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Brunelli C, Zecca E, Pigni A, Bracchi P, Caputo M, Lo Dico S, Fusetti V, Tallarita A, Bergamini C, Brambilla M, Raimondi A, Niger M, Provenzano S, Sepe P, Alfieri S, Tinè G, De Braud F, Caraceni AT. Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol. BMJ Open 2022; 12:e059410. [PMID: 36307164 PMCID: PMC9621186 DOI: 10.1136/bmjopen-2021-059410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Early palliative care (PC) in the clinical pathway of advanced cancer patients improves symptom control, quality of life and has a positive impact on overall quality of care. At present, standardised criteria for appropriate referral for early PC in oncology care are lacking. The aim of this project is to develop a set of standardised referral criteria and procedures to implement appropriate early PC for advanced cancer patients (the palliative care referral system, PCRS) and test its impact on user perception of quality of care received, on patient quality of life and on the use of healthcare resources. SETTING Selected oncology clinics and PC outpatient clinic. METHODS AND ANALYSIS A scoping literature review and an expert consultation through a nominal group technique will be used to revise existing referral tools and to develop a new one, the PCRS. 25 patients will be enrolled in a pilot study to assess feasibility of the implementation of PCRS; 10 interviews with patients and healthcare professionals will be carried out to evaluate applicability.A pretest-post-test quasiexperimental study involving 150 patients before implementation of the PCRS and 150 patients after implementation will be carried out.Patient satisfaction with care received, quality of life and use of resources, and caregiver satisfaction with care will also be assessed to explore the impact of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Institutional Review board of the Fondazione IRCCS Istituto Nazionale Tumori; approval reference INT201/19.Results will be disseminated through open access publications and through scientific communication presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT04936568.
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Affiliation(s)
- Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Pigni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mariangela Caputo
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Viviana Fusetti
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Roma Tor Vergata, Roma, Lazio, Italy
| | - Antonino Tallarita
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristiana Bergamini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Salvatore Provenzano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gabriele Tinè
- Unit of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo De Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Augusto Tommaso Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
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Chia YYP, Ekladious A. Australian public hospital inpatient satisfaction related to early patient involvement and shared decision-making in discharge planning. Intern Med J 2020; 51:891-895. [PMID: 32358924 PMCID: PMC8362186 DOI: 10.1111/imj.14872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
Background Surveys of hospital inpatient satisfaction may help develop actionable plans for quality improvement, and patients have preferred to give feedback during admission at the point of service compared to after discharge. However, patient satisfaction measurement has often been done by questionnaires post‐discharge, and without focussing on an Australian general internal medicine setting. Aims To understand patients' perceptions of their admission experiences in an Australian public teaching hospital's general internal medicine unit, and to understand the opportunities for quality improvement. Methods A prospective study of 50 inpatients of a general internal medicine unit at an Australian public teaching hospital was carried out using a patient satisfaction questionnaire given to patients on the day of discharge. Results Patients perceived deficits in early communication about discharge destination planning, and provision of written discharge instructions. Responses highlighted the importance of checking with patients to elicit further information that was not previously captured during initial history‐taking, patient‐centred communication to enable informed consent and decision making, use of language readily understandable to laypersons, and checking for patients' understanding of messages as communicated by the treating clinician. Conclusions In an Australian general internal medicine service, early involvement and shared decision‐making in discharge planning are valued by patients. Incorporating checking of patients' understanding of diagnoses, management, discharge instructions, and follow‐up plans into ward round routines may benefit patient satisfaction. This study stimulates further research into the use of a proforma to capture and check patients' understanding of discharge diagnoses and plans.
