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Ahmed S, Naqvi SF, Sinnarajah A, McGhan G, Simon J, Santana MJ. Patient & Caregiver Experiences: Qualitative Study Comparison Before and After Implementation of Early Palliative Care for Advanced Colorectal Cancer. Can J Nurs Res 2023; 55:110-125. [PMID: 35254117 PMCID: PMC9936441 DOI: 10.1177/08445621221079534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Palliative Care Early and Systematic (PaCES) program implemented an early palliative care pathway for advanced colorectal cancer patients in January 2019, to increase specialist palliative care consultation and palliative homecare referrals more than three months before death. This study aimed to understand the experience of patients with advanced colorectal cancer and family caregivers who received early palliative care supports from a specialist palliative care nurse and compared those experiences with participants who experienced standard oncology care prior to implementation of early palliative care. METHODS This was a qualitative and patient-oriented study. We conducted semi-structured telephone interviews with two cohorts of patients with advanced colorectal cancer before and after implementation of an early palliative care pathway. We conducted a thematic analysis of the transcripts guided by a Person-Centred Care Framework. RESULTS Seven patients living with advanced colorectal cancer and five family caregivers who received early palliative care supports expressed that visits from their early palliative care nurse was helpful, improved their understanding of palliative care, and improved their care. Four main themes shaped their experience of early palliative care: care coordination, perception of palliative care & advance care planning, coping with advanced cancer, and patient and family engagement. These findings were compared with experiences of 15 patients and seven caregivers prior to pathway implementation. CONCLUSION An early palliative care pathway can improve advanced cancer care, and improve understanding and acceptance of early palliative care. This work was conducted in the context of colorectal cancer but may have relevance for the care of other advanced cancers.
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Affiliation(s)
- Sadia Ahmed
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Sadia Ahmed, Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Syeda Farwa Naqvi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Simon
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Weerasinghe S. Inpatient end-of-life care delivery: discordance and concordance analysis of Canadian palliative care professionals' and South Asian family caregivers' perspectives. Palliat Care Soc Pract 2023; 17:26323524221145953. [PMID: 36643824 PMCID: PMC9837273 DOI: 10.1177/26323524221145953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background End-of-life care involves a multitude of functions delivered by a team of healthcare professionals. Family caregivers get involved in every aspect of the palliative care journey. Meeting the needs of ethnically diverse patients can be a daunting task for Western-trained healthcare professionals. Family and professional caregivers need to have a mutual understanding of perspectives and expectations to integrate family caregivers into end-of-life care. The South Asian population in Canada is fast growing, and very little is known about their understanding and expectations of end-of-life care. Methods The purpose is to provide research-based knowledge on discordances and concordances of encounters and perceptions of end-of-life care delivery between South Asian family caregivers and palliative care health professionals. Individual interviews were conducted among seven palliative care professionals, in a tertiary care center, and seven South Asian family caregivers who have provided care, in the same inpatient center, for the same period. The constant comparison, a component of the grounded theory approach, was employed to compare the two types of caregivers' perspectives that emerged in the qualitative data. Findings The family caregivers were divided in their perception based on death denial and acceptance. The findings weaved the discordances and concordances of meaning assigned to palliative care to the three themes that emerged: the role of the family caregiver, communication needs and challenges, and barriers to the family caregiver participation in decision-making. The discordance between professionals and family caregivers arose in the death-denial group and concorded with the death-accepted group. The findings revealed a consequence of the survival optimistic bias, as creating dissatisfaction toward the end-of-life care delivery system when the palliative care professionals prognosticate imminent end-of-life. Conclusion The family caregivers' interactions and encounters were shaped by their acceptance or denial of the death of their family member in care. Gaining conceptual clarity on the meaning of palliative care and providing education on the process of end-of-life care delivery are crucial to integrating ethnically diverse family caregivers into the decision-making process.
