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Senger A, Venetis MK, Greene K, Catona D, Devine KA. Healthcare provider assessments of caregiver communication behaviors during gynecologic Cancer treatment appointments. PEC INNOVATION 2024; 4:100259. [PMID: 38347863 PMCID: PMC10859277 DOI: 10.1016/j.pecinn.2024.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
Objective Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes. Methods Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers. Results Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges. Conclusion HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs. Innovation HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.
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Affiliation(s)
- Angela Senger
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
| | - Maria K. Venetis
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Kathryn Greene
- Rutgers, The State University of New Jersey, Department of Communication, 4 Huntington Street, New Brunswick, NJ 08901, USA
| | - Danielle Catona
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD 20742-2611, USA
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, Department of Pediatric Population Science, Outcomes, and Disparities Research, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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2
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Mossman B, Perry LM, Voss HM, Maciejewski PK, Gramling R, Duberstein P, Prigerson HG, Epstein RM, Hoerger M. Patient-Caregiver Dyads & End-of-Life Care: Caregiver Personality Disrupts Gender-Based Norms. J Pain Symptom Manage 2024; 67:e393-e398. [PMID: 38278189 PMCID: PMC11032258 DOI: 10.1016/j.jpainsymman.2024.01.030] [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] [Received: 10/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT Gender and personality may individually impact end-of-life care. Men often receive more aggressive treatments than women near death, and personality - particularly openness - may be associated with increased care utilization when it diverges from traditional treatment norms. However, research has not examined the interaction of these variables in a dyadic context. OBJECTIVES This study examined the dyadic effects of patient gender and caregiver personality on end-of-life care. METHODS Using data from the VOICE randomized clinical trial, the present sample consisted of patient-caregiver dyads receiving outpatient care for advanced cancer in Sacramento and Western New York. Analyses assessed whether caregiver personality was associated with gender-based differences in patient chemotherapy or emergency department/inpatient visits in the 30 days before death. Logistic regression examined the interaction between caregivers' Big Five personality dimensions and patient gender while accounting for patient and caregiver demographic and health characteristics. RESULTS Of a total of 134 patient-caregiver dyads, 19.4% (n = 26) of patients received chemotherapy and 47.8% (n = 64) had an emergency department/inpatient visit in the 30 days before death. Results demonstrated a significant interaction between caregiver openness and patient gender on receipt of chemotherapy (odds ratio = 0.07, p = 0.006). When caregivers were less open, men were more likely to receive chemotherapy near death, whereas when caregivers were more open, women were more likely to receive chemotherapy near death. CONCLUSION Results suggest caregiver personality characteristics, particularly openness, might disrupt gender-based treatment norms at end-of-life. Findings demonstrate that patient and caregiver factors can interact to explain patient healthcare utilization.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology (B.M., H.M.V., M.H.), Tulane University, New Orleans, LA, USA
| | - Laura M Perry
- Department of Medical Social Sciences (L.M.P.), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine (L.M.P.), Tulane University School of Medicine, New Orleans, LA, USA
| | - Hallie M Voss
- Department of Psychology (B.M., H.M.V., M.H.), Tulane University, New Orleans, LA, USA
| | - Paul K Maciejewski
- Cornell Center for Research on End-of-Life Care (P.K.M., H.G.P.), Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Robert Gramling
- Department of Family Medicine (R.G.), University of Vermont, Burlington, VT, USA
| | - Paul Duberstein
- Department of Health Behavior (P.D.), Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care (P.K.M., H.G.P.), Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald M Epstein
- Departments of Family Medicine (R.M.E.), Medicine and Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Hoerger
- Department of Psychology (B.M., H.M.V., M.H.), Tulane University, New Orleans, LA, USA; Departments of Psychiatry and Medicine (M.H.), Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, LA, USA.
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Toyoda Y, Tokumasu A, Minato Y, Sone T, Oshiro K, Kojima H, Nishikawa M. Relationship between implementation of systematic advance care planning and the quality of death among nursing home residents: a survey. Palliat Care Soc Pract 2024; 18:26323524231219519. [PMID: 38188460 PMCID: PMC10771744 DOI: 10.1177/26323524231219519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
Background Advance care planning (ACP) is beneficial for the quality of death (QOD). However, the effects of ACP on the QOD may vary across cultures. Objectives This study aimed to explore the relationship between the 15-step ACP program and the QOD among Japanese nursing home residents. Design A cross-sectional survey. Methods A cross-sectional survey was conducted among the family members of 39 nursing home residents who died between April 2017 and March 2019 by distributing the survey questionnaire by post. The survey included questions about the QOD of residents, and responses were evaluated using the Good Death Inventory (GDI) scale. Results Responses were obtained from 30 of the 39 bereaved families (76.9%). Data were analyzed using hierarchical clustering to determine five groups and conduct multiple comparisons. The following three domains of interest were identified: 'Dying in a favorite place', 'Good relationship with the medical staff', and 'Independence'. GDI scores were significantly higher for residents with higher ACP completion rates than for those with lower rates (p < 0.01). Residents who had taken ACP interviews had significantly higher GDI scores (p < 0.01) than those who had not taken interviews. Conclusion Overall, these findings suggest that systematic ACP might be related to the QOD among Japanese nursing home residents in the above mentioned three domains. Limitations of the present study were small sample size, cross-sectional survey design as opposed to a cohort survey design, and multiple biases, including the emotional instability of bereaved family members, the length of stay of the residents, the degree of dementia of the residents, and their tendency to talk about the place of death and to develop good relationships with the medical staff.
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Affiliation(s)
- Yoshie Toyoda
- Sawayaka-no Sato Special Nursing Home for the Elderly, Aichi, Japan
| | - Aya Tokumasu
- Sawayaka-no Sato Special Nursing Home for the Elderly, Aichi, Japan
| | - Yuki Minato
- Sawayaka-no Sato Special Nursing Home for the Elderly, Aichi, Japan
| | - Takayasu Sone
- Sawayaka-no Sato Special Nursing Home for the Elderly, Aichi, Japan
| | | | - Hideki Kojima
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Mitsunori Nishikawa
- End-of-Life Care Team, National Center for Geriatrics and Gerontology, Morioka-cho, 7-430, Obu, Aichi 474-8511, Japan
- Aioi Geriatric Health Services Facility, Aichi, Japan
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Oshiro K, Okochi S, Nakashima J, Hirano T, Ohe S, Kojima H, Nishikawa M. Changes in care managers' positive attitudes toward dying patients compared to that of nurses by one-day online advance care planning communication training. Palliat Care Soc Pract 2024; 18:26323524231222497. [PMID: 38188459 PMCID: PMC10768599 DOI: 10.1177/26323524231222497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background Culturally appropriate communication training programs for a wide range of professions that can be used during infection epidemics are crucial for advance care planning implementation. Starting in 2018, the Japanese Ministry of Health, Labour and Welfare made a major policy change, and doctors, nurses, and social workers, and care managers were identified in the guidelines as the professions that promote advance care planning. Motivated by the lack of online programs for Japanese care managers, we proposed a new one-day program. Objectives This study aimed to determine the changes in the positive attitude of care managers toward dying patients compared to that of nurses, which has been used in past literature as an outcome of advance care planning educational interventions, after administering the program in Japan. Design Before-after comparison study. Methods Care managers were recruited through our website, ACP-Piece, http://plaza.umin.ac.jp/~acp-piece/piece.html. A questionnaire survey concerning positive attitudes toward dying patients was administered before and after the program on 28 August 2021. Sixty-six subjects participated in the training and 60 participants, including 14 care managers, consented to the study and completed the questionnaire surveys before and after the program. Results The Frommelt attitude toward care of the dying scores for care managers increased after the program (p-values, confidence intervals, and effect sizes: p < 0.001, -11.90 to -4.388, -1.252). After training, care managers had a significantly higher maximum score occurrence than nurses. Older care managers with advance care planning experience may have had a higher maximum score occurrence compared to younger, inexperienced participants. Conclusion To our knowledge, this is the first to demonstrate the increased positive attitude scores toward dying patients after online communication training for Japanese care managers. The limitations of this study include the lack of evidence regarding reasons for score changes, long-term score changes, and effectiveness for patients and their families.
