1
|
Sayed AA. Assessing the Diagnostic Values of the Neutrophil-to-Lymphocyte Ratio (NLR) and Systematic Immunoinflammatory Index (SII) as Biomarkers in Predicting COVID-19 Severity: A Multicentre Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:602. [PMID: 38674248 PMCID: PMC11052014 DOI: 10.3390/medicina60040602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
COVID-19 has been notoriously unpredictable in its clinical course. Such unpredictability poses a challenge to clinicians in predicting patients who will develop severe cases and possibly die from the infection. This study aims to assess and compare the diagnostic value of the NLR and SII as biomarkers in predicting COVID-19 severity, represented by mortality, with a multicentre comparative study including 855 patients in Saudi Arabia. Descriptive and analytical statistics were used to compare haematological indices between survivors and non-survivors. The median age of patients included was 41 years old, with an almost equal ratio of men to women. Most participants were Saudis, and the mortality rate in the study cohort was 13.22%. Non-survivors, as compared to survivors, were significantly older, had lower RBC counts, haemoglobin and haematocrit levels, as well as significantly higher WBC and neutrophil counts. Both the NLR and SII were capable of differentiating between survivors and non-survivors, with the latter having significantly higher values. However, the NLR was superior to the SII in such differentiation, as it had a larger area under the curve. This study further confirms the diagnostic values of the NLR and SII as biomarkers in predicting COVID-19 severity and mortality, with the NLR being more sensitive and specific. Clinical guidelines on managing COVID-19 cases should benefit from these findings by harnessing the value of the NLR in COVID-19 management.
Collapse
Affiliation(s)
- Anwar A Sayed
- Department of Basic Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia
| |
Collapse
|
2
|
Nabi Foodani M, Abbasi Dolatabadi Z, Rahbariyan A, Rasti A, Jafaryparvar Z, Zakerimoghadam M. Perceived Stress and Level of Uncertainty Among Hospitalized COVID-19 Patients. SAGE Open Nurs 2024; 10:23779608241234980. [PMID: 38476571 PMCID: PMC10929029 DOI: 10.1177/23779608241234980] [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] [Received: 11/02/2023] [Revised: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Disease uncertainty refers to the inability to assign meaning to events related to the illness. Uncertainty of the disease can affect various aspects of human life such as psychological aspects. Objectives This study aims to examine the relationship between disease uncertainty and perceived stress in COVID-19 patients. Methods An analytical cross-sectional study was conducted on 212 hospitalized COVID-19 patients who were initially admitted to the intensive care units (ICUs) and later transferred to general wards within the same hospitals. Three instruments were utilized to collect data for this study. The Demographic Information Questionnaire, Mishel Uncertainty in Illness Scale (MUIS) for disease uncertainty, and Perceived Stress Questionnaire. For data analysis, both descriptive and inferential statistics were employed using IBM SPSS Statistics version 25. Results The Pearson correlation coefficient matrix results showed a positive and significant relationship between uncertainty about the illness (P < .001, r = 0.829), ambiguity (P < .001, r = 0.795), complexity (P < .001, r = 0.835), inconsistency or instability (P < .001, r = 0.787), and unpredictability (P < .001, r = 0.776) with perceived stress in COVID-19 patients transferred from the intensive care units. Conclusion Based on the findings of the current study, both uncertainty and perceived stress are elevated among COVID-19 patients, and a significant and direct relationship exists between these two variables. Healthcare providers, particularly nurses, should address the uncertainties surrounding emerging diseases, both at the hospital and community levels.
Collapse
Affiliation(s)
- Mahdi Nabi Foodani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Abbasi Dolatabadi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Rahbariyan
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Rasti
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakiyeh Jafaryparvar
- Ph.D. Candidate of Nursing Research, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Zakerimoghadam
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
van der Smissen D, van Leeuwen M, Sudore RL, Koffman J, Heyland DK, van der Heide A, Rietjens JAC, Korfage IJ. Newspaper coverage of advance care planning during the COVID-19 pandemic: Content analysis. DEATH STUDIES 2023; 48:33-42. [PMID: 36892315 PMCID: PMC10491734 DOI: 10.1080/07481187.2023.2180693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
COVID-19 may cause sudden serious illness, and relatives having to act on patients' behalf, emphasizing the relevance of advance care planning (ACP). We explored how ACP was portrayed in newspapers during year one of the pandemic. In 'LexisNexis Uni', we identified English-language newspaper articles about ACP and COVID-19, published January-November 2020. We applied content analysis; unitizing, sampling, recording or coding, reducing, inferring, and narrating the data. We identified 131 articles, published in UK (n = 59), Canada (n = 32), US (n = 15), Australia (n = 14), Ireland (n = 6), and one each from Israel, Uganda, India, New-Zealand, and France. Forty articles (31%) included definitions of ACP. Most mentioned exploring (93%), discussing (71%), and recording (72%) treatment preferences; 28% described exploration of values/goals, 66% encouraged engaging in ACP. No false or sensationalist information about ACP was provided. ACP was often not fully described. Public campaigns about ACP might improve the full picture of ACP to the public.