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Ahmed S, Naqvi SF, Sinnarajah A, McGhan G, Simon J, Santana M. Patient and caregiver experiences with advanced cancer care: a qualitative study informing the development of an early palliative care pathway. BMJ Support Palliat Care 2020:bmjspcare-2020-002578. [PMID: 33077495 DOI: 10.1136/bmjspcare-2020-002578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Palliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In order to effectively deliver palliative care, patient and caregiver priorities need to be incorporated in advanced cancer care. AIM This study identified experiences of patients living with advanced colorectal cancer and their caregivers to inform the development of an early palliative care pathway. DESIGN Qualitative patient-oriented study. SETTINGS/PARTICIPANTS Patients receiving care at two cancer centres were interviewed using semistructured telephone interviews to explore their experiences with cancer care services received prior to a new developed pathway. Interviews were transcribed verbatim, and the data were thematically analysed. RESULTS From our study, we identified gaps in advanced cancer care that would benefit from an early palliative approach to care. 15 patients and 7 caregivers from Edmonton and Calgary were interviewed over the phone. Participants identified the following gaps in advanced cancer care: poor communication of diagnosis, lack of communication between healthcare providers, role and involvement of the family physician, lack of understanding of palliative care and advance care planning. CONCLUSIONS Early palliative approaches to care should consider consistent and routine delivery of palliative care information, collaborations among different disciplines such as oncology, primary care and palliative care, and engagement of patients and family caregivers in the development of care pathways.
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Affiliation(s)
- Sadia Ahmed
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syeda Farwa Naqvi
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gwen McGhan
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Simon
- Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Maria Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Khan CP, Parver S, Kennedy Lesch J, DiGioia K, Gaglio B, Daugherty S, Clauser SB, Arora NK. Comparative Clinical Effectiveness Research Focused on Community-Based Delivery of Palliative Care: Overview of the Patient-Centered Outcomes Research Institute's Funding Initiative. J Palliat Med 2020; 22:2-6. [PMID: 31486731 DOI: 10.1089/jpm.2019.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care is a growing specialty that addresses the needs of individuals diagnosed with advanced illness and their caregivers. Although palliative care has been shown to improve a variety of patient- and caregiver-centered outcomes, access to comprehensive palliative care services for patients is often limited. There is a need to identify the most effective approaches to delivering palliative care to patients in community settings. In fiscal year 2017, based on extensive input from a diverse set of stakeholders, the Patient-Centered Outcomes Research Institute (PCORI) funded nine multisite comparative clinical effectiveness research (CER) trials focused on community-based delivery of palliative care for a total investment of $80 million. These studies, focusing on advance care planning and models of palliative care delivery, represent some of the largest most complex palliative care trials funded to date. Each study evaluates both patient and caregiver outcomes, and together, these trials include a broad range of health conditions, interventions, and settings of care. PCORI has also fostered a learning network of the funded awardees to facilitate the successful conduct of these CER studies and to support awardee efforts to develop collaborative products relevant to advancing the field of palliative care research and practice. The protocols of each of the nine trials, detailed in this issue, demonstrate the expansive reach of the investment PCORI has made in an effort to further the research agenda and provide substantive research evidence in stakeholder-identified areas of need in the field of palliative care.