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Affiliation(s)
- Kyoko Oshiro
- Wabisabi Home Care Support Office, Chita, Aichi, Japan
| | - Shozo Okochi
- Social Welfare Corporation Yotsubakai, Kurashiki, Okayama, Japan
| | | | | | - Shuichi Ohe
- Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Hideki Kojima
- National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Mitsunori Nishikawa
- End-of-Life Care Team, National Center for Geriatrics and Gerontology, Morioka-cho, 7-430, Obu City, Aichi 474-8511, Japan
- Aioi Geriatric Health Services Facility, Ogawahigasikomeda, 16, Higashiura-Cho, Chita-Gun, Aichi 470-2102, Japan
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Wolff JL, Cagle J, Echavarria D, Dy SM, Giovannetti ER, Boyd CM, Hanna V, Hussain N, Reiff JS, Scerpella D, Zhang T, Roth DL. Sharing Health Care Wishes in Primary Care (SHARE) among older adults with possible cognitive impairment in primary care: Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 129:107208. [PMID: 37116645 PMCID: PMC10258688 DOI: 10.1016/j.cct.2023.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Little is known about effective strategies to improve advance care planning (ACP) for persons with cognitive impairment in primary care, the most common setting of care. We describe a randomized controlled trial to test the efficacy of a multicomponent communication intervention, "Sharing Healthcare Wishes in Primary Care" (SHARE). PARTICIPANTS Planned enrollment of 248 dyads of adults 80 years and older with possible cognitive impairment and their care partner, from primary care clinics at 2 Mid-Atlantic health systems. METHODS The treatment protocol encompasses an introductory letter from the clinic; access to a designated facilitator trained in ACP; person-family agenda-setting to align perspectives about the family's role; and print education. The control protocol encompasses minimally enhanced usual care, which includes print education and a blank advance directive. Randomization occurs at the individual dyad-level. Patient and care partner surveys are fielded at baseline, 6-, 12-, and 24- months. Fidelity of interventionist delivery of the protocol is measured through audio-recordings of ACP conversations and post-meeting reports, and by ongoing monitoring and support of interventionists. OUTCOMES The primary outcome is quality of end-of-life care communication at 6 months; secondary outcomes include ACP process measures. An exploratory aim examines end-of-life care quality and bereaved care partner experiences for patients who die by 24 months. CONCLUSIONS Caregiver burden, clinician barriers, and impaired decisional capacity amplify the difficulty and importance of ACP discussions in the context of cognitive impairment: this intervention will comprehensively examine communication processes for this special subpopulation in a key setting of primary care. REGISTRATION ClinicalTrials.gov: NCT04593472.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - John Cagle
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, United States of America.
| | - Diane Echavarria
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Erin R Giovannetti
- Health Economics and Aging Research Institute, MedStar Health, 10980 Grantchester Way Columbia, MD 21044, United States of America.
| | - Cynthia M Boyd
- Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Room 317, Baltimore, MD 21224, United States of America.
| | - Valecia Hanna
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Naaz Hussain
- Johns Hopkins Community Physicians, 45 TJ Drive, Suite 109, Frederick, MD 21702, United States of America.
| | - Jenni S Reiff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Danny Scerpella
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Talan Zhang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, United States of America.
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, United States of America.
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Dehar N, Abedin T, Tang P, Bebb G, Cheung WY. A Comparison of Patients' and Physicians' Knowledge and Expectations Regarding Precision Oncology Tests. Curr Oncol 2022; 29:9916-9927. [PMID: 36547194 PMCID: PMC9776922 DOI: 10.3390/curroncol29120780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: As genomic testing is becoming a part of the mainstream oncology practice, it is vital to ensure that our patients fully understand the implications of these tests. This study aimed to compare the attitudes and expectations of cancer patients with those of their physicians regarding the role of biomarker testing in clinical decision making. (2) Methods: Two separate, complimentary, self-administered questionnaires for patients with cancer and their physicians, respectively, were collected in Calgary, Alberta, Canada. Out of 117, 113 completed patient surveys were included in the statistical analysis, constituting a 96.4% response rate. These surveys were subsequently matched with those of their corresponding oncologists to determine the concordance rates. (3) Results: Overall, patients demonstrated a good understanding of general cancer biology (80.0%) and diagnostic processes (90.0%) associated with precision oncology. Most patients wanted their tumours to be tested to guide treatment, and the oncologists broadly shared these views (concordance 65.1%). However, there were discrepancies between the knowledge and expectations regarding the applications of test results on actual diagnosis and prognosis between patients and their oncologists (concordance 26.1% and 36.0%, respectively). While only 28.0% of patients thought they had enough knowledge to make informed decisions, the majority (68.0%) said they needed more information. (4) Conclusion: Our study shows that patients and cancer physicians do not always agree with the roles and applications of genomic tests, which could lead to misplaced expectations and poor health outcomes. More research is needed to devise strategies to improve education and communication to align these expectations and improve the quality of clinical decision making.
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Affiliation(s)
- Navdeep Dehar
- Department of Medical Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
- Correspondence:
| | - Tasnima Abedin
- Clinical Research Unit, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Patricia Tang
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Gwyn Bebb
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Winson Y. Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
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Chou WYS, Falisi AL, Castro K, Ferrer RA, Gaysynsky A, Huang GC, Mollica MA, Peterson EB, Kent EE. Cancer clinical trial providers' perspectives on communicating goals of care: A key informant study. PEC INNOVATION 2022; 1:100041. [PMID: 37213723 PMCID: PMC10194320 DOI: 10.1016/j.pecinn.2022.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 05/23/2023]
Abstract
Objectives There has been limited research to date exploring provider communication in the context of cancer clinical trials. To elucidate multidisciplinary care providers' experiences, this qualitative study sought to understand their perspectives and communication patterns around goals of care discussions with patients enrolled in cancer clinical trials. Methods Semi-structured key informant interviews were conducted with a purposive sample of physicians, nurse practitioners, social workers, chaplains, nurses, and administrative staff in a cancer research hospital (N=19). Data were analyzed and interpreted using thematic analysis. Results Providers hold varied perspectives on goals of care in cancer clinical trials, highlighting the tension and potential for misalignment between scientific and clinical (patient-centered) goals. Inherent institutional hierarchies may impede some team members from initiating goal discussions. Care transitions (e.g., stopping treatment or initiating hospice) offer critical opportunities for goals of care discussions. Conclusion Conflicting perspectives among team members, perceptions of provider roles, and communication patterns could help explain some of the communication challenges previously documented in advanced cancer and clinical trial care. Innovation This qualitative study contributes to the literature on healthcare team communication in the clinical trial context and highlights tangible opportunities to better leverage providers' diverse experience and improve patient-centered care.