Collapse
Affiliation(s)
- Doris van der Smissen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marleen van Leeuwen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Kagan I, Lancman N, Weisbord I. Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid-19: A mixed-methods study. J Nurs Scholarsh 2022; 54:787-798. [PMID: 35752928 PMCID: PMC9349997 DOI: 10.1111/jnu.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses. AIM To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic. DESIGN This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021. METHODS The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire. RESULTS Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. CONCLUSIONS The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses' professional functioning and their work life well-being.
Collapse
Affiliation(s)
- Ilya Kagan
- Nursing DepartmentAshkelon Academic CollegeAshkelonIsrael
| | - Natalie Lancman
- Nursing Coordinator, Quality of Care, Rabin Medical CenterClalit Health ServicesTel Aviv‐YafoIsrael
| | - Irit Weisbord
- Nursing Director, Intensive Care Division, Rabin Medical CenterClalit Health ServicesTel Aviv‐YafoIsrael
| |
Collapse
|
5
|
McFarlane P, Halley A, Kano Y, Wade N, Wilson S, Droney J. End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19. J Patient Exp 2022; 9:23743735221074171. [PMID: 35111899 PMCID: PMC8801342 DOI: 10.1177/23743735221074171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients' specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provision were evaluated including treatment of pain and other symptoms, communication and decision making at end-of-life and level of involvement of the palliative care team. Physical symptoms were managed with relatively low doses of end-of-life medications. High levels of patient and family anxiety, however, highlight the complexity of death from a stigmatised disease. Prompt acknowledgement of the vulnerability of advanced cancer patients with COVID-19 can facilitate proactive symptom management, anticipatory communication and enhance family support.
Collapse
Affiliation(s)
| | | | - Yukie Kano
- Royal Marsden NHS Foundation
Trust, London, UK
| | - Nicola Wade
- Royal Marsden NHS Foundation
Trust, London, UK
| | | | | |
Collapse
|
6
|
Nopour R, Shanbehzadeh M, Kazemi-Arpanahi H. Using logistic regression to develop a diagnostic model for COVID-19: A single-center study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:153. [PMID: 35847143 PMCID: PMC9277749 DOI: 10.4103/jehp.jehp_1017_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/25/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND The main manifestations of coronavirus disease-2019 (COVID-19) are similar to the many other respiratory diseases. In addition, the existence of numerous uncertainties in the prognosis of this condition has multiplied the need to establish a valid and accurate prediction model. This study aimed to develop a diagnostic model based on logistic regression to enhance the diagnostic accuracy of COVID-19. MATERIALS AND METHODS A standardized diagnostic model was developed on data of 400 patients who were referred to Ayatollah Talleghani Hospital, Abadan, Iran, for the COVID-19 diagnosis. We used the Chi-square correlation coefficient for feature selection, and logistic regression in SPSS V25 software to model the relationship between each of the clinical features. Potentially diagnostic determinants extracted from the patient's history, physical examination, and laboratory and imaging testing were entered in a logistic regression analysis. The discriminative ability of the model was expressed as sensitivity, specificity, accuracy, and area under the curve, respectively. RESULTS After determining the correlation of each diagnostic regressor with COVID-19 using the Chi-square method, the 15 important regressors were obtained at the level of P < 0.05. The experimental results demonstrated that the binary logistic regression model yielded specificity, sensitivity, and accuracy of 97.3%, 98.8%, and 98.2%, respectively. CONCLUSION The destructive effects of the COVID-19 outbreak and the shortage of healthcare resources in fighting against this pandemic require increasing attention to using the Clinical Decision Support Systems equipped with supervised learning classification algorithms such as logistic regression.