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Affiliation(s)
- Carly P Khan
- Patient-Centered Outcomes Research Institute, Washington, DC
| | | | | | | | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC
| | - Sarah Daugherty
- Patient-Centered Outcomes Research Institute, Washington, DC
| | | | - Neeraj K Arora
- Patient-Centered Outcomes Research Institute, Washington, DC
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Dobrina R, Chialchia S, Palese A. "Difficult patients" in the advanced stages of cancer as experienced by nursing staff: A descriptive qualitative study. Eur J Oncol Nurs 2020; 46:101766. [PMID: 32480281 DOI: 10.1016/j.ejon.2020.101766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/07/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSES "Difficult patients", as labelled by staff members, have been studied for their peculiarities in primary care, family and internal medicine, physiotherapy, psychiatry, dermatology, and dentistry. However, no data has been documented on "difficult patients" in hospice care settings. The aim of the study was to address the following research questions: (a) When do nursing staff label a patient suffering from advanced cancer as "difficult" in a hospice care setting? (b) What are the problems that the nursing staff face in dealing with them, and (c) What are the specific strategies that nursing staff adopt in their daily practice to overcome issues and improve their relationship with "difficult patients"? METHODS A qualitative descriptive study design was performed in 2018 and reported according to the COnsolidated criteria for REporting Qualitative research. Three focus groups were conducted in three hospice settings in Northern Italy by involving 10 nurses and six nurses' aides. Three trained researchers performed interviews based on a set of open questions. Qualitative content analysis of the data collected was then performed by the same researchers. RESULTS Participants were labelled "difficult patients" according to three main themes: (1) "Feeling rejected"; (2) "Feeling uncomfortable with the life story experienced by the patient" and (3) "Experiencing the limits of the profession". Participants reported feeling "Frustrated", "Exhausted", "Powerless", "Overwhelmed" or "Embarrassed" when dealing with "difficult patients". Strategies to overcome these issues emerged. CONCLUSIONS As in other settings, hospice care nursing staff perceive some patients as "difficult". However, differently from other contexts, "difficult patients" are perceived as such also due to their relatives, who are perceived, in some cases, as being even more "difficult" than the patients themselves. Nursing staff should be aware of their personal attitudes and emotions in caring for patients perceived as "difficult" in order to identify and timely apply strategies to overcome issues that may compromise the therapeutic relationship and quality of care.
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Affiliation(s)
| | | | - Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy.
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Lindquist LA, Seltzer A, Forcucci C, Wong N, Ramirez-Zohfeld V. Leveraging Patient/Community Partnerships to Disseminate Patient Centered Outcomes Research in Geriatrics. Geriatrics (Basel) 2019; 4:geriatrics4020035. [PMID: 31083488 PMCID: PMC6630770 DOI: 10.3390/geriatrics4020035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background: With the growth of patient-centered outcomes research (PCOR), partnerships between researchers and patients have presented novel opportunities for disseminating results. A large gap exists in disseminating patient-centered research results to older adult patient end-users. We sought to examine the experiences of patient/community partners in disseminating PCOR results and characterize lessons learned that may facilitate future researcher-patient/community dissemination partnerships. Methods: Patient/community partners who participated in geriatrics-focused PCORI-funded research and were active in disseminating results, as part of their planned activities, were recruited for one-to-one qualitative interviews. Constant comparative and thematic analysis were used to identify and describe common themes that emerged in a survey of open-ended questions. Results: Ten individuals (four community partners, six patients) aged 55–87 years were interviewed. Analysis revealed that for successful dissemination, subjects felt it was vital to reach out to people affected by the results, leverage personal stories, and tap into pre-developed programming. Patient/Community partners identified potential audiences through word-of-mouth, community requests, and mapping a list of audiences—targeting those directly affected as well as those who worked with the audience (e.g., not specifically medical). Patient/community partners recommended that researchers engage patient/community partners for suggestions on audiences, show empathy, include diverse populations, and maintain a community-focus. One community partner stated, “Why wouldn’t we help disseminate results? It’s a no-brainer. We know people!” Conclusion: Patient/community partners provide effective ways to communicate results, new audiences to reach, improved communication with different audiences, and improved credibility of the findings. The lessons learned have implications for assisting future research-patient/community partnerships in the dissemination of their patient-centered research.
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Affiliation(s)
- Lee A Lindquist
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Anne Seltzer
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Chris Forcucci
- Aging and In-Home Services of Northeast Indiana, Fort Wayne, IN 46805, USA.
| | - Norine Wong
- First Vitals Health and Wellness, Inc., Honolulu, HI 96813, USA.
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Lyons KD, Padgett LS, Marshall TF, Greer JA, Silver JK, Raj VS, Zucker DS, Fu JB, Pergolotti M, Sleight AG, Alfano CM. Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation. CA Cancer J Clin 2019; 69:113-126. [PMID: 30457670 DOI: 10.3322/caac.21549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.
