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Chan WS, Funk L, Krawczyk M, Cohen SR, Cherba M, Dujela C, Stajduhar K. Community perspectives on structural barriers to dying well at home in Canada. Palliat Support Care 2024; 22:347-353. [PMID: 37503570 DOI: 10.1017/s1478951523001074] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To analyze how structural determinants and barriers within social systems shape options for dying well at home in Canada, while also shaping preferences for dying at home. METHODS To inform a descriptive thematic analysis, 24 Canadian stakeholders were interviewed about their views, experiences, and preferences about dying at home. Participants included compassionate community advocates, palliative care professionals, volunteers, bereaved family caregivers, residents of rural and remote regions, service providers working with structurally vulnerable populations, and members of francophone, immigrant, and 2SLGBTQ+ communities. RESULTS Analysis of stakeholders' insights and experiences led to the conceptualization of several structural barriers to dying well at home: inaccessible public and community infrastructure and services, a structural gap in death literacy, social stigma and discrimination, and limited access to relational social capital. SIGNIFICANCE OF RESULTS Aging in Canada, as elsewhere across the globe, has increased demand for palliative care and support, especially in the home. Support for people wishing to die at home is a key public health issue. However, while Canadian policy documents normalize dying in place as ideal, it is uncertain whether these fit with the real possibilities for people nearing the end of life. Our analysis extends existing research on health equity in palliative and end-of-life care beyond a focus on service provision. Results of this analysis identify the need to expand policymakers' structural imaginations about what it means to die well at home in Canada.
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Affiliation(s)
- Wing-Sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Marian Krawczyk
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | | | - Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON, Canada
| | - Carren Dujela
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Cherba M, Funk L, Scott E, Salman B, Rounce A, Mackenzie C, Stajduhar K, Dujela C, Krawczyk M, Cohen SR. How initial policy responses to COVID-19 contributed to shaping dying at home preferences and care provision: key informant perspectives from Canada. BMC Health Serv Res 2023; 23:1330. [PMID: 38037107 PMCID: PMC10691158 DOI: 10.1186/s12913-023-10340-x] [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: 05/28/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES In response to COVID-19's first wave, provincial governments rapidly implemented several public health directives, including isolation measures and care facility visitor restrictions, which profoundly affected healthcare delivery at the end of life and dying experiences and perceptions. The objective of this study was to identify implications of early policy changes for dying at home. METHODS Analysis of interviews with 29 key informants with expertise in the policy and practice context of dying at home and care for those dying at home was conducted as part of a larger mixed-methods study on dying at home in Canada. RESULTS Initial pandemic policy responses, especially visitor restrictions and limitations to home care services, shaped dying at home in relation to three themes: (1) increasing preferences and demand for, yet constrained system ability to support dying at home; (2) reinforcing and illuminating systemic reliance on and need for family/friend caregivers and community organizations, while constraining their abilities to help people die at home; and (3) illuminating challenges in developing and implementing policy changes during a pandemic, including equity-related implications. CONCLUSION This study contributes to broader understanding of the multifaceted impacts of COVID-19 policy responses in various areas within Canadian healthcare systems. Implications for healthcare delivery and policy development include (1) recognizing the role of family/friend caregivers and community organizations in end-of-life care, (2) recognizing health inequities at the end of life, and (3) considering possible changes in future end-of-life preferences and public attitudes about dying at home and responsibility for end-of-life care.
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Affiliation(s)
| | - Laura Funk
- University of Manitoba, Winnipeg, Canada
| | - Erin Scott
- University of Manitoba, Winnipeg, Canada
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Cohen SR, Wishard Guerra A, Miguel J, Bottema-Beutel K, Oliveira G. Hablando at home: Examining the interactional resources of a bilingual autistic child. J Child Lang 2023:1-23. [PMID: 37899270 DOI: 10.1017/s0305000923000600] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Daily language interactions predict child outcomes. For multilingual families who rear neurodiverse children and who may be minoritized for their language use, a dearth of research examines families' daily language interactions. Utilizing a language socialization framework and a case study methodology, 4,991 English and Spanish utterances from a 5-year old autistic child and his family were collected during naturally occurring interactions over 10 days. Utterances were analyzed for patterns of code-switching by speaker, activity setting, English or Spanish initial language, and code-switch function. Spanish was spoken in most activities. For reading, both languages were equally employed by the father. While participants used both languages across all activity settings, significant variations in code-switching type and function were observed by activity setting and speaker. We discuss implications for how home language resources can be integrated into autism interventions.
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Affiliation(s)
- S R Cohen
- Education Studies Department, University of California, San Diego, La Jolla, USA
| | - A Wishard Guerra
- Education Studies Department, University of California, San Diego, La Jolla, USA
| | - J Miguel
- Erikson Institute, Herr Research Center, Chicago, USA
| | - K Bottema-Beutel
- Lynch School of Education and Human Development, Boston College, Boston, USA
| | - G Oliveira
- Harvard Graduate School of Education, Cambridge, USA
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Schick-Makaroff K, Klarenbach S, Kwon JY, Cohen SR, Czupryn J, Lee L, Pauly R, MacRae JM, Forde B, Sawatzky R. Electronic patient-reported outcomes in clinical kidney practice (ePRO Kidney): a process evaluation of educational support for clinicians. Ther Adv Chronic Dis 2023; 14:20406223231173624. [PMID: 37332391 PMCID: PMC10272664 DOI: 10.1177/20406223231173624] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background Patient-reported outcomes (PROs) are increasingly mandated in kidney care to incorporate patients' perspectives. Objectives We assessed whether educational support for clinicians using electronic (e)PROs could enhance person-centered care. Design A process evaluation, using a mixed methods longitudinal comparative concurrent design was undertaken of educational support to clinicians on routine use of ePROs. In two urban home dialysis clinics in Alberta, Canada, patients completed ePROs. At the implementation site, clinicians were provided with ePROs and clinician-oriented education via voluntary workshops. At the non-implementation site, neither were provided. Person-centered care was measured using the Patient Assessment of Chronic Illness Care-20 (PACIC-20). Methods Longitudinal structural equation models (SEMs) compared change in overall PACIC scores. The interpretive description approach, using thematic analysis of qualitative data, further evaluated processes of implementation. Results Data were collected from questionnaires completed by 543 patients, 4 workshops, 15 focus groups, and 37 interviews. There was no overall difference in person-centered care throughout the study, including after delivery of workshops. The longitudinal SEMs revealed substantial individual-level variability in overall PACIC trajectories. However, there was no improvement at the implementation site and no difference between the sites during both the pre- and post-workshop periods. Similar results were obtained for each PACIC domain. Qualitative analysis provided insights into why there was no substantial difference between sites: (1) clinicians wanted to see kidney symptoms, not quality of life, (2) workshops were tailored to clinicians' educational needs, not patients' needs, and (3) variable use of ePRO data by clinicians. Conclusion Training clinicians on use of ePROs is complex and likely only part of what is required to enhance person-centered care. Registration NCT03149328. https://clinicaltrials.gov/ct2/show/NCT03149328.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, 4-116 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jae-Yung Kwon
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Research Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Joanna Czupryn
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Loretta Lee
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Robert Pauly
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Bruce Forde
- Cambian Business Services, Surrey, BC, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Stajduhar K, Sawatzky R, Funk L, Cohen SR, Bitschy A, Donald E, Votova K. Shifts in Homecare Nursing Practices and Their Implications for Families and Clients Receiving Palliative Care at Home. Nurs Leadersh (Tor Ont) 2023; 36:75-86. [PMID: 37552519 DOI: 10.12927/cjnl.2023.27122] [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] [Indexed: 08/09/2023]
Abstract
Homecare nurses provide essential healthcare services at home. Changes in the nature of homecare nursing practice, however, suggest that older and frail homecare clients are less likely to have timely access to needed homecare nursing services as acute management takes priority. This has an impact on people's ability to be cared for and to die at home, a reported priority for many Canadians. This study highlights how health system changes may be constraining homecare nurses' abilities to enact care that is consistent with palliative care principles and philosophies, and calls for consideration of how shifts in homecare nursing practice have implications for families and clients receiving palliative care at home.