Collapse
Affiliation(s)
- Raoof Nopour
- Department of Health Information Management, Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran
- Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
- Address for correspondence: Dr. Hadi Kazemi-Arpanahi, Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. E-mail:
| |
Collapse
|
7
|
Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic. AIDS Res Ther 2021; 18:87. [PMID: 34798881 PMCID: PMC8604195 DOI: 10.1186/s12981-021-00413-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Events associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspectives of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. METHODS Adults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. RESULTS Of the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty [median 30; Interquartile range (IQR): 16, 43] and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p < 0.001), severity (11.4; p < 0.001), and episodic nature (9.3; p < 0.05) of disability. Most participants (> 60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. CONCLUSIONS People living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.
Collapse
|
8
|
O'Brien KK, Bayoumi AM, Carusone SC, Davis AM, Aubry R, Avery L, Solomon P, Erlandson KM, Bergin C, Harding R, Brown DA, Vera JH, Hanna S. Disability and Self-care Living Strategies Among Adults Living With HIV During the COVID-19 Pandemic. RESEARCH SQUARE 2021. [PMID: 34545356 PMCID: PMC8452102 DOI: 10.21203/rs.3.rs-868864/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BackgroundEvents associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspective of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. MethodsAdults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. ResultsOf the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty (median 30; Interquartile range (IQR): 16, 43) and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p<0.001), severity (11.4; p<0.001), and episodic nature (9.3; p<0.05) of disability. Most participants (>60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. ConclusionsPeople living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.
Collapse
|
9
|
Selman LE, Chamberlain C, Sowden R, Chao D, Selman D, Taubert M, Braude P. Sadness, despair and anger when a patient dies alone from COVID-19: A thematic content analysis of Twitter data from bereaved family members and friends. Palliat Med 2021; 35:1267-1276. [PMID: 34016005 PMCID: PMC8267082 DOI: 10.1177/02692163211017026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To inform clinical practice and policy, it is essential to understand the lived experience of health and social care policies, including restricted visitation policies towards the end of life. AIM To explore the views and experiences of Twitter social media users who reported that a relative, friend or acquaintance died of COVID-19 without a family member/friend present. DESIGN Qualitative content analysis of English-language tweets. DATA SOURCES Twitter data collected 7-20th April 2020. A bespoke software system harvested selected publicly-available tweets from the Twitter application programming interface. After filtering we hand-screened tweets to include only those referring to a relative, friend or acquaintance who died alone of COVID-19. Data were analysed using thematic content analysis. RESULTS 9328 tweets were hand-screened; 196 were included. Twitter users expressed sadness, despair, hopelessness and anger about their experience and loss. Saying goodbye via video-conferencing technology was viewed ambivalently. Clinicians' presence during a death was little consolation. Anger, frustration and blame were directed at governments' inaction/policies or the public. The sadness of not being able to say goodbye as wished was compounded by lack of social support and disrupted after-death rituals. Users expressed a sense of political neglect/mistreatment alongside calls for action. They also used the platform to reinforce public health messages, express condolences and pay tribute. CONCLUSION Twitter was used for collective mourning and support and to promote public health messaging. End-of-life care providers should facilitate and optimise contact with loved ones, even when strict visitation policies are necessary, and provide proactive bereavement support.
