada.
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Stajduhar KI, Funk L, Cohen SR, Williams A, Bidgood D, Allan D, Norgrove L, Heyland D. Bereaved family members' assessments of the quality of end-of-life care: what is important? J Palliat Care 2011; 27:261-269. [PMID: 22372280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Families of patients are well poised to comment on the end-of-life (EOL) care received by those patients and can provide feedback to care providers and decision makers. To better understand family-member evaluations of the quality of in-patient EOL care, this study draws on qualitative interview data (n = 24) to identify core aspects of EOL care that are important for family members. Based on this analysis, a conceptual framework of family members' assessments of their experiences with EOL health care services is developed. Findings suggest the need to distinguish between perceived substantive or tangible features of received care, interpretations of the causes and symbolic meanings of that care, and personal and affective outcomes. Practitioners are encouraged to reflect on how behaviours and communications may be interpreted by families. Attention also needs to be given to the changes in practice and organizational decision making that can facilitate more positive experiences for families and patients.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, Canada VBW 2Y2.
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Funk LM, Stajduhar KI, Cloutier-Fisher D. Exploring Family Caregivers’ Rationales for Nonuse of Formal Home Health Services When Caring for a Dying Family Member. Home Health Care Management & Practice 2010. [DOI: 10.1177/1084822310384920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drawing on interviews with 26 bereaved individuals who provided care to a dying family member at home, the purpose of this article is to identify and explore motivations behind the “nonuse” of home health services. Participants resided in a Western Canadian regional health authority. In their accounts of not asking for help from formal providers, participants highlighted personal reasons, coping needs, and a lack of knowledge. In their accounts of refused help, they placed more emphasis on a perceived lack of need for help (including constructing themselves as capable and coping), as well as their perceptions of the quality and competence of formal services. Findings are compared against existing literature. Implications for health system policy and planning, and for home health nursing practice, training and education, particularly with reference to situations in which responsibility is left with families to ask for help from formal providers, are also discussed.
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Affiliation(s)
- Laura M. Funk
- University of Victoria, Victoria, British Columbia, Canada
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Stajduhar KI, Funk L, Roberts D, McLeod B, Cloutier-Fisher D, Wilkinson C, Purkis ME. Home care nurses' decisions about the need for and amount of service at the end of life. J Adv Nurs 2010; 67:276-86. [PMID: 20973810 DOI: 10.1111/j.1365-2648.2010.05491.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS We explore home care nurse decision-making about the need for and amount of service by clients and families at the end of life. We identify factors nurses refer to when describing these decisions, situated within contextual features of nursing practice. BACKGROUND Home care nurses are often responsible for decisions which have an impact on the access of clients and families to services at the end of life. Understanding how these decisions, are made, factors that are considered, and contextual influences is critical for improving access and enhancing care. METHODS Qualitative data were collected between 2006 and 2008 from two samples of home care nurses: the first group (n = 29) recorded narrative descriptions of decisions made during visits to families. The second group (n = 27) completed in-person interviews focusing on access to care and their interactions with clients and families. Data were analysed with thematic coding and constant comparison. FINDINGS Participants described assessing client and family needs and capacity. These assessments, at times integrated with considerations about relationships with clients and families, inform predictive judgements about future visits; these judgments are integrated with workload and home health resource considerations. In describing decisions, participants referred to concepts such as expertise, practice ideals and approaches to care. CONCLUSION Findings highlight the role of considerations of family caregiver capacity, the influence of relationships and the importance of the context of practice, as part of a complete understanding of the complexity of access to care at the end of life.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, British Columbia, Canada.
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Hudson PL, Trauer T, Graham S, Grande G, Ewing G, Payne S, Stajduhar KI, Thomas K. A systematic review of instruments related to family caregivers of palliative care patients. Palliat Med 2010; 24:656-68. [PMID: 20605852 DOI: 10.1177/0269216310373167] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Support for family caregivers is a core function of palliative care. However, there is a lack of consistency in the way needs are assessed, few longitudinal studies to examine the impact of caregiving, and a dearth of evidence-based interventions. In order to help redress this situation, identification of suitable instruments to examine the caregiving experience and the effectiveness of interventions is required. A systematic literature review was undertaken incorporating representatives of the European Association for Palliative Care's International Palliative Care Family Caregiver Research Collaboration and Family Carer Taskforce. The aim of the review was to identify articles that described the use of instruments administered to family caregivers of palliative care patients (pre and post-bereavement). Fourteen of the 62 instruments targeted satisfaction with service delivery and less than half were developed specifically for the palliative care context. In approximately 25% of articles psychometric data were not reported. Where psychometric results were reported, validity data were reported in less than half (42%) of these cases. While a considerable variety of instruments have been administered to family caregivers, the validity of some of these requires further consideration. We recommend that others be judicious before developing new instruments for this population.
