Randomized trial of a hospice video educational tool for patients with advanced cancer and their caregivers

Meaning of Hospice Care: Perceptions of Patients and Families

Background: About half of hospice-eligible adults die without hospice each year. Misconceptions about hospice are frequently identified as barriers to utilization, but hospice perceptions are not well documented. Objectives and Setting/Subjects: To examine perceptions of hospice (initial and post-enrollment) among 90 U.S. patients/families actively enrolled in a large, metropolitan hospice in Texas, and to identify factors associated with participant perceptions. Design and Measurement: Concurrent mixed methods and cross-sectional design collecting data via research questionnaire with Likert scales and open-ended questions. Wilcoxon signed-rank test determined differences between recall of initial hospice perceptions at time of referral and perceptions while actively receiving services; Fisher's exact and Kruskal-Wallis tests were used to examine bivariate relationships between perceptions of hospice and satisfaction with physician communication and demographic variables. Qualitative statements were analyzed using an inductive, content analysis approach. Results: There was a significant difference between participants' perceptions of hospice recalled from initial conversations compared with current perceptions following hospice enrollment (z = -6.44, P < .01). Initial perceptions of hospice were significantly related to satisfaction with physician communication (P = .011) and diagnosis (P = .019). Qualitative themes range from negative (ie hospice = death) to positive (ie comfort, support, loving staff) with 65.6% of participants demonstrating positive increases in understanding. Conclusion: Participants' perceptions of hospice were positively associated with satisfaction with physician communication prior to hospice enrollment, and potentially impacted by the experience of care itself. During hospice discussions, clinicians should elicit patient and family perceptions in addition to providing descriptions of eligibility and services.

Hospice Transitions From the Perspective of the Caregiver: A Qualitative Study and Development of a Preliminary Hospice Transition Checklist

Background: Relative to curative and traditional care delivery, hospice care has been associated with superior end of life (EOL) outcomes for both patient and caregiver. Still, comprehensive orientation and caregiver preparation for the transition to hospice is variable and often inadequate. From the perspective of the caregiver, it is unclear what information would better prepare them to support the transition of their loved one to hospice. Objectives: Our two sequential objectives were: 1) Explore caregivers' experiences and perceptions on the transition of their loved one to hospice; and 2) Develop a preliminary checklist of considerations for a successful transition. Design: We conducted semi-structured interviews and used a descriptive inductive/deductive thematic analysis to identify themes. Subjects: 19 adult caregivers of patients across the United States who had enrolled in hospice and died in the year prior (January - December 2019). Measurements: An interview guide was iteratively developed based on prior literature and expanded through collaborative coding and group discussion. Results: Four key themes for inclusion in our framework emerged: hospice intake, preparedness, burden of care and hospice resources. Conclusions: Focusing on elements of our preliminary checklist, such as educating families on goals of hospice or offering opportunities for respite care, into the orientation procedures may be opportunities to improve satisfaction with the transition and the entirety of the hospice experience. Future directions include testing the effectiveness of the checklist and adapting for expanded poputlations.

Patient awareness of palliative care: systematic review

BACKGROUND

One of the barriers to the integration of palliative care within the process of patient care and treatment is the lack of awareness of patients about palliative care. In order to develop efficient resources to improve patient awareness, comprehensive information is required to determine the specific aspects of palliative care where a paucity of evidence on patient awareness exists. This review aims to synthesise evidence from previous studies in order to provide a comprehensive information set about the current state of patient awareness of palliative care.

METHODS

In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Magiran, Scientific Information Database(SID) and Islamic Science Citation (ISC) were searched to identify articles published between 2000 and 2021 that considered patients' awareness of palliative care.

RESULTS

Of the 5347 articles found, 22 studies were retained after quality evaluation; three full-text articles were excluded. Nineteen articles are included in this review. More than half of the patients did not have any information about palliative care or hospice care. Some patients accurately defined hospice care and palliative care; other patients had misunderstandings about palliative care. Patients had limited information about pastoral care, social care and bereavement care. Patients' awareness about individuals or centres providing palliative care or hospice care was limited. Video presentation and distribution of information at the community level indicated that this method would be beneficial in increasing the awareness.

CONCLUSION

The review points to the need for patient education programmes and interventional studies to increase patients' awareness.

Comparison of Traditional Videos With Telenovelas for Hospice Family Caregivers Education

BACKGROUND

While research has shown that hospice family caregivers (HFCG) seek additional information related to patient care, pain and symptom management, and self-care, it is unknown how the use of telenovela videos for education in hospice would be received by HFCG.

OBJECTIVE

To explore HFCG perceived benefits and challenges with the use of telenovelas as compared to traditional educational videos during online support group.

METHODS

A mixed methods study with a concurrent triangulated design that analyzed qualitative interviews and YouTube analytics report to identify how viewers responded (number of views and their feedback) to telenovela videos as compared to traditional educational videos.

RESULTS

Among 39 (n = 39) HFCGs, most participants were female (80%) of White/Caucasian race, with more than high school education (85%) and they were adult children of hospice cancer patient (49%). Comparing HFCG that viewed traditional videos with HFCG that viewed telenovela videos, the telenovela video was watched more (12% longer viewing duration) and caregivers reported better content recall with informative benefits, more follow up actions and reflection about their own hospice experience.

CONCLUSION

Caregiver feedback indicated that watching the telenovela was engaging, acceptable and produced more conversations about patient care, than watching a non-telenovela format video. Further research is needed to test telenovela efficacy in enhancing HFCG outcomes.