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Affiliation(s)
- Wen-Ying Sylvia Chou
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
- Corresponding author at: Health Communication and Informatics Research Branch, National Cancer Institute, 9609 Medical Center Dr. 3E614, MSC – 9761, Rockville, MD 20850, USA.
| | - Angela L. Falisi
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Kathleen Castro
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Rebecca A. Ferrer
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Anna Gaysynsky
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
- ICF, 530 Gaither Road, Rockville, MD 20850, USA
| | - Grace C. Huang
- Westat, 1600 Research Boulevard, Rockville, MD 20850, USA
| | - Michelle A. Mollica
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Emily B. Peterson
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Erin E. Kent
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
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Henry SG, Fenton JJ, Campbell CI, Sullivan M, Weinberg G, Naz H, Graham WM, Dossett ML, Kravitz RL. Development and Testing of a Communication Intervention to Improve Chronic Pain Management in Primary Care: A Pilot Randomized Clinical Trial. Clin J Pain 2022; 38:620-631. [PMID: 36037051 PMCID: PMC9481730 DOI: 10.1097/ajp.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes. METHODS Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients. Study 2 pilot tested an intervention for teaching this framework using standardized patient instructors-actors trained to portray patients and provide immediate clinician feedback-deployed during regular clinic hours. Primary care physicians were randomized to receive either the intervention or pain management recommendations from the Centers for Disease Control and Prevention. Primary outcomes were pain-related interference at 2 months and clinician use of targeted communication skills (coded from transcripts of audio-recorded visits); secondary outcomes were pain intensity at 2 months, clinician self-efficacy for communicating about chronic pain, patient experience, and clinician-reported visit difficulty. RESULTS We enrolled 47 primary care physicians from 2 academic teaching clinics and recorded visits with 48 patients taking opioids for chronic pain who had an appointment scheduled with an enrolled physician. The intervention was not associated with significant changes in primary or secondary outcomes other than clinician self-efficacy, which was significantly greater in the intervention group. DISCUSSION This study developed a novel framework and intervention for teaching clinician pain-related communications skills. Although the intervention showed promise, more intensive or multicomponent interventions may be needed to have a significant impact on clinicians' pain-related communication and pain outcomes.
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Affiliation(s)
- Stephen G Henry
- Departments of Internal Medicine
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Joshua J Fenton
- Family and Community Medicine, University of California Davis, Sacramento, CA
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mark Sullivan
- Department of Anesthesiology and Pain Medicine and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Gary Weinberg
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Hiba Naz
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Wyatt M Graham
- University of California Davis School of Medicine, Sacramento, CA
| | | | - Richard L Kravitz
- Departments of Internal Medicine
- University of California Davis Center for Healthcare Policy and Research, CA
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Fang JT, Chen SY, Yang LY, Liao KC, Lin CH, Fujimori M, Tang WR. Improving transitional care through online communication skills training. Aging Clin Exp Res 2022; 34:3063-3071. [PMID: 36129617 PMCID: PMC9489478 DOI: 10.1007/s40520-022-02251-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Background As the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient. Aims This study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members. Methods A total of 38 HCPs caring for older patients were randomized to the experimental (n = 18) or control groups (n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis. Results Experimental group HCPs showed a significant improvement in communication confidence over the control group (p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge (p < 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden. Conclusion The OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02251-4.
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Affiliation(s)
- Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital Taoyuan, Taoyuan City, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist., Taoyuan City, 333, Taiwan
| | - Lan-Yen Yang
- Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chen Liao
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Hao Lin
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Maiko Fujimori
- Section of Psychological Science, Division of Health Care Research/Section of Behavior Research, Division of Behavioral Science, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Kashiwa, Chiba, Japan
| | - Woung-Ru Tang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital Taoyuan, Taoyuan City, Taiwan. .,School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist., Taoyuan City, 333, Taiwan.
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10
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Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev 2022; 7:CD013116. [PMID: 35802350 PMCID: PMC9266997 DOI: 10.1002/14651858.cd013116.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication about end of life (EoL) and EoL care is critically important for providing quality care as people approach death. Such communication is often complex and involves many people (patients, family members, carers, health professionals). How best to communicate with people in the period approaching death is not known, but is an important question for quality of care at EoL worldwide. This review fills a gap in the evidence on interpersonal communication (between people and health professionals) in the last year of life, focusing on interventions to improve interpersonal communication and patient, family member and carer outcomes. OBJECTIVES To assess the effects of interventions designed to improve verbal interpersonal communication about EoL care between health practitioners and people affected by EoL. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018, without language or date restrictions. We contacted authors of included studies and experts and searched reference lists to identify relevant papers. We searched grey literature sources, conference proceedings, and clinical trials registries in September 2019. Database searches were re-run in June 2021 and potentially relevant studies listed as awaiting classification or ongoing. SELECTION CRITERIA This review assessed the effects of interventions, evaluated in randomised and quasi-randomised trials, intended to enhance interpersonal communication about EoL care between patients expected to die within 12 months, their family members and carers, and health practitioners involved in their care. Patients of any age from birth, in any setting or care context (e.g. acute catastrophic injury, chronic illness), and all health professionals involved in their care were eligible. All communication interventions were eligible, as long as they included interpersonal interaction(s) between patients and family members or carers and health professionals. Interventions could be simple or complex, with one or more communication aims (e.g. to inform, skill, engage, support). Effects were sought on outcomes for patients, family and carers, health professionals and health systems, including adverse (unintended) effects. To ensure this review's focus was maintained on interpersonal communication in the last 12 months of life, we excluded studies that addressed specific decisions, shared or otherwise, and the tools involved in such decision-making. We also excluded studies focused on advance care planning (ACP) reporting ACP uptake or completion as the primary outcome. Finally, we excluded studies of communication skills training for health professionals unless patient outcomes were reported as primary outcomes. DATA COLLECTION AND ANALYSIS Standard Cochrane methods were used, including dual review author study selection, data extraction and quality assessment of the included studies. MAIN RESULTS Eight trials were included. All assessed intervention effects compared with usual care. Certainty of the evidence was low or very low. All outcomes were downgraded for indirectness based on the review's purpose, and many were downgraded for imprecision and/or inconsistency. Certainty was not commonly downgraded for methodological limitations. A summary of the review's findings is as follows. Knowledge and understanding (four studies, low-certainty evidence; one study without usable data): interventions to improve communication (e.g. question prompt list, with or without patient and physician training) may have little or no effect on knowledge of illness and prognosis, or information needs and preferences, although studies were small and measures used varied across trials. Evaluation of the communication (six studies measuring several constructs (communication quality, patient-centredness, involvement preferences, doctor-patient relationship, satisfaction with consultation), most low-certainty evidence): across constructs there may be minimal or no effects of interventions to improve EoL communication, and there is uncertainty about effects of interventions such as a patient-specific feedback sheet on quality of communication. Discussions of EoL or EoL care (six studies measuring selected outcomes, low- or very low-certainty evidence): a family conference intervention may increase duration of EoL discussions in an intensive care unit (ICU) setting, while use of a structured serious illness conversation guide may lead to earlier discussions of EoL and EoL care (each assessed by one study). We are uncertain about effects on occurrence of discussions and question asking in consultations, and there may be little or no effect on content of communication in consultations. Adverse outcomes or unintended effects (limited evidence): there is insufficient evidence to determine whether there are adverse outcomes associated with communication interventions (e.g. question prompt list, family conference, structured discussions) for EoL and EoL care. Patient and/or carer anxiety was reported by three studies, but judged as confounded. No other unintended consequences, or worsening of desired outcomes, were reported. Patient/carer quality of life (four studies, low-certainty evidence; two without useable data): interventions to improve communication may have little or no effect on quality of life. Health practitioner outcomes (three studies, low-certainty evidence; two without usable data): interventions to improve communication may have little or no effect on health practitioner outcomes (satisfaction with communication during consultation; one study); effects on other outcomes (knowledge, preparedness to communicate) are unknown. Health systems impacts: communication interventions (e.g. structured EoL conversations) may have little or no effect on carer or clinician ratings of quality of EoL care (satisfaction with care, symptom management, comfort assessment, quality of care) (three studies, low-certainty evidence), or on patients' self-rated care and illness, or numbers of care goals met (one study, low-certainty evidence). Communication interventions (e.g. question prompt list alone or with nurse-led communication skills training) may slightly increase mean consultation length (two studies), but other health service impacts (e.g. hospital admissions) are unclear. AUTHORS' CONCLUSIONS Findings of this review are inconclusive for practice. Future research might contribute meaningfully by seeking to fill gaps for populations not yet studied in trials; and to develop responsive outcome measures with which to better assess the effects of communication on the range of people involved in EoL communication episodes. Mixed methods and/or qualitative research may contribute usefully to better understand the complex interplay between different parties involved in communication, and to inform development of more effective interventions and appropriate outcome measures. Co-design of such interventions and outcomes, involving the full range of people affected by EoL communication and care, should be a key underpinning principle for future research in this area.