Collapse
Affiliation(s)
- Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlotte Chamberlain
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryann Sowden
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Davina Chao
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Daniel Selman
- Chief Technology Officer, Clause, Inc., Winchester, UK
| | - Mark Taubert
- Palliative Care Department, Cardiff University School of Medicine and Velindre University NHS Trust, Cardiff, UK
| | - Philip Braude
- Department for Medicine for Older People, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
10
|
Thery L, Vaflard P, Vuagnat P, Soulie O, Dolbeault S, Burnod A, Laouisset C, Marchal T, Massiani MA, Bozec L, Bidard FC, Cottu P, Angellier E, Bouleuc C. Advanced cancer and COVID-19 comorbidity: medical oncology-palliative medicine ethics meetings in a comprehensive cancer centre. BMJ Support Palliat Care 2021:bmjspcare-2021-002946. [PMID: 33927013 PMCID: PMC8098300 DOI: 10.1136/bmjspcare-2021-002946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In managing patients with cancer in the COVID-19 era, clinical oncologists and palliative care practitioners had to face new, disrupting and complex medical situations, challenging the quality of the shared decision-making process. During the first lockdown in France, we developed an onco-palliative ethics meeting to enhance the quality of the decision-making process for patients with advanced cancer treated for COVID-19. METHODS A least one of the institutional ethics committee members was present along with oncologists, palliative care teams, psycho-oncologists, radiologists and intensive care specialists. Specific medical parameters were systematically collected to form a standardised framework for the discussions. RESULTS The main raised issues were the definition of new criteria for the implementation of invasive resuscitation techniques, optimal ways to adapt or delay anticancer treatment and best procedures to address terminal respiratory failure and end-of-life care. The main clinical and ethical guidelines that emerged during these debates are presented. The palliative care team played a major role in assessing and reporting patients' awareness of cancer-related prognosis and their wishes concerning invasive therapies or transfer to intensive care units, enabling an individualised benefit-risk balance assessment. The ethics committee members ensured continuous monitoring during the discussions. Their function was to recall the main ethical principles including dignity, which is conferred on people when there are treated as having equal status. CONCLUSIONS The onco-palliative ethics meeting provided a powerful avenue for improvement of collegiality and reinforcement of teamwork, which could be a major protection against burnout for healthcare professionals facing an epidemic onslaught.
Collapse
Affiliation(s)
- Laura Thery
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Pauline Vaflard
- PSL University, Paris, France
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Ophélie Soulie
- PSL University, Paris, France
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - Sylvie Dolbeault
- PSL University, Paris, France
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - Alexis Burnod
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Céline Laouisset
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Timothée Marchal
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Marie-Ange Massiani
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Paul Cottu
- PSL University, Paris, France
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
| | - Elisabeth Angellier
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Carole Bouleuc
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| |
Collapse
|
11
|
Harrop E, Mann M, Semedo L, Chao D, Selman LE, Byrne A. What elements of a systems' approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19. Palliat Med 2020; 34:1165-1181. [PMID: 32736489 PMCID: PMC7495712 DOI: 10.1177/0269216320946273] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. AIM To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. DESIGN A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (www.crd.york.ac.uk/prospero, CRD 42020180723). DATA SOURCES MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. RESULTS Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. CONCLUSION Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts.
Collapse
Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Mala Mann
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK.,Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Lenira Semedo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Davina Chao
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
12
|
Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory. PLoS One 2020; 15:e0239181. [PMID: 32936837 PMCID: PMC7494119 DOI: 10.1371/journal.pone.0239181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/02/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To examine the use of Normalisation Process Theory (NPT) to establish if, and in what ways, the AMBER care bundle can be successfully normalised into acute hospital practice, and to identify necessary modifications to optimise its implementation. Method Multi-method process evaluation embedded within a mixed-method feasibility cluster randomised controlled trial in two district general hospitals in England. Data were collected using (i) focus groups with health professionals (HPs), (ii) semi-structured interviews with patients and/or carers, (iii) non-participant observations of multi-disciplinary team meetings and (iv) patient clinical note review. Thematic analysis and descriptive statistics, with interpretation guided by NPT components (coherence; cognitive participation; collective action; reflexive monitoring). Data triangulated across sources. Results Two focus groups (26 HPs), nine non-participant observations, 12 interviews (two patients, 10 relatives), 29 clinical note reviews were conducted. While coherence was evident, with HPs recognising the value of the AMBER care bundle, cognitive participation and collective action presented challenges. Specifically: (1) HPs were unable and unwilling to operationalise the concept of ‘risk of dying’ intervention eligibility criteria (2) integration relied on a ‘champion’ to drive participation and ensure sustainability; and (3) differing skills and confidence led to variable engagement with difficult conversations with patients and families about, for example, nearness to end of life. Opportunities for reflexive monitoring were not routinely embedded within the intervention. Reflections on the use of the AMBER care bundle from HPs and patients and families, including recommended modifications became evident through this NPT-driven analysis. Conclusion To be successfully normalised, new clinical practices, such as the AMBER care bundle, must be studied within the wider context in which they operate. NPT can be used to the aid identification of practical strategies to assist in normalisation of complex interventions where the focus of care is on clinical uncertainty in acute hospital settings.
Collapse
|