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Affiliation(s)
- Yong Yau Paul Chia
- Department of General Internal Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adel Ekladious
- Department of Medicine, Bunbury Hospital, Bunbury, Western Australia, Australia
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Hambly N, Goodwin S, Aziz-Ur-Rehman A, Makhdami N, Ainslie-Garcia M, Grima D, Cox G, Kolb M, Fung D, Cabalteja C, DeMarco P, Moldaver D. A cross-sectional evaluation of the idiopathic pulmonary fibrosis patient satisfaction and quality of life with a care coordinator. J Thorac Dis 2019; 11:5547-5556. [PMID: 32030274 DOI: 10.21037/jtd.2019.11.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Canadian and international guidelines recommend specialized, multidisciplinary teams for the treatment of patients with idiopathic pulmonary fibrosis (IPF). The objective of this cross-sectional clinical study was to investigate the effect of a care coordinator on IPF patient satisfaction and quality of life. Methods Forty IPF patients were enrolled from the practices of two physicians (n=20/physician), with either low (LCU) or high-coordinator use (HCU). Patient satisfaction was measured with modified FAMCARE and IPF Care UK Patient Support Program (UK-CARE) surveys. Health related quality of life (HRQoL) was assessed with the living with IPF impacts (L-IPFi) survey. An economic model assessed the impact of the coordinator; staff surveys informed patient management requirements, and costs were derived from published literature. Results Patient satisfaction was similar between the clinics; a trend (P=0.1) towards increased satisfaction among HCU patients was observed. Patients in the HCU clinic reported increased satisfaction (P<0.05) with their current care compared with care prior to joining the tertiary-care clinic, while LCU patients did not. IPF patient HRQoL did not differ between clinics. The coordinator was estimated to alleviate approximately 30% of a physician's IPF-related work load, and to facilitate the care of more patients per physician. Modelled estimates suggest the coordinator lead to annual cost-savings of $137,212. Conclusions Reliance upon a coordinator during routine management of IPF patients may improve patient satisfaction, spare physician time and lead to annual cost-savings. Future studies should examine the impact of a coordinator on healthcare resource utilization.
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Affiliation(s)
- Nathan Hambly
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Goodwin
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Afia Aziz-Ur-Rehman
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Gerard Cox
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Martin Kolb
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Fung
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | - Czerysh Cabalteja
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | - Patricia DeMarco
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
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Neo SHS, Yang GMJ, Kanesvaran R, Cheung YB. Translation and Validation of the 10-Item FAMCARE Scale to Assess Satisfaction of Family Caregivers With Care Given to Cancer Patients. J Pain Symptom Manage 2019; 58:878-885.e2. [PMID: 31349035 DOI: 10.1016/j.jpainsymman.2019.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Family satisfaction with care is an important quality indicator in palliative care. OBJECTIVES This study aimed to translate and validate the 10-item Family Satisfaction with End-of-Life Care (FAMCARE) tool. METHODS Family caregivers of patients with advanced cancer were recruited. FAMCARE was translated from English to Chinese using a forward and backward translation process. Chinese-speaking caregivers were interviewed with the preliminary Chinese FAMCARE, and phrasing was edited to ensure clarity of the items. Subsequently, a baseline and follow-up survey in English and the finalized Chinese version were performed to assess psychometric properties. Cronbach's alpha (α) and intraclass correlation coefficient were used for internal consistency and test-retest reliability, respectively. Validity was assessed with Spearman's correlation coefficient (r). The Comprehensive Needs Assessment Tool-Caregiver (CNAT-C) and a one-item assessment by caregivers regarding "good-care" acted as a validity criterion. Pooled analysis of both languages and language-specific analyses were performed. RESULTS There were 259 participants; 134 and 125 participants filled in the English and Chinese versions, respectively. Pooled analysis showed that the intraclass correlation coefficient of FAMCARE was 0.95; α was 0.91. There was a moderate positive correlation between the total FAMCARE scores and "good-care" (r = 0.54) and a moderate negative correlation between the total FAMCARE score and the CNAT-C "Healthcare Staff" domain (r = 0.41). There was a weak negative correlation between the total FAMCARE score and the CNAT-C domain of "family and social support" (r = -0.13). Language-specific analyses revealed similar results regarding FAMCARE's psychometric properties. CONCLUSION FAMCARE showed good reliability and validity.