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Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin and Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Natalie K Bradford
- Centre for Children's Health Research, Cancer and Palliative Care Outcomes at Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Australia
| | - Simon Henderson
- Department of Aviation, The University of New South Wales, Sydney, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Children's Health Queensland, Hospital and Health Service, South Brisbane, Australia
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | | | - Amanda Henderson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
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11
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Bloom JR, Marshall DC, Rodriguez-Russo C, Martin E, Jones JA, Dharmarajan KV. Prognostic disclosure in oncology - current communication models: a scoping review. BMJ Support Palliat Care 2022; 12:167-177. [PMID: 35144938 DOI: 10.1136/bmjspcare-2021-003313] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prognostic disclosure is essential to informed decision making in oncology, yet many oncologists are unsure how to successfully facilitate this discussion. This scoping review determines what prognostic communication models exist, compares and contrasts these models, and explores the supporting evidence. METHOD A protocol was created for this study using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews. Comprehensive literature searches of electronic databases MEDLINE, EMBASE, PsycINFO and Cochrane CENTRAL were executed to identify relevant publications between 1971 and 2020. RESULTS In total, 1532 articles were identified, of which 78 met inclusion criteria and contained 5 communication models. Three of these have been validated in randomised controlled trials (the Serious Illness Conversation Guide, the Four Habits Model and the ADAPT acronym) and have demonstrated improved objective communication measures and patient reported outcomes. All three models emphasise the importance of exploring patients' illness understanding and treatment preferences, communicating prognosis and responding to emotion. CONCLUSION Communicating prognostic estimates is a core competency skill in advanced cancer care. This scoping review highlights available communication models and identifies areas in need of further assessment. Such areas include how to maintain learnt communication skills for lifelong practice, how to assess patient and caregiver understanding during and after these conversations, and how to best scale these protocols at the institutional and national levels.
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Affiliation(s)
- Julie Rachel Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Martin
- Palliative Care Program, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua Adam Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kavita Vyas Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Bany Hamdan A, Ballourah W, Elghazaly A, Javison S, Alshammary S, Erlandez R, Garatli A, Mohammed H, Alharbi M. The Effect of Video-Assisted Education Prior Intrathecal Chemotherapy on Anxiety and Knowledge Enhancement. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:65-70. [PMID: 32519327 DOI: 10.1007/s13187-020-01787-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intrathecal chemotherapy procedures are stressful to patients and caregivers, especially the first time. Providing the patient and caregiver with sufficient information to address their concerns before the scheduled procedure is necessary. This study aims to determine whether the use of video instructions could enhance learning outcomes and decrease anxiety levels in patients' caregivers. A prospective trial was conducted in pediatric hematology for 1 year. Thirty-seven respondents were randomly assigned to two groups wherein one group was given conventional educational leaflets and verbal instructions, while the other group received the same information through an educational video presentation before the intrathecal chemotherapy procedure. Knowledge enhancement in the two groups was evaluated using the summative assessment method and measured by a 10-point Likert scale. The validated Arabic version of the Beck Anxiety Inventory (BAI) scale was used to assess anxiety levels. The anxiety level (12.31 ± 8.84) in the video presentation group was significantly higher than that in the conventional group (6.16 ± 5.91). Similarly, the overall Beck scale score revealed that palpitation, frightening, lightheadedness, and hot/cold sweat levels were decreased in the video presentation group. Additionally, a significant difference in knowledge enhancement was noted between the two groups, as knowledge enhancement in the video presentation group (7.61 ± 1.88) was better than that in the conventional group (6.00 ± 1.00). This produced a domino effect on the anxiety level scores of both groups. An educational video presentation before the intrathecal chemotherapy procedure is effective since both visual and auditory senses are involved. This could be considered a good source of an interventional approach before a therapeutic procedure.
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Affiliation(s)
| | - Walid Ballourah
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Assem Elghazaly
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sherwynn Javison
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami Alshammary
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Richard Erlandez
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Garatli
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Husain Mohammed
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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13
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Hoerger M, Gramling R, Epstein R, Fenton JJ, Mohile S, Kravitz R, Mossman B, Prigerson H, Alonzi S, Malhotra K, Duberstein P. Patient, Caregiver, and Oncologist Predictions of Quality of Life in Advanced Cancer: Accuracy and Associations with End-of-Life Care and Caregiver Bereavement. Psychooncology 2022; 31:978-984. [PMID: 35088926 DOI: 10.1002/pon.5887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Informed treatment decision-making necessitates accurate prognostication,including predictions about quality of life. We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement. METHODS We secondary analyses of clinical trial data. Patients with advanced cancer (n=156), caregivers (n=156), and oncologists (n=38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n=79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, 21 and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients' quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists. RESULTS Caregivers (P<.0001) and oncologists (P=.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers' predictions were more negative, patients were less likely to receive chemotherapy (P=.028) or have an ED/inpatient visit (P=.033), and caregivers reported worse depression (P=.002), anxiety (P=.019), and grief (P=.028) and less purpose in life (P<.001) 7-months post-mortem. CONCLUSION When caregivers have more negative expectations about patients' quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael Hoerger
- Tulane Cancer Center, New Orleans, LA.,Tulane University, Department of Psychology, New Orleans, LA
| | - Robert Gramling
- Department of Family Medicine,Burlington, University of Vermont, VT
| | - Ronald Epstein
- Department of Medicine, University of Rochester Medical Center, Rochester, NY.,Wilmot Cancer Institute, Rochester, NY
| | - Joshua J Fenton
- Center forHealthcare Policy and Research, University of California Davis, Sacramento, CA
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY.,Wilmot Cancer Institute, Rochester, NY
| | - Richard Kravitz
- Center forHealthcare Policy and Research, University of California Davis, Sacramento, CA.,Departmentof Internal Medicine, University of California Davis, Sacramento, CA
| | - Brenna Mossman
- Tulane University, Department of Psychology, New Orleans, LA
| | - Holly Prigerson
- Weill Cornell Medicine, Department of Medicine, Center for Research on End-of-Life Care, New York, NY
| | - Sarah Alonzi
- Tulane University, Department of Psychology, New Orleans, LA
| | - Kirti Malhotra
- Departmentof Internal Medicine, University of California Davis, Sacramento, CA
| | - Paul Duberstein
- Rutgers School of Public Health,Department of Health Behavior, Society, and Policy, Piscataway, NJ
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14
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Epstein RM, Marshall F, Sanders M, Krasner MS. Effect of an Intensive Mindful Practice Workshop on Patient-Centered Compassionate Care, Clinician Well-Being, Work Engagement, and Teamwork. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:19-27. [PMID: 34459443 DOI: 10.1097/ceh.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Mindfulness-based interventions for health professionals have been linked to improvements in burnout, well-being, empathy, communication, patient-centered care, and patient safety, but the optimal formats and intensity of training have been difficult to determine because of the paucity of studies and the heterogeneity of programs. A 4-days residential "Mindful Practice" workshop for physicians and medical educators featuring contemplative practices, personal narratives, and appreciative dialogs about challenging experiences may hold promise in improving participants' well-being while also improving compassionate care, job satisfaction, work engagement, and teamwork. METHODS We collected baseline and 2-month follow-up data during four workshops conducted in 2018 to 2019 at conference centers in the United States and Europe. Primary outcomes were burnout, work-related distress, job satisfaction, work engagement, patient-centered compassionate care, and teamwork. RESULTS Eighty-five of 120 participants (71%) completed both surveys (mean age was 49.3 and 68.2% female). There were improvements (P < .01) in two of three burnout components (emotional exhaustion and depersonalization), work-related distress, job satisfaction, patient-centered compassionate care, work engagement and meaning, teamwork, well-being, positive emotion, mindfulness, somatic symptoms, and spirituality. Effect sizes (standardized mean difference of change) ranged from 0.25 to 0.61. With Bonferroni adjustments (P < .0031), teamwork, general well-being, and mindfulness became nonsignificant. DISCUSSION An intensive, multiday, mindfulness-based workshop for physicians had clinically significant positive effects on clinician well-being, quality of interpersonal care and work satisfaction, and meaning and engagement, all important indicators of improved health and sustainability of the health care workforce. Future iterations of the program should increase the focus on teamwork.