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Affiliation(s)
- Kelli Stajduhar
- Professor and Canada Research Chair in Palliative Approaches to Care in Aging and Community Health, School of Nursing, University of Victoria, Victoria, BC
| | - Richard Sawatzky
- Professor School of Nursing, Trinity Western University, Langley, BC
| | - Laura Funk
- Professor, Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB
| | - S Robin Cohen
- Professor Emerita, Department of Oncology and Medicine, McGill University, Montréal, QC
| | - Ami Bitschy
- Research Coordinator, Institute on Aging & Lifelong Health, University of Victoria Victoria, BC
| | - Erin Donald
- School of Nursing, University of Victoria, Victoria, BC
| | - Kristine Votova
- Director Analytics, Evaluation and Monitoring, Vancouver Island Health Authority Victoria, BC
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Funk L, Krawczyk M, Cherba M, Cohen SR, Dujela C, Nichols C, Stajduhar K. 'The beauty and the less beautiful': exploring the meanings of dying at 'home' among community and practitioner representatives and advocates across Canada. Palliat Care Soc Pract 2023; 17:26323524231156944. [PMID: 36936628 PMCID: PMC10017957 DOI: 10.1177/26323524231156944] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023] Open
Abstract
Background Significant structural and normative pressures privilege the ideal of dying at home in Canada. At the same time, the social complexities and meanings associated with dying in particular locations remain critically unexamined. Objective The aim of this study is to explore how diverse community members, including health and social care stakeholders, talk about preferences for locations of dying, with a particular focus on meanings of dying at home. Design Semi-structured virtual interviews were conducted with 24 community and practitioner representatives and advocates across Canada during the Covid-19 pandemic. This included compassionate community advocates, palliative care professionals and volunteers, bereaved carers, and members of queer, rural, and immigrant communities. Participants were asked about their own preferences for location of dying and elaborated on these aspects with regard to their client population or community group. Results Our analysis illuminates how meanings of dying at home are connected to previous experiences and perceptions of institutional care. As such, participants' perspectives are often framed as a rejection of institutional care. Dying at home also often signals potential for preserving ontological security and relational connection in the face of life-threatening illness. However, participants' expertise simultaneously informs a sense that dying at home is often unattainable. At times, this awareness underpins interpretations of both preferences and choices as contingent on considerations of the nature and type of illness, concerns about impacts on families, and available resources. Conclusion The ideal of dying at home is nuanced by identity, relational, and structural contexts. Knowledge from this study can inform realistic and practical person-centered planning across care settings. It can also help create more representative public policy and health system quality indicators regarding a 'good death' that do not rely on or perpetuate undeveloped and unrealistic assumptions about dying, home, and family care.
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Affiliation(s)
| | - Marian Krawczyk
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON, Canada
| | | | - Carren Dujela
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Camille Nichols
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Gao DX, Kahn JS, Cohen SR, Dumont N, Yang FC, Rosmarin D. Analysis of patient attitudes and behavior regarding dermatologic care during the COVID-19 pandemic: a survey-based study at a single academic institution. Dermatol Online J 2022; 28. [PMID: 36809108 DOI: 10.5070/d328659738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- D X Gao
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts, USA
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Funk LM, Mackenzie CS, Cherba M, Del Rosario N, Krawczyk M, Rounce A, Stajduhar K, Cohen SR. Where would Canadians prefer to die? Variation by situational severity, support for family obligations, and age in a national study. Palliat Care 2022; 21:139. [PMID: 35909120 PMCID: PMC9340714 DOI: 10.1186/s12904-022-01023-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age.
Methods
Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care.
Results
Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older.
Conclusions
Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.
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Dumont K, Marcoux I, Warren É, Alem F, Alvar B, Ballu G, Bostock A, Cohen SR, Daneault S, Dubé V, Houle J, Minyaoui A, Rouly G, Weil D, Kellehear A, Boivin A. How compassionate communities are implemented and evaluated in practice: a scoping review. BMC Palliat Care 2022; 21:131. [PMID: 35854292 PMCID: PMC9297657 DOI: 10.1186/s12904-022-01021-3] [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] [Received: 03/22/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Compassionate communities are rooted in a health promotion approach to palliative care, aiming to support solidarity among community members at the end of life. Hundreds of compassionate communities have been developed internationally in recent years. However, it remains unknown how their implementation on the ground aligns with core strategies of health promotion. The aim of this review is to describe the practical implementation and evaluation of compassionate communities. Methods We undertook a scoping review of the empirical peer-reviewed literature on compassionate communities. Bibliographic searches in five databases were developed with information specialists. We included studies in English describing health promotion activities applied to end-of-life and palliative care. Qualitative analysis used inductive and deductive strategies based on existing frameworks for categorization of health promotion activities, barriers and facilitators for implementation and evaluation measures. A participatory research approach with community partners was used to design the review and interpret its findings. Results Sixty-three articles were included for analysis. 74.6% were published after 2011. Health services organizations and providers are most often engaged as compassionate community leaders, with community members mainly engaged as target users. Adaptation to local culture and social context is the most frequently reported barrier for implementation, with support and external factors mostly reported as facilitators. Early stages of compassionate community development are rarely reported in the literature (stakeholder mobilization, needs assessment, priority-setting). Health promotion strategies tend to focus on the development of personal skills, mainly through the use of education and awareness programs. Few activities focused on strengthening community action and building healthy public policies. Evaluation was reported in 30% of articles, 88% of evaluation being analyzed at the individual level, as opposed to community processes and outcomes. Conclusions The empirical literature on compassionate communities demonstrates a wide variety of health promotion practices. Much international experience has been developed in education and awareness programs on death and dying. Health promotion strategies based on community strengthening and policies need to be consolidated. Future research should pay attention to community-led initiatives and evaluations that may not be currently reported in the peer-review literature. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01021-3.