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Affiliation(s)
| | - Grace Mei-Juan Yang
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
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Ito E, Tadaka E. [Development of a Japanese Version of the Short-Form FAMCARE Scale for family caregivers of terminal cancer patients at home in Japan]. Nihon Ronen Igakkai Zasshi 2019; 55:81-89. [PMID: 29503372 DOI: 10.3143/geriatrics.55.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To develop a Japanese version of the short-form FAMCARE Scale (Ornstein, 2015) for family caregivers of terminal cancer patients at home. METHODS The survey was conducted with 316 family caregivers of terminal cancer patients at home selected as eligible participants in 11 major regions in Japan (the Tokyo metropolitan area, and the prefectures of Tochigi, Ibaraki, Saitama, Chiba, Kanagawa, Nara, Hyogo, Kagawa, Ehime, and Saga). Construct validity was confirmed using a confirmatory factor analysis, and the Caregiver Quality of Life Index-Cancer (CQOLC) scale was administered to assess criterion-related validity. RESULTS A total of 120 family caregivers provided valid responses. The mean±standard deviation of the age of the family caregivers was 64.6±12.0 years, and 91 (75.8%) were female. A factor analysis of the results showed that the Japanese version of the 10-item and 5-item short-form FAMCARE Scale was a unidimensional construct, and a confirmatory factor analysis demonstrated a goodness of fit index of 0.910 and 0.972, an adjusted goodness of fit index of 0.835 and 0.916, a comparative fit index of 0.968 and 0.992, and a root mean square error of approximation of 0.095 and 0.081, respectively. The Cronbach's α coefficients of the 10- and 5-item scales were 0.95 and 0.93, respectively. The scale scores were significantly correlated with the family caregiver's quality of life (CQOLC) (10-item r=0.304, P<0.01; 5-item r=0.311, P<0.01). CONCLUSION The Japanese version of the 10-item and 5-item short-form FAMCARE Scale was found to have sufficient reliability and validity for assessing family satisfaction with terminal cancer patient at home in Japan.
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Affiliation(s)
- Eriko Ito
- Graduate School of Nursing, School of Medicine, Yokohama City University
| | - Etsuko Tadaka
- Graduate School of Nursing, School of Medicine, Yokohama City University
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Scarpi E, Dall'Agata M, Zagonel V, Gamucci T, Bertè R, Sansoni E, Amaducci E, Broglia CM, Alquati S, Garetto F, Schiavon S, Quadrini S, Orlandi E, Casadei Gardini A, Ruscelli S, Ferrari D, Pino MS, Bortolussi R, Negri F, Stragliotto S, Narducci F, Valgiusti M, Farolfi A, Nanni O, Rossi R, Maltoni M. Systematic vs. on-demand early palliative care in gastric cancer patients: a randomized clinical trial assessing patient and healthcare service outcomes. Support Care Cancer 2018; 27:2425-2434. [PMID: 30357555 DOI: 10.1007/s00520-018-4517-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/16/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Early palliative care (EPC) has shown a positive impact on quality of life (QoL), quality of care, and healthcare costs. We evaluated such effects in patients with advanced gastric cancer. METHODS In this prospective, multicenter study, 186 advanced gastric cancer patients were randomized 1:1 to receive standard cancer care (SCC) plus on-demand EPC (standard arm) or SCC plus systematic EPC (interventional arm). Primary outcome was a change in QoL between randomization (T0) and T1 (12 weeks after T0) in the Trial Outcome Index (TOI) scores evaluated through the Functional Assessment of Cancer Therapy-Gastric questionnaire. Secondary outcomes were patient mood, overall survival, and family satisfaction with healthcare and care aggressiveness. RESULTS The mean change in TOI scores from T0 to T1 was - 1.30 (standard deviation (SD) 20.01) for standard arm patients and 1.65 (SD 22.38) for the interventional group, with a difference of 2.95 (95% CI - 4.43 to 10.32) (p = 0.430). The change in mean Gastric Cancer Subscale values for the standard arm was 0.91 (SD 14.14) and 3.19 (SD 15.25) for the interventional group, with a difference of 2.29 (95% CI - 2.80 to 7.38) (p = 0.375). Forty-three percent of patients in the standard arm received EPC. CONCLUSIONS Our results indicated a slight, albeit not significant, benefit from EPC. Findings on EPC studies may be underestimated in the event of suboptimally managed issues: type of intervention, shared decision-making process between oncologists and PC physicians, risk of standard arm contamination, study duration, timeliness of assessment of primary outcomes, timeliness of cohort inception, and recruitment of patients with a significant symptom burden. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01996540).