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Affiliation(s)
- Peter L Hudson
- St Vincent's and The University of Melbourne, Centre for Palliative Care, Melbourne, Australia.
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Garrett DD, Tuokko H, Stajduhar KI, Lindsay J, Buehler S. Planning for End-of-Life Care: Findings from the Canadian Study of Health and Aging. Can J Aging 2010. [DOI: 10.3138/cja.27.1.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RÉSUMÉLes étapes utilisées pour l'officialisation des préférences en matière de soins en fin de vie et les facteurs en rapport avec ces étapes sont flous dans la documentation. À l'aide des données de la troisième phase de l'Étude sur la santé et le vieillissement au Canada (ESVC-3), nous avons examiné les relations entre les prédicteurs démographiques et en matière de santé, et les trois résultats (à savoir si les participants avaient réfléchi à leurs préférences de fin de vie, s'ils en avaient discuté, ou s'ils les avaient officialisées), et s'il y avait des relations entre les trois résultats. La région de résidence au Canada, le sexe féminin, et davantage d'années de scolarité étaient des facteurs associés à des personnes ayant réfléchi à leurs préférences. La région de résidence, le sexe féminin, et le manque de déficience cognitive étaient associés aux discussions en matière de préférences, et la région de résidence et le fait de ne pas avoir de conjoint étaient associés au dépôt de documents officiels. Les résidents de l'Ontario étaient les plus enclins à avoir réfléchi à leurs préférences, à en avoir discuté, et à les avoir officialisées, tandis que les résidents des Maritimes étaient les moins enclins à y avoir pensé et à avoir agi en conséquence. Enfin, avoir réfléchi à leurs préférences était associé au fait d'en discuter, et y avoir réfléchi et en avoir discuté étaient chacun associés à l'officialisation des préférences. Ces résultats correspondent au postulat que l'exécution du mandat (directive par procuration) est un processus comportant plusieurs étapes. Avoir une meilleure idée de ce processus peut se révéler utile lors de l'élaboration d'interventions visant à promouvoir la planification des soins en fin de vie.
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Thorne S, Armstrong EA, Harris SR, Hislop TG, Kim-Sing C, Oglov V, Oliffe JL, Stajduhar KI. Patient real-time and 12-month retrospective perceptions of difficult communications in the cancer diagnostic period. Qual Health Res 2009; 19:1383-1394. [PMID: 19805801 DOI: 10.1177/1049732309348382] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Communication is a notoriously complex challenge in the cancer care context. Our program of research involves exploration of patient-provider communications across the cancer trajectory from the patient perspective.Toward this end, we have been following a cohort of 60 cancer patients, representing a range of tumor sites, from immediately after diagnosis through to recovery, chronic, or advanced disease. Drawing on interpretive description analytic techniques, we documented patterns and themes related to various components of the cancer journey. In this article, we report on findings pertaining to poor communication during the initial diagnostic period, as described by patients at the time of diagnosis and 1 year later.These findings illuminate the dynamics of communication problems during that complex period, and depict the mechanisms by which patients sought to confront these challenges to optimize their cancer care experience. On the basis of these findings, considered in the context of the body of available evidence, suggestions are proposed as to appropriate directions for system-level solutions to the complex communication challenges within cancer care.
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Affiliation(s)
- Sally Thorne
- University of British Columbia,Vancouver, British Columbia, Canada.
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Abstract
Most research into caregiver employment and outcomes conceives of employment as a dichotomous variable—employed or not. This study examines the relationship between work interferences and caregiver burden, well-being, and self-esteem within a modified stress process model. Regression models are employed using a population-based random sample of caregivers. Employment status effects on outcomes for the total sample are estimated, followed by estimations of the effects of work interferences on the same outcomes for the employed subsample. Employment status is unrelated to outcomes in the total sample. In the employed subsample, a 13-item work interferences scale is related to burden but unrelated to well-being and self-esteem. Of the 13 items, only “performance at work was affected because of caring for a care recipient” is associated with all three caregiver outcomes. These findings suggest that subjective assessment of work interferences may play a more important role than does employment status.