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Affiliation(s)
- Katia Dumont
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Isabelle Marcoux
- Faculty of Health Sciences, University of Ottawa, 25 University Street, office 206, Ottawa, K1N 6N5, Canada
| | - Émilie Warren
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Farah Alem
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Bea Alvar
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Gwenvaël Ballu
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Anitra Bostock
- Montreal Palliative Care Institute, 265 André-Brunet Street, Kirkland, QC, H9H 3R4, Canada
| | - S Robin Cohen
- Departments of Oncology and Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Lady Davis Research Institute of the Jewish General Hospital, Palliative Care Research, room E8.06, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Serge Daneault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, QC, H3T 1J4, Canada.,Centre de Recherche de L'Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen-Mary, , Montreal, QC, H3W 1W5, Canada
| | - Véronique Dubé
- Marguerite d'Youville Research Chair On Humanistic Nursing Interventions, Faculty of Nursing, Centre-Ville Station, Université de Montréal, P.O Box 6128, Montreal, QC, H3C 3J7, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec À Montréal, 100 Sherbrooke Street West, Montreal, QC, H2X 3P2, Canada
| | - Asma Minyaoui
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Ghislaine Rouly
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada
| | - Dale Weil
- Montreal Palliative Care Institute, 265 André-Brunet Street, Kirkland, QC, H9H 3R4, Canada
| | - Allan Kellehear
- College of Nursing and Health Sciences, University of Vermont, Burlington, USA
| | - Antoine Boivin
- Canada Research Chair in Partnership With Patients and Communities, University of Montreal Hospital Research Center (CRCHUM), Pavillon S, 850 Saint-Denis Street, Montreal, QC, S01.136H2X 0A0, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, QC, H3T 1J4, 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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11
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Babbush KM, Andriano TM, Cohen SR. Antiandrogen therapy in hidradenitis suppurativa: finasteride for females. Clin Exp Dermatol 2021; 47:86-92. [PMID: 34260109 DOI: 10.1111/ced.14847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given its widely accepted efficacy, androgen blockade therapy for hidradenitis suppurativa (HS) has become a standard of care. Although much less frequently used than spironolactone, a small number of HS studies have reported finasteride as an alternative treatment for women. In this study, we describe the response to and perception of finasteride therapy in a diverse cohort of women with HS. AIM To describe finasteride therapy in a diverse cohort of female patients with HS. METHODS We conducted an institutional review board-approved retrospective chart review and telephone survey of 20 female patients aged ≥ 18 years with a diagnosis of HS. Finasteride was prescribed by a single provider at a specialized HS centre. RESULTS The mean age of the patients was 34.3 ± 13.5 years. Finasteride was initiated predominantly because of one or more contraindications or poor responsiveness to spironolactone. Most patients interviewed (90%; n = 18) were willing to take finasteride again or continue with therapy if indicated. Of the 20 patients, 10 (50%) reported overall satisfaction with finasteride, while 7 (35%) were neutral and 3 (15%) were dissatisfied. No patient reported worsening disease activity while on finasteride and only one (5%) reported decreased quality of life. When asked about adverse effects of finasteride, 80% (n = 16) reported none, while 20% (n = 4) experienced ≥ 1 of the following: headache, nausea, menstrual irregularities, breast tenderness or reduced libido/sexual function. CONCLUSIONS Our study suggests that androgen blockade therapy with finasteride is a safe and effective alternative for female patients with HS who have contraindication(s) or intolerance to spironolactone.
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Affiliation(s)
- K M Babbush
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - T M Andriano
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - S R Cohen
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York, NY, USA
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12
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. Gerontologist 2021; 61:e23-e38. [PMID: 31942997 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal.,Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Sweden
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13
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Affiliation(s)
- Z S Patel
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - L K Hoffman
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - L Sutton
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - S R Cohen
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - E K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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14
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Axelsson L, Alvariza A, Carlsson N, Cohen SR, Sawatzky R, Årestedt K. Measuring quality of life in life-threatening illness - content validity and response processes of MQOL-E and QOLLTI-F in Swedish patients and family carers. BMC Palliat Care 2020; 19:40. [PMID: 32213170 PMCID: PMC7098088 DOI: 10.1186/s12904-020-00549-6] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background The McGill Quality of Life Questionnaire - Expanded (MQOL-E) and the Quality of Life in Life-Threatening Illness-Family Carer/Caregiver version (QOLLTI-F) are developed for use with patients facing the end of life and their family carers, respectively. They are also developed for possible use as companion instruments. Contemporary measurement validity theory places emphasis on response processes, i.e. what people feel and think when responding to items. Response processes may be affected when measurement instruments are translated and adapted for use in different cultures. The aim of this study was to translate and examine content validity and response processes during completion of MQOL-E and QOLLTI-F version 2 (v2) among Swedish patients with life-threatening illness and their family carers. Methods The study was conducted in two stages (I) translation and adaptation (II) examination of content validity and response processes using cognitive interviews with 15 patients and 9 family carers. Participants were recruited from the hemodialysis unit, heart clinic, lung clinic and specialized palliative care of a Swedish county hospital. Patients had life-threatening illness such as advanced heart failure, advanced chronic obstructive pulmonary disease, end-stage kidney disease or advanced cancer. Patients were outpatients, inpatients or receiving home care. Results Patients and family carers respectively believed that the items of the MQOL-E and QOLLTI-F v2 reflect relevant and important areas of their quality of life. Although some items needed more time for reflection, both instruments were considered easy to understand. Some changes were made to resolve issues of translation. Participants expressed that reflecting on their situation while answering questions was valuable and meaningful to them, and that responding was an opportunity to express feelings. Conclusions The results of response processes pertaining to the Swedish translations of both MQOL-E and QOLLTI-F v2 contribute evidence regarding content validity, linguistic equivalence and cultural appropriateness of the translated instruments. In addition, results show that the instruments may support conversations on matters of importance for quality of life between patients and/or family carers and health care professionals. Further research is needed to study the psychometric properties of Swedish translations.