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Affiliation(s)
- Ronald M Epstein
- Mr. Epstein: Professor of Family Medicine, Oncology and Medicine (Palliative Care), and American Cancer Society's Clinical Research Professor, Codirector, Center for Communication and Disparities Research, Departments of Family Medicine and Medicine and the Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Marshall: Professor, Department of Neurology, Division of Geriatric Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Sanders: Senior Instructor, Department of Family Medicine, Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Krasner: Professor of Clinical Medicine and Clinical Family Medicine, Departments Medicine and Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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15
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Mossman B, Perry LM, Walsh LE, Gerhart J, Malhotra S, Horswell R, Chu S, Raines AM, Lefante J, Blais CM, Miele L, Melancon B, Alonzi S, Voss H, Freestone L, Dunn A, Hoerger M. Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer. Psychooncology 2021; 30:1876-1883. [PMID: 34157174 DOI: 10.1002/pon.5754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Leah E Walsh
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonia Malhotra
- Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Section of General Internal Medicine & Geriatrics, Deming Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,Department of Psychiatry, School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - John Lefante
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Christopher M Blais
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Lucio Miele
- Department of Genetics and Louisiana Cancer Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Melancon
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Hallie Voss
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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16
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Relationship between Provider Communication Behaviors and the Quality of Life for Patients with Advanced Cancer in Saudi Arabia. Curr Oncol 2021; 28:2893-2901. [PMID: 34436019 PMCID: PMC8395490 DOI: 10.3390/curroncol28040253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/10/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
Context: Patients with advanced cancer from Saudi Arabia are often not well informed about diagnoses, prognoses, and treatment options. Poor communication can lead to health-care decisions that insufficiently meet patients’ preferences, concerns, and needs and that subsequently affect patients’ quality of life. Objectives: The purpose of this study is to examine the relationship between provider communication behaviors and the quality of life of patients with advanced cancer. Method: A cross-sectional, correlation design was used in the present study, in which 159 patients with confirmed diagnoses of stage III or IV solid cancer were surveyed. Results: The mean summary score of the patients’ quality of life was 57.31. We found a significant relationship between provider communication behaviors and patient quality of life (β = 0.18, b = 0.35, SE = 0.15, p = 0.021). In addition, R2 shows that only 3.4% of variance in patient quality of life is predicated on provider communication behaviors. Conclusions: The relationship between provider communication behaviors and patient quality of life was low (r = 0.18). A possible reason for this is that provider communication behaviors are not the only factor that affects patient quality of life; other variables, such as the patient’s age, cancer type, and level of awareness, can also have an effect. Another possible explanation is that communication behaviors between patients and providers may vary depending on the level of cultural contact.
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17
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Thomas T, Althouse A, Sigler L, Arnold R, Chu E, White DB, Rosenzweig M, Smith K, Smith TJ, Schenker Y. Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer. Psychooncology 2021; 30:1086-1094. [PMID: 33547717 DOI: 10.1002/pon.5648] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress. METHODS Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model. RESULTS Patients reported high levels of therapeutic alliance (56.4 ± 7.4) and moderate quality of life (130.3 ± 25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β = 3.7, 95% confidence interval = 2.1, 5.3, p < 0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress. CONCLUSIONS Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.
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Affiliation(s)
- Teresa Thomas
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Sigler
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Douglas B White
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, Program on Ethics and Decision Making in Critical Illness, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Department of Medicine Section of General Internal Medicine, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Koenig Kellas J, Castle KM, Johnson AZ, Cohen MZ. Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers. HEALTH COMMUNICATION 2021; 36:280-292. [PMID: 31665940 DOI: 10.1080/10410236.2019.1683952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.
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Affiliation(s)
| | | | - Alexis Z Johnson
- Department of Communication and Journalism, Arkansas Tech University
| | - Marlene Z Cohen
- Department of Nursing, VA Nebraska Western Iowa Healthcare System, College of Nursing, University of Nebraska Medical Center
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Kazan AS, Perry LM, Atiya WF, Voss HM, Kim S, Easwar S, Mercorella HN, Lewson A, Rogers JL, Arnold D, Raines AM, Brown L, Moore T, Hoerger M. Development and acceptability of an educational video about a smoking cessation quitline for use in adult outpatient mental healthcare. Transl Behav Med 2021; 11:1579-1584. [PMID: 33647990 DOI: 10.1093/tbm/ibaa145] [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: 11/15/2022] Open
Abstract
Tobacco use is a leading preventable cause of early mortality and is prevalent among adults with mental health diagnoses, especially in the southern USA. Increasing cessation resources in outpatient mental health care and targeting individuals most receptive to changing their behavior may improve cessation. Drawing on the transtheoretical model, our goals were to develop an educational video about the Louisiana Tobacco Quitline and evaluate its acceptability. We designed the video with knowledge derived from Louisiana-specific data (2016 Louisiana Adult Tobacco Survey, N = 6,469) and stakeholder feedback. Bivariate associations between demographic/tobacco-use characteristics and participants' stage of quitting (preparation phase vs. nonpreparation phase) were conducted, which informed design elements of the video. Four stakeholder advisory board meetings involving current smokers, mental health clinicians, and public health advocates convened to provide iterative feedback on the intervention. Our stakeholder advisory board (n = 10) and external stakeholders (n = 20) evaluated intervention acceptability. We found that 17.9% of Louisiana adults were current smokers, with 46.9% of them in the preparation phase of quitting. Using insights from data and stakeholders, we succeeded in producing a 2-min video about the Louisiana Tobacco Quitline which incorporated three themes identified as important by stakeholders: positivity, relatability, and approachability. Supporting acceptability, 96.7% of stakeholders rated the video as helpful and engaging. This study demonstrates the acceptability of combining theory, existing data, and iterative stakeholder feedback to develop a quitline educational video. Future research should examine whether the video can be used to reduce tobacco use.
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Affiliation(s)
- Adina S Kazan
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Wasef F Atiya
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hallie M Voss
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Sanjana Easwar
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hannah N Mercorella
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Ashley Lewson
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - James L Rogers
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Dodie Arnold
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.,School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Lisanne Brown
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Tonia Moore
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA.,Tulane Cancer Center, Tulane University, New Orleans, LA, USA
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20
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Park J, Kotzias D, Kuo P, Logan Iv RL, Merced K, Singh S, Tanana M, Karra Taniskidou E, Lafata JE, Atkins DC, Tai-Seale M, Imel ZE, Smyth P. Detecting conversation topics in primary care office visits from transcripts of patient-provider interactions. J Am Med Inform Assoc 2021; 26:1493-1504. [PMID: 31532490 PMCID: PMC6857514 DOI: 10.1093/jamia/ocz140] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/30/2019] [Accepted: 08/06/2019] [Indexed: 01/18/2023] Open
Abstract
Objective Amid electronic health records, laboratory tests, and other technology, office-based patient and provider communication is still the heart of primary medical care. Patients typically present multiple complaints, requiring physicians to decide how to balance competing demands. How this time is allocated has implications for patient satisfaction, payments, and quality of care. We investigate the effectiveness of machine learning methods for automated annotation of medical topics in patient-provider dialog transcripts. Materials and Methods We used dialog transcripts from 279 primary care visits to predict talk-turn topic labels. Different machine learning models were trained to operate on single or multiple local talk-turns (logistic classifiers, support vector machines, gated recurrent units) as well as sequential models that integrate information across talk-turn sequences (conditional random fields, hidden Markov models, and hierarchical gated recurrent units). Results Evaluation was performed using cross-validation to measure 1) classification accuracy for talk-turns and 2) precision, recall, and F1 scores at the visit level. Experimental results showed that sequential models had higher classification accuracy at the talk-turn level and higher precision at the visit level. Independent models had higher recall scores at the visit level compared with sequential models. Conclusions Incorporating sequential information across talk-turns improves the accuracy of topic prediction in patient-provider dialog by smoothing out noisy information from talk-turns. Although the results are promising, more advanced prediction techniques and larger labeled datasets will likely be required to achieve prediction performance appropriate for real-world clinical applications.