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Affiliation(s)
- R. Colin Reid
- University of British Columbia Okanagan, Kelowna, Canada
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Abstract
Family caregiving tends to involve strong and often competing emotional experiences. Most of our knowledge of caregiving stems from interview research, much of it cross-sectional in nature. In this article we explore the implications of interviews as a research method for understanding caregiving. Specifically, we address difficulties in interpreting participants' talk about caregiving when this talk is simultaneously an articulation of experience and an attempt to cope with that experience. Either uncritically accepting accounts as reflective of experience, without considering the role of coping, or making assumptions about the success of caregiver coping in this context, might be erroneous. Our own experiences of interviewing family caregivers in different research projects will be drawn upon as examples. We conclude by questioning the ability to draw conclusions about caregiving and/or caregiver coping based solely on interview research, and call for greater integration of observational and longitudinal methods in family caregiving research.
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Affiliation(s)
- Laura M Funk
- University of Victoria, Victoria, British Columbia, Canada
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Affiliation(s)
- Kelli I. Stajduhar
- * *†Doctoral Candidates and ‡ Professor, University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
| | - Lynda Balneaves
- * *†Doctoral Candidates and ‡ Professor, University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
| | - Sally E. Thorne
- * *†Doctoral Candidates and ‡ Professor, University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
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Allan DE, Waskiewich S, Stajduhar KI, Bidgood D. Use of palliative care services in a semirural program in British Columbia. Can J Rural Med 2009; 14:10-15. [PMID: 19146786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although specialized palliative care services in rural areas are scarce, many people who are dying, and their families, want to remain in their homes or within their own community. As such, semirural communities across Canada have developed a variety of initiatives to address this need. The purpose of our paper is to describe a semirural palliative care program located in British Columbia. METHODS We used univariate and bivariate analyses to examine all patients for whom a palliative care bed was requested in the Saanich Peninsula Hospital Palliative Care Unit (PCU) between Jan. 1, 2005, and Dec. 31, 2006. RESULTS Data suggest that there is provision of care for local residents in this semirural community. Throughout 2005 and 2006, SPH received a total of 411 requests for a palliative care bed with about three-quarters of admissions coming from other units within the hospital and from local residents. CONCLUSION Use of services data collected from hospital charts can provide valuable information to help inform program and policy decision-makers. Yet such information is limited in relation to answering the question of whether the end-of-life needs of local residents are being met. Future studies should consider input from families and patients to enhance our understanding of the role of a PCU in a semirural environment.
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Affiliation(s)
- Diane E Allan
- Centre on Aging, University of Victoria, Victoria, BC
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Stajduhar KI, Nickel DD, Martin WL, Funk L. Situated/being situated: Client and co-worker roles of family caregivers in hospice palliative care. Soc Sci Med 2008; 67:1789-97. [PMID: 18922609 DOI: 10.1016/j.socscimed.2008.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Indexed: 11/26/2022]
Abstract
Since the inception of the modern hospice movement, the patient and family caregiver (FCG) have been considered the unit of care; family members are identified as 'clients' within palliative care philosophy. Little research has focused on how FCGs define their roles within the hospice palliative care (HPC) system. The aim of this study was to describe how FCGs of dying cancer patients view their roles in relation to the HPC system. Secondary analysis of interviews with 36 bereaved FCGs in Western Canada, guided by interpretive descriptive methods, found that FCGs perceived themselves as having two roles: client and co-worker. FCGs situated themselves as clients, where they actively sought help from the health care system. FCGs at times also perceived they had been situated as clients by health care providers, and were more resistant to accepting help. In other comments FCGs situated themselves as co-workers, seeking out an active role within the HPC team, whereas in other instances, felt they were situated as co-workers by a health care system with limited financial and human resources. Findings suggest that greater emphasis be placed on helping family members identify suitable interventions depending on how they view their roles within the HPC system. How we define family members in relation to the HPC system may also require reconsideration to reflect a more current conceptualization of realities in end-of-life care.
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