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Affiliation(s)
- Kathleen D Lyons
- Scientist, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Assistant Professor of Psychiatry, Department of Psychiatry, Dartmouth College, Hanover, NH
| | - Lynne S Padgett
- Health Psychologist, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Timothy F Marshall
- Assistant Professor, School of Physical Therapy, Kean University, Union, NJ
| | - Joseph A Greer
- Program Director, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital, Boston, MA
- Assistant Professor of Psychology, Harvard Medical School, Boston, MA
| | - Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
- Associate in Physiatry, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA
| | - Vishwa S Raj
- Associate Professor, Director of Oncology Rehabilitation, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Department of Supportive Care, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - David S Zucker
- Medical Director & Program Leader, Cancer Rehabilitation Services, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Jack B Fu
- Associate Professor, Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mackenzi Pergolotti
- Director of Research, ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA
| | - Alix G Sleight
- Postdoctoral Fellow, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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A Portfolio Analysis of Culturally Tailored Trials to Address Health and Healthcare Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091859. [PMID: 30154333 PMCID: PMC6165382 DOI: 10.3390/ijerph15091859] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 07/30/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022]
Abstract
In 2010, Patient-Centered Outcomes Research Institute (PCORI) was authorized by Congress to improve the quality and relevance of evidence available to help patients, caregivers, employers, insurers, and policy makers make better-informed health decisions. We conducted a qualitative analysis of behavioral health trials in the PCORI Addressing Disparities portfolio to examine cultural tailoring strategies across the following priority populations: racial and ethnic minorities, rural populations, people with low-income or low socioeconomic status, individuals with disabilities, people with low health literacy, and lesbian, gay, bisexual, and transgender (LGBT) communities. The Common Strategies for Enhancing Cultural Appropriateness model was used to examine cultural tailoring strategies within trials. We hypothesized increased intersectionality within a patient population at risk for disparities would correlate with the dosage and type of cultural tailoring strategies applied. Thirty-three behavioral health trials applied cultural tailoring strategies and a majority of trials (n = 30) used three or more strategies. Trends in cultural tailoring were associated with certain racial and ethnic groups; however, increased use of tailoring was not associated with the number of priority populations included in a trial. The PCORI Addressing Disparities portfolio demonstrates how a range of cultural tailoring strategies are used, within comparative clinical effectiveness research trials, to address the needs and intersectionality of patients to reduce health and healthcare disparities.
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Thompson G, Shindruk CL, Adekoya AA, Demczuk L, McClement S. Meanings of 'centredness' in long-term care facilities: a scoping review protocol. BMJ Open 2018; 8:e022498. [PMID: 30099403 PMCID: PMC6089323 DOI: 10.1136/bmjopen-2018-022498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION There is a growing demand for long-term care services for older adults that embrace a model of care centred on individual recipients of care. In long-term care, models of person, resident and relationship-centred care have been developed and implemented to promote independence, decision making and choices of residents. Although the concepts of centredness have been readily adopted in these environments, what constitutes centredness is often vague and lacks conceptual clarity and definition. The research questions guiding this scoping review are: (1) What are the defining attributes, conceptual boundaries and theoretical underpinnings of each centredness term in long-term care? (2) For what purposes have centredness directed models of care been used in this context? (3) What types of study designs have been used to examine centredness in this context? (4) What outcomes related to centredness have been reported or evaluated and how were they measured in long-term care? METHODS AND ANALYSIS This review uses the methodological framework for conducting a scoping review by Arksey and O'Malley. The search strategy will be applied to nine bibliographic and citation databases, Google Scholar and the grey literature. Study selection will occur in a two-step process. First, the titles and abstracts of all search results will be screened by individual reviewers. Second, a full-text review will be conducted by a pair of reviewers. To be included articles must (1) define centredness in the context of long-term care; (2) describe the defining features of centredness; (3) explore the theoretical underpinnings of centredness; (4) outline outcomes of centredness or (5) use outcome measures related to centredness. Data will be extracted from included studies and analysed using thematic analysis as described by Braun and Clark. ETHICS AND DISSEMINATION Research ethics approval is not required for this scoping review. Dissemination strategies will follow a targeted and tailored approach based on study findings.
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Affiliation(s)
- Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chloe Lyn Shindruk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adebusola Abiodun Adekoya
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Demczuk
- Elizabeth Dafoe Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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