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Affiliation(s)
- Jihyun Park
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
| | - Dimitrios Kotzias
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
| | - Patty Kuo
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Logan Iv
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
| | - Kritzia Merced
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sameer Singh
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
| | - Michael Tanana
- Social Research Institute, University of Utah, Salt Lake City, Utah, USA
| | - Efi Karra Taniskidou
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Padhraic Smyth
- Department of Computer Science, University of California, Irvine, Irvine, California, USA
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21
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Otto AK, Reblin M, Harper FWK, Hamel LM, Moore TF, Ellington L, Eggly S. Impact of Patients' Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists. JCO Oncol Pract 2021; 17:e676-e685. [PMID: 33411574 DOI: 10.1200/op.20.00820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists. METHODS This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other. RESULTS Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication. DISCUSSION Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Public Health Sciences at the University of Miami, Miami, FL
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Felicity W K Harper
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lauren M Hamel
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Tanina F Moore
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
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22
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Perceived quality of care and its associated factors among Chinese patients with advanced cancer: findings from the APPROACH study in Beijing. Support Care Cancer 2020; 29:1395-1401. [PMID: 32671564 DOI: 10.1007/s00520-020-05559-x] [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: 12/18/2019] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patient-perceived quality of care has become an increasingly important index within the healthcare setting. We examined patient-reported overall quality of care and patient experiences in three specific domains of care (physician communication, nursing care, and care coordination) in a sample of Chinese patients with advanced cancer. METHODS A cross-sectional study was conducted with stage IV cancer patients (N = 202) who were recruited from a public, tertiary hospital in Beijing. Study participants completed surveys administered by a research assistant. Multivariable regression analysis was conducted to examine the extent to which patient demographic factors (age, gender, socioeconomic status), disease/treatment factors, and domain-specific care were associated with overall quality of care. RESULTS A majority of patients reported overall quality of care scores that we were either excellent (23%) or very good (41%). Patients reported highest ratings in the domain of nursing care (M = 87.57, SD = 31.05), followed by physician communication (M = 68.93, SD = 32.30), and care coordination (M = 66.79, SD = 25.17). Better perceived physician communication (b = 0.17, p < 0.01), care coordination (b = 0.26, p < 0.01), and higher socioeconomic status (b = 11.30, p < 0.05) were associated with higher overall quality of care. CONCLUSIONS A majority of patients with advanced cancer in this Chinese hospital reported positive overall quality of care. Physician communication and care coordination are potential areas to focus on to improve patient-reported overall quality of care. Understanding perceptions of care quality will allow opportunities to improve delivery of healthcare.
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23
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Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. J Gen Intern Med 2020; 35:2107-2117. [PMID: 31919725 PMCID: PMC7351919 DOI: 10.1007/s11606-019-05525-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). METHODS We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. RESULTS Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. DISCUSSION Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
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Affiliation(s)
- Marie C Haverfield
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA. .,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA.
| | - Aaron Tierney
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Schwartz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA
| | | | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Dani L Zionts
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Fischer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonoo Thadaney
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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24
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Loh KP, Xu H, Epstein RM, Mohile SG, Prigerson HG, Plumb S, Ladwig S, Kadambi S, Wong ML, McHugh C, An A, Trevino K, Saeed F, Duberstein PR. Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety. J Pain Symptom Manage 2020; 60:20-27. [PMID: 32061833 PMCID: PMC7311277 DOI: 10.1016/j.jpainsymman.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. OBJECTIVES We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death. METHODS We conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety. RESULTS We included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (β = -2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (β = -5.87; SE = 2.56; P = 0.02). CONCLUSION A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Huiwen Xu
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald M Epstein
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Holly G Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Cornell Center for Research on End-of-Life Care, New York, New York, USA
| | - Sandra Plumb
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Susan Ladwig
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sindhuja Kadambi
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Melisa L Wong
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Colin McHugh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Amy An
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kelly Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fahad Saeed
- Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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25
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Ngo V, Matsumoto CG, Joseph JG, Bell JF, Bold RJ, Davis A, Reed SC, Kim KK. The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e16527. [PMID: 32452814 PMCID: PMC7284410 DOI: 10.2196/16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)-a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. OBJECTIVE This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. METHODS A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. RESULTS A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. CONCLUSIONS The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.
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Affiliation(s)
- Victoria Ngo
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Cynthia G Matsumoto
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Richard J Bold
- Comprehensive Cancer Center, University of California Davis Health, Sacramento, CA, United States
| | - Andra Davis
- Washington State University College of Nursing - Vancouver, Vancouver, WA, United States
| | - Sarah C Reed
- Division of Social Work, California State University Sacramento, Sacramento, CA, United States
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Perry LM, Hoerger M, Malhotra S, Gerhart JI, Mohile S, Duberstein PR. Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care. J Pain Symptom Manage 2020; 59:293-301.e8. [PMID: 31539604 DOI: 10.1016/j.jpainsymman.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Palliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose. OBJECTIVES The objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors. METHODS Data were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations. RESULTS Internal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics. CONCLUSION Findings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.
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Affiliation(s)
- Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA; Department of Medicine, Section of Hematology and Medical Oncology, Tulane University, New Orleans, Louisiana, USA
| | - Sonia Malhotra
- Department of General Internal Medicine & Geriatrics, Section of Palliative Medicine, Tulane University, New Orleans, Louisiana, USA
| | - James I Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey, USA
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27
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Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer. PLoS One 2020; 15:e0227802. [PMID: 31935263 PMCID: PMC6959662 DOI: 10.1371/journal.pone.0227802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/31/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While patient-centered care is recommended as a key dimension for quality improvement, in case of serious illness, patients may have different expectations regarding information and participation in medical decision-making. In oncology, anticipation of disease worsening remains difficult, especially when patient's preferences towards prognosis medical information are unclear. Valid tools to explore patients' preferences could help targeting end-of-life discussions, which have been shown to decrease aggressiveness of end-of-life care. Our aim was to establish the validity and reliability of the French version of the Autonomy Preference Index (API) among patients with incurable cancer and in primary care setting. Three supplementary items were specifically developed to evaluate preparedness to anticipate disease deterioration among patients with incurable cancer. METHODS The psychometric properties of the API translated into French were assessed among patients consecutively recruited from January to March 2017 in the waiting rooms of 19 general practitioners (N = 391) and in an oncology (N = 187) clinic in Paris. Relationships between the newly-developed items and the API subscale scores were studied. RESULTS A three correlated factors confirmatory model (two factors related to decision-making and a factor related to information-seeking preferences) showed an acceptable fit on the whole sample and no measurement invariance issue was found across settings, age, sex and educational level. Internal consistency and test-retest reliability were acceptable for the information-seeking and decision-making subscales. One of the newly-developed items on patients' ability to anticipate a decision on the use of artificial respiration if a sudden deterioration of their illness occurred was not related to the API subscale scores. CONCLUSION The French version of the API was found valid and reliable for use in general practice and oncology settings. The additional items on patient preparedness to anticipate disease deterioration can be of interest to ensure that patient values guide all end-of-life clinical decisions.