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Affiliation(s)
- Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, Sweden.
| | - Anette Alvariza
- Department of Health Care Sciences/ Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen hospital, Stockholm, Sweden
| | - Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence HealthCare, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
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15
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Prolonged grief and the disruption of meaning: Establishing a mediation model. J Couns Psychol 2019; 66:714-725. [DOI: 10.1037/cou0000370] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Cohen SR, Russell LB, Leis A, Shahidi J, Porterfield P, Kuhl DR, Gadermann AM, Sawatzky R. More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire - Expanded. BMC Palliat Care 2019; 18:92. [PMID: 31672131 PMCID: PMC6823967 DOI: 10.1186/s12904-019-0473-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 07/13/2018] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) - Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL - Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. METHODS Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. RESULTS Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). CONCLUSIONS MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
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Affiliation(s)
- S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montréal, Canada. .,Lady Davis Research Institute of the Jewish General Hospital, Palliative Care Research, room E8.06, 3755 Côte Ste. Catherine Road, Montréal, Québec, H3T 1E2, Canada.
| | - Lara B Russell
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Anne Leis
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - David R Kuhl
- Departments of Family Practice and Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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17
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Soliman YS, Chaitowitz M, Hoffman LK, Lin J, Lowes MA, Cohen SR. Identifying anaemia in a cohort of patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 34:e5-e8. [PMID: 31374127 DOI: 10.1111/jdv.15837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Y S Soliman
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - M Chaitowitz
- Department of Internal Medicine, Division of Hematology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - L K Hoffman
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - S R Cohen
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
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18
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Affiliation(s)
- S. Robin Cohen
- Palliative Care Medicine, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Balfour M. Mount
- Palliative Care Medicine, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
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19
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Abstract
Background Although several instruments have been developed to measure the quality of life (QOL) of palliative care patients, a rigorous research study has not specifically asked patients themselves what is important to their QOL. It is, therefore, not clear whether these instruments measure what is most important to these patients’ QOL. Purpose To understand the primary determinants of the QOL of palliative care patients with cancer. Method The study used a qualitative paradigm. Participants were interviewed concerning what was important to their QOL. A systematic content analysis of the transcripts was carried out by all the investigators. Results Five broad domains were found to be important determinants of patient QOL: (1) the patient's own state, including physical and cognitive functioning, psychological state, and physical condition; (2) quality of palliative care; (3) physical environment; (4) relationships; and (5) outlook. Conclusions Existing instruments cover many of these domains, but no single instrument includes all of the relevant content. The McGill Quality of Life Questionnaire, which we developed previously, has been revised based on these data.
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Affiliation(s)
- S. Robin Cohen
- Canadian Institutes of Health Research and the National Cancer Institute of Canada Dorothy J. Lamont Scientist, Division of Palliative Care, Departments of Oncology and Medicine, McGill University, Montreal, Quebec
| | - Anne Leis
- Canadian Cancer Society Research Scientist, Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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20
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Rumination moderates the role of meaning in the development of prolonged grief symptomatology. J Clin Psychol 2019; 75:1047-1065. [DOI: 10.1002/jclp.22751] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Krista R. Muis
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | - S. Robin Cohen
- Departments of Oncology and MedicineMcGill UniversityMontreal Quebec
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21
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Abstract
The purpose of this grounded theory study was to understand the processes used by family care-givers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled “the puzzle of pain management,” which includes four main processes: “drawing on past experiences”; “strategizing a game plan”; “striving to respond to pain”; and “gauging the best fit,” a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.
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Affiliation(s)
- Anita Mehta
- McGill University Health Center, Psychosocial Oncology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4
| | - S. Robin Cohen
- Departments of Oncology and Medicine, Faculty of Medicine, McGill University, Montreal, and Lady Davis Institute, SMBD Jewish General Hospital, Montreal
| | | | - Hélène Ezer
- School of Nursing, McGill University, Montreal
| | - Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal, Montreal, and Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
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22
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Abstract
This paper describes the quality of life and symptom burden of 211 cancer patients admitted to an acute palliative care unit (PCU) in a comprehensive cancer centre. Participants completed the McGill Quality of Life Questionnaire (MQOL), Edmonton Symptom Assessment Scale (ESAS), Short Orientation-Memory-Concentration Test, and Palliative Performance Scale within 24 hours of admission to the PCU. The mean MQOL total was 6.1±1.4, and the mean single-item scale score was 4.9±2.4. The mean total ESAS score was 36.3±15.8, with a median of six reported symptoms. Women and younger patients reported a lower quality of life (QoL) and a higher symptom burden. Regression and correlational analyses highlighted the importance of the existential and psychological domains to overall QoL. These findings emphasize the need for interdisciplinary, collaborative approaches to managing the complex physical, psychosocial, and existential needs of cancer patients admitted to acute PCUs.
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Affiliation(s)
- Jennifer M. Jones
- JM Jones (corresponding author): Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, and Department of Psychiatry, University of Toronto, 200 Elizabeth Street, BCS-045, Toronto, Ontario, Canada M5G 2C4
| | - S. Robin Cohen
- SR Cohen: Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada, and Lady Davis Institute for Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Camilla Zimmermann
- C Zimmerman: Department of Medicine, University of Toronto, and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Gary Rodin
- G Rodin: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, and Department of Psychiatry, University of Toronto, Toronto, Ontario
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23
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Affiliation(s)
- S. Robin Cohen
- NCIC Sociobehavioural Cancer Research Network Palliative Care Team: SMBD Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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24
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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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25
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Abstract
Over the last few decades, improvement in the quality of life (QOL) of cancer patients has received a lot of attention in oncology. This study aims to further explore what factors terminally ill cancer patients report as influencing their QOL. Content analysis of 110 terminally ill cancer patients’ answers to the McGill Quality of Life Questionnaire open-ended question was performed. Negative and positive factors reported by patients as having an impact on their QOL were identified then categorized into eight domains: “physical condition and symptoms,” “psychological status,” “existential,” “relationships and support,” “quality of care,” “physical environment and living facilities,” “hobbies and daily activities,” and “finances.” The “physical condition and symptoms” and “relationships and support” domains were the two most often described by participants as important to their QOL. The results support previous work identifying domains important to the QOL of terminally ill patients with cancer, but they also identify “finances” as a new domain. Based on these findings, we suggest including “finances” in QOL instruments for the terminally ill as an experimental domain.
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Affiliation(s)
- Javad Shahidi
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Send mail to: SMBD Jewish General Hospital, H-364, 3755 Cote Sainte Catherine Road, Montreal, Quebec, Canada H3T 1E2
| | - Nadine Bernier
- Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec
| | - S. Robin Cohen
- Department of Oncology and Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, and Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Quebec, Canada
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26
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Abstract
The purpose of this grounded theory study was to understand the processes used by family care-givers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled “the puzzle of pain management,” which includes four main processes: “drawing on past experiences”; “strategizing a game plan”; “striving to respond to pain”; and “gauging the best fit,” a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.