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Affiliation(s)
- Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy.
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Teresa Gamucci
- Oncology Unit, SS Trinità Hospital, Sora, ASL Frosinone, Italy
| | - Raffaella Bertè
- Palliative Care, Oncology Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Elisabetta Sansoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Amaducci
- Palliative Care and Hospice Unit, AUSL Romagna, Cesena, Italy
| | | | - Sara Alquati
- Palliative Care Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Stefania Schiavon
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Silvia Quadrini
- Oncology Unit, SS Trinità Hospital, Sora, ASL Frosinone, Italy
| | - Elena Orlandi
- Medical Oncology Unit, Oncology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Casadei Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Maria Simona Pino
- Medical Oncology Unit, Oncology Department, Azienda USL Toscana Centro, S. Maria Annunziata Hospital, Florence, Italy
| | - Roberto Bortolussi
- Palliative care and Pain Therapy Unit, Aviano National Cancer Institute, Aviano, Italy
| | - Federica Negri
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale, Cremona, Italy
| | - Silvia Stragliotto
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | - Martina Valgiusti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
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D'Angelo D, Punziano AC, Mastroianni C, Marzi A, Latina R, Ghezzi V, Piredda M, De Marinis MG. Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers' Satisfaction With Palliative Care. JOURNAL OF FAMILY NURSING 2017; 23:252-272. [PMID: 28795900 DOI: 10.1177/1074840717697538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Family satisfaction is an important outcome of palliative care and is a critical measure for health care professionals to address when assessing quality of care. The FAMCARE-2 is a widely used measure of family satisfaction with the health care received by both patient and family in palliative care. In this study, a team of Italian researchers culturally adapted the FAMCARE-2 to the Italian language and psychometrically tested the instrument by measuring satisfaction of 185 family caregivers of patients admitted into two palliative care services. FAMCARE-2 showed excellent levels of internal consistency (Cronbach's α coefficient = .96) and test-retest reliability ( r = .98, p < .01). The confirmatory factor analysis showed a single-factor structure with good fit. Satisfaction levels were significantly correlated with family caregivers being females with less education, patient length of care, and place of assistance and death. This scale can help health care professionals identify which aspects of care need improvement and enable family caregivers to manage their challenging role.
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Affiliation(s)
| | | | | | - Annamaria Marzi
- 4 Modena University, Italy
- 5 Casa Madonna dell'Uliveto, Reggio Emilia, Italy
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Maltoni M, Scarpi E, Dall'Agata M, Zagonel V, Bertè R, Ferrari D, Broglia CM, Bortolussi R, Trentin L, Valgiusti M, Pini S, Farolfi A, Casadei Gardini A, Nanni O, Amadori D, Frassineti GL, Sansoni E, Ragazzini A, Ruscelli S, Crivellari G, Galiano A, Rodriquenz MG, Biasini C, Porzio R, Pittureri C, Amaducci E, Faedi M, Codecà C, Crepaldi F, Pedrazzoli P, Bramanti A, Buonadonna A, Garetto F, Comandone A, Giordano M, Luchena G, Luzzani M, Cifatte C, Pino MS, Zoccali S, Cattaneo MT, Dalu D, Sozzi P, Gauna R, Alquati S, Costantini M, Quadrini S, Narducci F, Mastromauro C, Scognamiglio R, Degiovanni D, Negri F, Caraceni A, Montanari L. Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial. Eur J Cancer 2016; 65:61-8. [DOI: 10.1016/j.ejca.2016.06.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/07/2016] [Indexed: 12/20/2022]
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