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28
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An AW, Ladwig S, Epstein RM, Prigerson HG, Duberstein PR. The impact of the caregiver-oncologist relationship on caregiver experiences of end-of-life care and bereavement outcomes. Support Care Cancer 2020; 28:4219-4225. [DOI: 10.1007/s00520-019-05185-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
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Gaspar RB, Silva MMD, Zepeda KGM, Silva ÍR. Nurses defending the autonomy of the elderly at the end of life. Rev Bras Enferm 2019; 72:1639-1645. [DOI: 10.1590/0034-7167-2018-0768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/27/2019] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to understand how nurses deal with the elderly’s autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.
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Arscott WT, Emmett J, Ghiam AF, Jones JA. Palliative Radiotherapy: Inpatients, Outpatients, and the Changing Role of Supportive Care in Radiation Oncology. Hematol Oncol Clin North Am 2019; 34:253-277. [PMID: 31739947 DOI: 10.1016/j.hoc.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Palliative radiotherapy is an effective treatment in alleviating many symptoms of advanced cancer. Short courses of radiotherapy provide rapid symptom relief and minimize impact on patients. Patients referred for palliative radiotherapy have many concerns beyond radiotherapy; often, these concerns are not fully addressed in traditional radiotherapy clinics. Discussions of prognosis, patient goals, and concerns are areas for improved collaboration. Innovative, dedicated palliative radiotherapy programs have developed over the past 20 years to provide holistic care to patients referred for palliative radiotherapy and have improved patient-focused outcomes. Advanced radiotherapy techniques may provide opportunities to further improve palliative radiotherapy outcomes.
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Affiliation(s)
| | - Jaclyn Emmett
- Inpatient Oncology, Department of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Alireza Fotouhi Ghiam
- Department of Radiation Oncology, British Columbia Cancer Agency (BCCA), University of British Columbia, 2410 Lee Avenue, Victoria, British Columbia V8R 6V5, Canada
| | - Joshua A Jones
- Palliative Radiotherapy Service, Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
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31
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Aminaie N, Mirlashari J, Lehto RH, Lashkari M, Negarandeh R. Iranian Cancer Patients Perceptions of Barriers to Participation in Decision-Making: Potential Impact on Patient-Centered Care. Asia Pac J Oncol Nurs 2019; 6:372-380. [PMID: 31572757 PMCID: PMC6696813 DOI: 10.4103/apjon.apjon_11_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care. Methods: Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients. Results: Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities’ limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs). Conclusions: Barriers may impact the perceived ability of Iranian patients’ with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.
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Affiliation(s)
- Naism Aminaie
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Mirlashari
- Department of Pediatric and Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Obstetric and Gynecology Department, University of British Colombia, Canada
| | - Rebecca H Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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32
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LeBlanc TW, Baile WF, Eggly S, Bylund CL, Kurtin S, Khurana M, Najdi R, Blaedel J, Wolf JL, Fonseca R. Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies. PATIENT EDUCATION AND COUNSELING 2019; 102:1602-1612. [PMID: 31076236 DOI: 10.1016/j.pec.2019.04.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify factors limiting and facilitating patient-centered communication (PCC) in the United States hematology-oncology setting, with a focus on multiple myeloma (MM), given the limited attention to PCC and rapid pace of change that has taken place in this setting. METHODS A literature search was performed from 2007 to 2017 to identify published articles and congress abstracts related to clinician-patient communication and treatment decision-making in oncology. Search results were evaluated by year of publication and disease area. A thematic assessment was performed to identify factors limiting and promoting PCC for patients with MM and other hematologic malignancies. RESULTS Of the 6673 publications initially retrieved, 18 exclusively reported findings in patients with hematologic malignancies and were included in this review. We identified three critical, but modifiable, barriers to PCC in the hematologic malignancy setting, including insufficient information exchange, treatment goal misalignment, and discordant role preferences in treatment decision-making. Factors that enhanced interaction quality included educational programs for clinicians and patients. CONCLUSIONS Patients with MM and other hematologic malignancies experience a distinct set of challenges that may affect PCC. PRACTICE IMPLICATIONS Clinicians have the opportunity to improve patient care by proactively addressing the identified barriers and implementing strategies demonstrated to improve PCC.
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Affiliation(s)
- Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA; Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA; College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | | | | | - Jeffrey L Wolf
- Department of Medicine, Division of Hematology & Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
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33
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Duberstein PR, Maciejewski PK, Epstein RM, Fenton JJ, Chapman B, Norton SA, Hoerger M, Wittink MN, Tancredi DJ, Xing G, Mohile S, Kravitz RL, Prigerson HG. Effects of the Values and Options in Cancer Care Communication Intervention on Personal Caregiver Experiences of Cancer Care and Bereavement Outcomes. J Palliat Med 2019; 22:1394-1400. [PMID: 31237459 DOI: 10.1089/jpm.2019.0078] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. Objective: To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. Design: We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Setting/Subjects: Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Measurements: Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. Results: The intervention did not significantly improve caregivers' scores on the PG-13 (p = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores (p = 0.018). Cohen's d (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (-0.19 to 0.63) to 0.39 (-0.07 to 0.86) although none was statistically significant. Conclusion: Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes.
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Affiliation(s)
- Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, Piscataway, New Jersey
| | - Paul K Maciejewski
- Department of Radiology, Department of Medicine, Weill Cornell Medical College, New York, New York.,Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ronald M Epstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California.,UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California.,Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California
| | - Benjamin Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sally A Norton
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,School of Nursing, University of Rochester, Rochester, New York
| | - Michael Hoerger
- Tulane Cancer Center, Tulane University, New Orleans, Louisiana.,Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.,Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California
| | - Supriya Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard L Kravitz
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California.,Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.,Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medical College, New York, New York.,Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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34
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Trevino KM, Prigerson HG, Shen MJ, Tancredi DJ, Xing G, Hoerger M, Epstein RM, Duberstein PR. Association between advanced cancer patient-caregiver agreement regarding prognosis and hospice enrollment. Cancer 2019; 125:3259-3265. [PMID: 31145833 PMCID: PMC6717015 DOI: 10.1002/cncr.32188] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/12/2019] [Accepted: 04/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with advanced, incurable cancer who understand their illness is incurable are more likely to prefer hospice care at the end of life compared with patients who believe their illness is curable. To the authors' knowledge, it is unclear whether patient-caregiver agreement regarding perceived prognosis is associated with hospice enrollment. METHODS The current study examined the prospective relationship between patient-caregiver agreement concerning perceived prognosis and hospice enrollment in the last 30 days of life. Data were collected during a cluster randomized controlled trial examining a communication intervention for oncologists and patients with advanced cancer and their caregivers. At the time of study entry, patients and caregivers (141 dyads) were categorized as endorsing a "good" prognosis if they: 1) reported a >50% chance of surviving ≥2 years; or if they 2) predicted that the patient's quality of life 3 months into the future would be ≥7 on an 11-point scale. RESULTS Approximately one-fifth of dyads agreed on a poor prognosis whereas approximately one-half disagreed regarding prognosis. In approximately one-third of dyads, patients and caregivers both believed the patient's future quality of life would be good (34%) and that the patient would live for ≥2 years (30%). Patients in these dyads were less likely to enroll in hospice compared with patients in dyads who disagreed and those who agreed on a shorter life expectancy and poor future quality of life. CONCLUSIONS Dyadic understanding of patients' projected life expectancy and future quality of life appears to be predictive of care received at the end of life. Improving rates of hospice enrollment may be best achieved with dyadic interventions.