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Affiliation(s)
- Anita Mehta
- A Mehta (corresponding author): McGill University Health Center, Psychosocial Oncology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4
| | - S. Robin Cohen
- SR Cohen: Departments of Oncology and Medicine, Faculty of Medicine, McGill University, Montreal, and Lady Davis Institute, SMBD Jewish General Hospital, Montreal
| | | | - Hélène Ezer
- FA Carnevale, H Ezer: School of Nursing, McGill University, Montreal
| | - Francine Ducharme
- F Ducharme: Faculté des sciences infirmières, Université de Montréal, Montreal, and Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
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27
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Affiliation(s)
- Lisa S. Chan
- School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mary Ellen Macdonald
- School of Nursing and Departments of Pediatrics and Oncology, McGill University, and Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Institute for Research, Montreal, Quebec, Canada
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28
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Sawatzky R, Laforest E, Schick-Makaroff K, Stajduhar K, Reimer-Kirkham S, Krawczyk M, Öhlén J, McLeod B, Hilliard N, Tayler C, Robin Cohen S. Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings. J Patient Rep Outcomes 2018; 2:36. [PMID: 30175318 PMCID: PMC6104521 DOI: 10.1186/s41687-018-0065-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/09/2017] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation.
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Affiliation(s)
- Richard Sawatzky
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,2Centre for Health Evaluation and Outcome Sciences, Providence Health Care, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z 1Y6 Canada.,13Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden
| | - Esther Laforest
- 3Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC H3A 2M7 Canada
| | - Kara Schick-Makaroff
- 4Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kelli Stajduhar
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Sheryl Reimer-Kirkham
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,7Faculty of Graduate Studies, University of Calgary, MacKimmie Tower, Room 213, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada.,8Faculty of Graduate Studies, University of Victoria, PO Box 3025 STN CSC, Victoria, BC V8W 3P2 Canada
| | - Marian Krawczyk
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - Joakim Öhlén
- 9Center for Person-Centered Care, Institute of Health and Care Sciences, Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden.,14Palliative Centre, Sahlgrenska University Hospital, Box 30110, 400 43 Göteborg, Sweden
| | - Barbara McLeod
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Neil Hilliard
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Carolyn Tayler
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,BC Centre for Palliative Care, 300 - 601 Sixth St., New Westminster, BC V3L 3C1 Canada
| | - S Robin Cohen
- 11Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,12Lady Davis Research Institute of the Jewish General Hospital, 3755 Côte Ste. Catherine Road, Montreal, QC H3T 1E2 Canada
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Prolonged grief symptomatology following violent loss: the mediating role of meaning. Eur J Psychotraumatol 2018; 8:1503522. [PMID: 30128081 PMCID: PMC6095024 DOI: 10.1080/20008198.2018.1503522] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/02/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.
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Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | | | - Krista R. Muis
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, Palliative Care Research, Jewish General Hospital, Montreal, QC, Canada
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Hoffman LK, Ghias MH, Cohen SR, Lowes MA. Polyclonal hyperglobulinaemia and elevated acute-phase reactants in hidradenitis suppurativa. Br J Dermatol 2018; 178:e134-e135. [PMID: 28886222 DOI: 10.1111/bjd.15958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L K Hoffman
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, U.S.A
| | - M H Ghias
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, U.S.A
| | - S R Cohen
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, U.S.A
| | - M A Lowes
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, U.S.A
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Stajduhar K, Sawatzky R, Robin Cohen S, Heyland DK, Allan D, Bidgood D, Norgrove L, Gadermann AM. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. BMC Palliat Care 2017; 16:59. [PMID: 29178901 PMCID: PMC5702136 DOI: 10.1186/s12904-017-0237-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. METHODS A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test - Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. RESULTS Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of "doctor and nurse care", "illness management", "health services" and "communication". The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. CONCLUSION Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.
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Affiliation(s)
- Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - S. Robin Cohen
- Oncology and Medicine, McGill University, Lady Davis Research Institute, Jewish General Hospital, 845 Sherbrooke Street West, Montreal, QC H3A 0G4 Canada
| | - Daren K. Heyland
- Critical Care Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Diane Allan
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SASK S7N 2Z4 Canada
| | - Darcee Bidgood
- Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Leah Norgrove
- Palliative Care, Saanich Peninsula Hospital, Island Health, 2166 Mt. Newton X Road, Saanichton, BC V8M 2B2 Canada
| | - Anne M. Gadermann
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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Chan LS, Macdonald ME, Carnevale FA, Cohen SR. 'I'm only dealing with the acute issues': How medical ward 'busyness' constrains care of the dying. Health (London) 2017; 22:451-468. [PMID: 28552003 DOI: 10.1177/1363459317708822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute hospital units are a common location of death. Curative characteristics of the acute medical setting make it difficult to provide adequate palliative care; these characteristics include an orientation to life-prolonging treatment, an emphasis on routine or task-oriented care and a lack of priority on emotional engagement with patients. Indeed, research shows that dying patients in acute medical units often experience unmet needs at the end of life, including uncontrolled symptoms (e.g. pain, breathlessness), inadequate emotional support and poor communication. A focused ethnography was conducted on an acute medical ward in Canada to better understand how this curative/life-prolonging care environment shapes the care of dying patients. Fieldwork was conducted over a period of 10 months and included participant-observation and interviews with patients, family members and staff. On the acute medical ward, a 'logic of care' driven by discourses of limited resources and the demanding medical unit created a context of busyness. Staff experienced an overwhelming workload and felt compelled to create priorities, which reflected taken-for-granted values regarding the importance of curative/life-prolonging care over palliative care. This could be seen through the way staff prioritized life-prolonging practices and rationalized inconsistent and less attentive care for dying patients. These values influenced care of the dying through delaying a palliative approach to care, limiting palliative care to those with cancer and providing highly interventive end-of-life care. Awareness of these taken-for-granted values compels a reflective and critical approach to current practice and how to stimulate change.
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Affiliation(s)
- Lisa S Chan
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
| | - Mary Ellen Macdonald
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - Franco A Carnevale
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - S Robin Cohen
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
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Stevenson M, Achille M, Liben S, Proulx MC, Humbert N, Petti A, Macdonald ME, Cohen SR. Understanding How Bereaved Parents Cope With Their Grief to Inform the Services Provided to Them. Qual Health Res 2017; 27:649-664. [PMID: 26848080 DOI: 10.1177/1049732315622189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents' individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents' relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.
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Affiliation(s)
- Moire Stevenson
- 1 MAB-Mackay Rehabilitation Centre, Montreal, Québec, Canada
- 2 Université de Montréal, Québec, Canada
| | | | | | | | | | - Antoinette Petti
- 4 Centre hospitalier universitaire Sainte-Justine, Montreal, Québec, Canada
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Cohen SR, Sawatzky R, Russell LB, Shahidi J, Heyland DK, Gadermann AM. Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire-Revised. Palliat Med 2017; 31:120-129. [PMID: 27412257 DOI: 10.1177/0269216316659603] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 11/16/2022]
Abstract
BACKGROUND The McGill Quality of Life Questionnaire has been widely used with people with life-threatening illnesses without modification since its publication in 1996. With use, areas for improvement have emerged; therefore, various minor modifications were tested over time. AIM To revise the McGill Quality of Life Questionnaire (McGill Quality of Life Questionnaire-Revised) while maintaining or improving its psychometric properties and length, keeping it as close as possible to the McGill Quality of Life Questionnaire to enable reasonable comparison with existing McGill Quality of Life Questionnaire literature. DESIGN Data sets from eight studies were used (four studies originally used to develop the McGill Quality of Life Questionnaire, two to develop new McGill Quality of Life Questionnaire versions, and two with unrelated purposes). The McGill Quality of Life Questionnaire-Revised was developed using analyses of measurement invariance, confirmatory factor analysis, and calculation of correlations with the McGill Quality of Life Questionnaire's global quality of life item. SETTING/PARTICIPANTS Data were from 1702 people with life-threatening illnesses recruited from acute and palliative care units, palliative home care services, and oncology and HIV/AIDS outpatient clinics. RESULTS The McGill Quality of Life Questionnaire-Revised consists of 14 items (plus the global quality of life item). A new Physical subscale was created combining physical symptoms and physical well-being and a new item on physical functioning. The Existential subscale was reduced to four items. The revised Support subscale, renamed Social, focuses more on relationships. The Psychological subscale remains unchanged. Confirmatory factor analysis results provide support for the measurement structure of the McGill Quality of Life Questionnaire-Revised. The overall scale has good internal consistency reliability ( α = 0.94). CONCLUSION The McGill Quality of Life Questionnaire-Revised improves on and can replace the McGill Quality of Life Questionnaire since it contains improved wording, a somewhat expanded repertoire of concepts with fewer items, and a single subscale for the physical domain, while retaining good psychometric properties.
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Affiliation(s)
- S Robin Cohen
- 1 Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,2 Lady Davis Research Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Richard Sawatzky
- 3 School of Nursing, Trinity Western University, Langley, BC, Canada.,4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Lara B Russell
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,5 School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Daren K Heyland
- 7 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.,8 Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Anne M Gadermann
- 4 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.,9 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Iddins CJ, Cohen SR, Goans RE, Wanat R, Jenkins M, Christensen DM, Dainiak N. Case Report: Industrial X-Ray Injury Treated With Non-Cultured Autologous Adipose-Derived Stromal Vascular Fraction (SVF). Health Phys 2016; 111:112-116. [PMID: 27356054 DOI: 10.1097/hp.0000000000000483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Local cutaneous injuries induced by ionizing radiation (IR) are difficult to treat. Many have reported local injection of adipose-derived stromal vascular fraction (SVF), often with additional therapies, as an effective treatment of IR-induced injury even after other local therapies have failed. The authors report a case of a locally recurrent, IR-induced wound that was treated with autologous, non-cultured SVF without other concurrent therapy. A nondestructive testing technician was exposed to 130 kVp x rays to his non-dominant right thumb on 5 October 2011. The wound healed 4 mo after initial conservative therapy with oral/topical α-tocopherol, oral pentoxifylline, naproxen sodium, low-dose oral steroids, topical steroids, hyperbaric oxygen therapy (HBOT), oral antihistamines, and topical aloe vera. Remission lasted approximately 17 mo with one minor relapse in July 2012 after minimal trauma and subsequent healing. Aggressive wound breakdown during June 2013 required additional therapy with HBOT. An erythematous, annular papule developed over the following 12 mo (during which time the patient was not undergoing prescribed treatment). Electron paramagnetic resonance (EPR) done more than 2 mo after exposure to IR revealed dose estimates of 14 ± 3 Gy and 19 ± 6 Gy from two centers using different EPR techniques. The patient underwent debridement of the 0.5 cm papular area, followed by SVF injection into and around the wound bed and throughout the thumb without complication. Eleven months post SVF injection, the patient has been essentially asymptomatic with an intact integument. These results raise the possibility of prolonged benefit from SVF therapy without the use of cytokines. Since there is currently no consensus on the use of isolated SVF therapy in chronic, local IR-induced injury, assessment of this approach in an appropriately powered, controlled trial in experimental animals with local radiation injury appears to be indicated.
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Affiliation(s)
- C J Iddins
- *Radiation Emergency Assistance Center/Training Site, Oak Ridge, TN; †Division of Plastic Surgery,, University of California, San Diego, CA; ‡MJW Corporation, Amherst, NY; §TriHealth, Cincinnati, OH; **Yale University School of Medicine, New Haven, CT
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Abstract
Caring culture is a concept embodying the perceptions and caring practices of caregivers, acknowledging the unique role of cultural beliefs in shaping behavior. A qualitative descriptive study with 13 caregivers of adult family members with a cancer diagnosis in Japan was conducted to gain insight into perceptions and experiences surrounding caregiving. Several major categories were identified, representing rarely reported cultural constructs of high cultural value for the Japanese: On-repayment for what the patient has given, Caregiving as performing a socially expected role, Enryo/meiwaku-restraint in asking for help, Family decision making reflecting strong bonds, Omoiyari-empathizing with the patient's feelings, and Inori-praying to myriad gods and ancestors. The Japanese cultural construct of ie (the strong relationship to family lineage and spiritual connection to past and future generations) is helpful in understanding these categories. Invisible yet powerful cultural constructs permeated caregiving practices. Insights from Japanese cultural concepts and beliefs may foster sensitivity and individualized care in diverse settings, cultures, and societies.
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Affiliation(s)
| | - S Robin Cohen
- McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
| | - Miyoko Uza
- University of the Ryukyus, Okinawa, Japan
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Lang A, Toon L, Cohen SR, Stajduhar K, Griffin M, Fleiszer AR, Easty T, Williams A. Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/2056-5917-1-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cohen SR, Keats S, Cherba M, Allen D, MacKinnon CJ, Bitzas V, Kogan N, Penner JL, Calislar MP, Feindel A, Lapointe B, Baxter S, O’Brien S, Stajduhar K. OA8 Caring for the family caregiver: working with volunteers to implement and improve a service to enable family caregivers to maintain their own wellbeing. BMJ Support Palliat Care 2015; 5 Suppl 1:A3. [DOI: 10.1136/bmjspcare-2015-000906.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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MacKinnon CJ, Smith NG, Henry M, Milman E, Berish M, Farrace A, Körner A, Chochinov HM, Cohen SR. A Pilot Study of Meaning-Based Group Counseling for Bereavement. Omega (Westport) 2015. [DOI: 10.1177/0030222815575002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
Scientific studies demonstrating either the efficacy or effectiveness of interventions for uncomplicated bereavement are lacking. This study reports the results of a novel meaning-based group counseling (MBGC) intervention developed for bereaved adults. MBGC was built on previous scholarly critiques using a formative evaluation methodology within a group of bereaved adults ( n = 11). The primary research questions were as follows: (a) How do bereft individuals respond to MBGC? and (b) What refinements are needed to MBGC to ensure feasibility? A secondary research question was: (c) Is collection of quantitative outcome measures at baseline and postintervention feasible? Analysis of multiple qualitative data sources resulted in numerous refinements to MBGC. Results indicate that the majority of participants found the meaning-based intervention beneficial. Limitations included concurrent external therapies and a small sample size that was largely homogenous. There were no major counterindications to proceeding with a pilot randomized controlled trial (RCT).
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Affiliation(s)
- Christopher J. MacKinnon
- Department of Oncology, McGill University, Montréal, Québec, Canada
- Balfour M. Mount Palliative Care Unit, McGill University Health Center, Montréal, Québec, Canada
- Palliative Care Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nathan Grant Smith
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, USA
| | - Melissa Henry
- Department of Oncology, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montréal, Québec, Canada
- Otolaryngology—Head and Neck Surgery and Segal Cancer Centre, Jewish General Hospital, Montréal, Québec, Canada
| | - Evgenia Milman
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
| | - Mel Berish
- Student Services, Champlain College, St-Lambert, Québec, Canada
| | - Amanda Farrace
- Palliative Care Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
| | - Harvey M. Chochinov
- Community Health Sciences and Family Medicine (Division of Palliative Care), University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - S. Robin Cohen
- Department of Oncology, McGill University, Montréal, Québec, Canada
- Palliative Care Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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Allen D, Badro V, Denyer-Willis L, Ellen Macdonald M, Paré A, Hutchinson T, Barré P, Beauchemin R, Bocti H, Broadbent A, Cohen SR. Fragmented care and whole-person illness: Decision-making for people with chronic end-stage kidney disease. Chronic Illn 2015; 11:44-55. [PMID: 25475415 DOI: 10.1177/1742395314562974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/17/2022]
Abstract
PURPOSE The study reported herein sought to better understand how patients with multi-morbid, chronic illness-who receive care in institutions designed for treatment of acute illness-experience and engage in health-related decisions. METHODS In an urban Canadian teaching hospital, we studied the interactions of six hemodialysis patients and 11 of the health professionals involved in their care. For 1 year (September 2009 to September 2010), we conducted ethnographic observation and interviews of six cases each comprising one hemodialysis patient and various health professionals including medical specialists, nurses, a social worker, and a dietician. RESULTS We found that the ubiquity and complexity of health-related decision-making in the lives of these patients suggests the need for a more holistic interpretation of health-related decision-making. DISCUSSION We propose an interpretation of decision-making as an ongoing process of integrating illness and life; as frequently open-ended, cumulative, and relational; and as fundamentally shaped by the fragmented delivery of care for patients with multiple morbidities. CONCLUSION Our understanding of decision-making suggests that people living with complex chronic illness need to receive care from institutions that recognize and address their multi-morbidity as a whole illness that is constantly being integrated into the life of a whole person.
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Affiliation(s)
- Dawn Allen
- BC Centre for Palliative Care, Vancouver BC, Canada
| | - Valerie Badro
- Champlain Centre for Health Care Ethics, Ottawa, ON, Canada
| | | | | | - Anthony Paré
- Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Tom Hutchinson
- McGill Programs in Whole Person Care, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Paul Barré
- McGill University Health Centre, Montreal, QC, Canada
| | | | - Helen Bocti
- McGill University Health Centre, Montreal, QC, Canada
| | | | - S Robin Cohen
- Department of Medicine and Oncology, McGill University, Montreal, QC, Canada The Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
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MacKinnon CJ, Smith NG, Henry M, Milman E, Chochinov HM, Körner A, Berish M, Farrace AJ, Liarikos N, Cohen SR. Reconstructing Meaning with Others in Loss: A Feasibility Pilot Randomized Controlled Trial of a Bereavement Group. Death Stud 2015; 39:411-421. [PMID: 25674830 DOI: 10.1080/07481187.2014.958628] [Citation(s) in RCA: 11] [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: 06/04/2023]
Abstract
More effective psychosocial interventions that target uncomplicated bereavement are needed for those actively seeking support. The objective of this study was to assess the feasibility of evaluating a unique meaning-based group counseling (MBGC) intervention with a randomized controlled trial (RCT) design. Twenty-six bereft individuals were randomly assigned to either MBGC or a control bereavement support group. Twenty participants (11 experimental, nine control) completed all aspects of the study including self-report measures at baseline, postintervention, and 3-month follow-up of meaning in life, anxiety, depression, and grief. Results support the feasibility of an RCT with MBGC.
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Cohen SR, Holloway SD, Domínguez-Pareto I, Kuppermann M. Receiving or believing in family support? Contributors to the life quality of Latino and non-Latino families of children with intellectual disability. J Intellect Disabil Res 2014; 58:333-345. [PMID: 23323957 DOI: 10.1111/jir.12016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Previous studies have identified the role of family support in mitigating the stress of parents caring for a child with intellectual disability. Less is known about families whose members are willing but unable to support each other because of geographical, structural and economic barriers. Our study examined the contribution to family quality of life (FQL) of family support beliefs, actual assistance from family members, as well as the moderating effects of ethnicity and household income. METHOD We conducted telephone interviews with 84 Latino and 61 non-Latino mothers. RESULTS Mothers who received more emotional support from partners and other family members reported a higher FQL, controlling for family characteristics. Familism beliefs were also associated with FQL, particularly for Latino mothers. Income was not a significant moderator. CONCLUSIONS These findings suggest that some predictors of FQL are partially moderated by ethnicity, while others may be powerful across diverse communities.
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Affiliation(s)
- S R Cohen
- University of California, Riverside, California, USA
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Abstract
Pain requiring treatment is experienced by many cancer patients at the end of life. Family caregivers are often directly implicated in pain management. This article highlights areas of psychosocial concern for family caregivers managing a family member's cancer pain at home as they engage in pain management processes. This article is based on the secondary analysis, guided by interpretive description, of data collected for a grounded theory study that explored the processes used by family caregivers to manage cancer patients' pain in the home. Interviews and field notes from 24 family caregiver interviews were examined to identify areas of family caregiver psychosocial distress. The analysis revealed that family caregivers experienced distress at different phases of the pain management process. Sources of distress for caregivers included feeling as though they were "in a prison" (overwhelmingly responsible), "lambs to slaughter" (unsupported), and "flying blind" (unprepared). In addition, family caregivers expressed distress when witnessing their loved one in pain and when pain crises invoked thoughts of death. In sum, family caregivers managing a loved one's cancer pain at home are at risk for psychosocial distress. This study identified four key sources of distress that can help health care professionals better understand the experiences of these family caregivers and tailor supportive interventions to meet their needs. Knowledge about sources of distress can help healthcare professionals understand the experiences of these family caregivers and tailor supportive interventions to meet their needs.
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Affiliation(s)
- Anita Mehta
- a Psychosocial Oncology, McGill University Health Center - Montreal General Hospital , Montreal , Quebec , Canada
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Shahidi J, Taghizadeh-Kermani A, Gohari MR, Ghavamnasiri MR, Khoshroo F, Pourali L, Cohen SR. Changes in daily activities of cancer patients after diagnosis: how do canadian and Iranian patients perceive the change? Iran J Cancer Prev 2014; 7:28-34. [PMID: 25250145 PMCID: PMC4142954] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/26/2013] [Indexed: 10/29/2022]
Abstract
BACKGROUND Being diagnosed with cancer has major impacts on a patient's life. This study was conducted to explore how specific daily activities of patients change as a result of cancer diagnosis or its treatment and how these patients feel about such changes. METHODS This was a cross-sectional descriptive study. Cancer patients referred to our clinics and by completing a questionnaire, they reported their daily activities and how they changed after diagnosis. A total of 201 patients in Canada and 167 patients in Iran completed the questionnaire. The research setting was the outpatient cancer clinics of the Jewish General Hospital in Montreal, Canada (February to April 2008) and Imam Reza Hospital and Ghaem Hospital in Mashhad, Iran (March to August 2008). RESULTS More than 40 percent of the patients reported changes after the diagnosis in at least 8 out of 22 daily activities listed in the questionnaire. While a negative perception towards the changes was more common, some patients also perceived some changes as positive. More than half of the participants (56.9%) who were employed at the time of diagnosis experienced changes in the amount or type of their paid work after being diagnosed with cancer. CONCLUSION The impact of a cancer diagnosis and treatment on a patient's daily activities is drastic. There is a need to provide support and interventions to help patients maintain daily activities they need and/or like. Further studies are needed to better understand the nature of such interventions.
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Affiliation(s)
- Javad Shahidi
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Ali Taghizadeh-Kermani
- Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding Author: Ali Taghizadeh-Kermani, MD; Assistant Professor of Radiation Oncology
Tel: (+98) 511 802 26 77
| | - Mahmood Reza Gohari
- Dept. of Statistics, Hospital Research Management Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fahimeh Khoshroo
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Pourali
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S. Robin Cohen
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada,Depts. of Oncology and Medicine, McGill University, Montreal, QC, Canada
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MacKinnon CJ, Smith NG, Henry M, Berish M, Milman E, Körner A, Copeland LS, Chochinov HM, Cohen SR. Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research. Death Stud 2014; 38:137-144. [PMID: 24524541 DOI: 10.1080/07481187.2012.738768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.
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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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Heyland DK, Jiang X, Day AG, Cohen SR. The development and validation of a shorter version of the Canadian Health Care Evaluation Project Questionnaire (CANHELP Lite): a novel tool to measure patient and family satisfaction with end-of-life care. J Pain Symptom Manage 2013; 46:289-97. [PMID: 23102756 DOI: 10.1016/j.jpainsymman.2012.07.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT The recently developed Canadian Health Care Evaluation Project (CANHELP) questionnaire, which can be used to assess both patient and family satisfaction with end-of-life care, takes 40-60 minutes to complete. The length of the interview may limit its uptake and clinical utility; a shorter version would make its use more feasible. OBJECTIVES The purpose of this study was to develop and validate a shorter version of the CANHELP questionnaire. METHODS Data were collected using a cross-sectional survey of patients with advanced medical diseases and their family members. Participants completed the long version of CANHELP, a global rating of satisfaction with care (GRS), the FAMCARE scale (family members only), and a quality-of-life (QOL) questionnaire. We reduced the items on the long version based on their relationship to the GRS, the frequency of missing data, the distribution of responses, the redundancy of the items, and focus groups with frontline users. With the remaining items, we assessed internal consistency using Cronbach's alpha, and evaluated construct validity by describing the correlation of the new CANHELP Lite with the full version of CANHELP, GRS, FAMCARE, and the QOL questionnaire scores. RESULTS A total of 363 patients and 193 family members participated in this study. The patient version was reduced from 37 items to 20 items and the caregiver version was reduced from 38 items to 21 items. Cronbach's alphas ranged from 0.68 to 0.93 for all domains of both the patient and caregiver questionnaires. We observed a high degree of correlation between CANHELP Lite domains and overall scores and the same domains and overall scores for the full version of CANHELP. In addition, we observed moderate to strong correlation between the CANHELP Lite overall satisfaction scores and the GRS questions. There was moderate correlation between the overall family member CANHELP Lite score and overall FAMCARE score (r = 0.45) and this was similar to the correlation between the full version of CANHELP and FAMCARE scores (r = 0.41). CANHELP Lite correlated more strongly with the QOL subscale on health care than the other QOL subscales. CONCLUSION The CANHELP Lite questionnaire is a valid and internally consistent instrument to measure satisfaction with end-of-life care.
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Affiliation(s)
- Daren K Heyland
- Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada.
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MacKinnon CJ, Milman E, Smith NG, Henry M, Berish M, Copeland LS, Körner A, Chochinov HM, Cohen SR. Means to Meaning in Cancer-Related Bereavement. The Counseling Psychologist 2012. [DOI: 10.1177/0011000012459969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The search for meaning in bereavement is a topic of increasing scholarly interest. Nonetheless, literature has not yet appeared that examines the intersections of diverse theories of meaning, corresponding empirical findings, and clinical implications for counseling psychologists engaged in cancer-related bereavement psychotherapy. Meaning theories drawn from several domains of scholarship including existential, spirituality, stress, and bereavement are surveyed followed by a review of related empirical trends in the scholarship. A hypothetical case vignette is then presented to highlight potential strategies for counseling psychologists to integrate a broadened meaning-based approach to bereavement psychotherapy related to the loss of a loved one from cancer. The article concludes by identifying limitations of a meaning-based approach, as well as directions for further research.
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Affiliation(s)
| | | | | | | | - Mel Berish
- Champlain Regional College, Montreal, QC, 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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Abstract
Although the modern pediatric intensive care unit (PICU) has followed general pediatrics and adopted the family-centered care model, little is known about how families prospectively experience PICU care. The authors' goal was to better understand the experiences of families whose child was hospitalized in a PICU. They conducted a 12-month prospective ethnographic study in a PICU in a tertiary care hospital in a large North American urban center. Data were obtained via participant-observation and formal and informal interviews with 18 families and staff key informants. Findings revealed a disconnect between the espoused model of family-centered care and quotidian professional practices. This divergence emerged in the authors' analysis as a heuristic that contrasts a professional "office" to a sick child's "bedroom." PICU practices and protocols transformed the child into a patient and parents into visitors; issues such as noise, visitation, turf, and privacy could favor staff comfort and convenience over that of the child and family. The authors' discussion highlights suggestions to overcome this divergence in order to truly make the PICU family centered.
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Affiliation(s)
- Mary Ellen Macdonald
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, 3550 University Street, Suite 030, Montréal, QC H3A 2A7, Canada.
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