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Affiliation(s)
- Kelly M Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
| | - Megan Johnson Shen
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
| | - Daniel J Tancredi
- Department of Pediatrics, University of California at Davis, Davis, California
| | - Guibo Xing
- Department of Pediatrics, University of California at Davis, Davis, California
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Paul R Duberstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, New Brunswick, New Jersey
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35
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Rodenbach RA, Norton SA, Wittink MN, Mohile S, Prigerson HG, Duberstein PR, Epstein RM. When chemotherapy fails: Emotionally charged experiences faced by family caregivers of patients with advanced cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:909-915. [PMID: 30579772 PMCID: PMC6491225 DOI: 10.1016/j.pec.2018.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/23/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore family caregivers' emotional experiences while caring for patients with advanced cancer and navigating distressing information, awareness of dying, and difficult decisions. METHODS Qualitative descriptive study of semi-structured interviews with 92 bereaved caregivers of patients with advanced cancer. Interviews explored caregivers' experiences as patients transitioned out of active cancer treatment and neared the end of life. RESULTS Included in caregivers' characterization of this transition time were three particularly emotionally charged experiences. The first occurred when caregivers felt jolted into awareness that patients were dying.They were startled to realize that patients would die sooner than expected; some expressed frustration that they had not been adequately warned. In the second, caregivers felt conflicted when involved in decisions that pitted patients' preferences against what caregivers felt patients needed, resulting in ambivalence, guilt, and grief. Thirdly, caregivers who felt they did their best for patients expressed fulfillment and gratitude. CONCLUSION Caregivers of patients with advanced cancer face unique, emotionally charged experiences that can lead to distress and affect care at the end of life. PRACTICE IMPLICATIONS Awareness of these situations may help oncology teams to provide sufficient guidance and support, partner with caregivers to clarify patients' needs, and deliver higher quality care.
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Affiliation(s)
- Rachel A Rodenbach
- University of Pittsburgh Medical Center, 3459 5th Ave, Pittsburgh, PA, 15213, USA; Center for Communication and Disparities Research, 1381 South Ave, Rochester, NY, 14620, USA.
| | - Sally A Norton
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Marsha N Wittink
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Supriya Mohile
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Holly G Prigerson
- Weill Cornell Medicine, 413 E 69th St, New York City, NY, 10021, USA
| | - Paul R Duberstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA; Center for Communication and Disparities Research, 1381 South Ave, Rochester, NY, 14620, USA; Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Ronald M Epstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA; Center for Communication and Disparities Research, 1381 South Ave, Rochester, NY, 14620, USA
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36
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Malhotra K, Fenton JJ, Duberstein PR, Epstein RM, Xing G, Tancredi DJ, Hoerger M, Gramling R, Kravitz RL. Prognostic accuracy of patients, caregivers, and oncologists in advanced cancer. Cancer 2019; 125:2684-2692. [PMID: 31034597 DOI: 10.1002/cncr.32127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/04/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND In caring for patients with advanced cancer, accurate estimation of survival is important for clinical decision making. The purpose of this study was to assess the accuracy of 2-year survival probabilities estimated by oncologists, patients, and caregivers and to identify demographic and clinical factors associated with prognostic accuracy. METHODS This was a secondary observational analysis of data obtained from a cluster randomized controlled trial. Participants included 38 oncologists, 263 patients with advanced nonhematologic cancer, and 193 of their caregivers from clinics in Sacramento and Western New York. Discrimination within each group (oncologists, patients, caregivers) was evaluated using the C statistic, whereas calibration was assessed by comparing observed to predicted 2-year mortality using the chi-square statistic. RESULTS The median survival from study entry was 18 months, and 41.8% of patients survived for 2 years. C statistics for oncologists, patients, and caregivers were 0.81 (95% CI, 0.76-0.86), 0.62 (95% CI, 0.55-0.68), and 0.72 (95% CI, 0.65-0.78), respectively; oncologists' predictions were better than the predictions of both patients (P = .001) and caregivers (P = .03). Oncologists also had superior calibration: their predictions of 2-year survival were similar to actual survival (P = .17), whereas patients' (P = .0001) and caregivers' (P = .003) predictions diverged significantly from actual survival. Although most oncologists' predictions were classified as realistic (62.0%), approximately one-half of patients' and caregivers' predictions (50.0% and 46.0%, respectively) were unduly optimistic. Among patients, nonwhite race and higher levels of social well-being predicted undue optimism (P < .05). CONCLUSIONS Compared with oncologists, patients and caregivers displayed inferior prognostic discrimination, and their predictions were poorly calibrated, primarily because of overoptimism.
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Affiliation(s)
- Kirti Malhotra
- Department of Internal Medicine, University of California at Davis, Sacramento, California
| | - Joshua J Fenton
- Department of Family and Community Medicine, University of California at Davis, Sacramento, California
| | - Paul R Duberstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Robert Gramling
- Division of Palliative Medicine, University of Vermont, Burlington, Vermont
| | - Richard L Kravitz
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California
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Adamson M, Cotoc C, Choi K, Notaro S. Cancer Communication Outside of the Physician-Patient Relationship: The Experience of Communicating and Understanding the Meaning of Prognosis. Am J Hosp Palliat Care 2019; 36:711-717. [PMID: 30818959 DOI: 10.1177/1049909119832811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RESEARCH QUESTION How does the process of engagement and integration of sources of information outside patient-physician interaction affect how individuals with cancer interpret their treatment experience and prognosis? BACKGROUND Studies of patient-physician communication of prognosis in oncology highlight areas where misunderstanding occurs: understanding consequences of treatment, likelihood of treatment success, probability of cure, status/progression of illness, and prognosis. Theories proposing mechanisms that underlie this discrepancy cannot account for all instances of misunderstanding, including when complete and direct physician disclosure occurs. Prior research focused on patient-physician communication event(s) and immediate antecedents and consequences. However, less is known about what happens to information once it has been communicated and how a patient's process to interpret the meaning of their experience affects their understanding of it. Our study explores this question by examining patient communication with sources of information other than treating physicians. METHODOLOGY We conducted 10 semi-structured qualitative interviews with individuals diagnosed with 4 types of cancer at different stages. The interviews were analyzed using inductive qualitative analysis. RESULTS Participants in our sample consulted a variety of additional sources to give context and understanding to their communicated prognosis. These were important contributors to how they understood their prognosis and incorporated that understanding. They included family, friends/acquaintances, cancer survivors, support/survivor groups, secondary health-care staff, and relevant informational materials. Different motivations for seeking out these sources were also expressed. Participants expressed a link between their understanding of their prognosis and the variety of outside sources they enlisted for input and support.
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Affiliation(s)
- Matthew Adamson
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Crina Cotoc
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kelsey Choi
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stephen Notaro
- 1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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DeMartini J, Fenton JJ, Epstein R, Duberstein P, Cipri C, Tancredi D, Xing G, Kaesberg P, Kravitz RL. Patients' Hopes for Advanced Cancer Treatment. J Pain Symptom Manage 2019; 57:57-63.e2. [PMID: 30261227 PMCID: PMC6310622 DOI: 10.1016/j.jpainsymman.2018.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 01/06/2023]
Abstract
CONTEXT Little is known about the hopes patients with advanced (incurable) cancer have for their treatment. OBJECTIVES The objective of this study was to describe the treatment hopes of advanced cancer patients, factors associated with expressing specific hopes, and the persons with whom hopes are discussed. METHODS We surveyed 265 advanced cancer patients in the U.S. about their hopes for treatment at the baseline and after three months. We developed a taxonomy of hopes for treatment, which two investigators used to independently code patient responses. We explored associations between hopes for cure and patient covariates. RESULTS We developed eight categories of hopes. We were able to apply these codes reliably, and 95% of the patient's responses fit at least one hope category. The hope categories in order of descending baseline prevalence were as follows: quality of life, life extension, tumor stabilization, remission, milestone, unqualified cure, control not otherwise specified, and cure tempered by realism. Most patients reported discussing hopes with partners, family/friends, and oncologists; a minority reported discussing hopes with nurses, primary care physicians, clergy, or support groups. In logistic regression analysis, unqualified hopes for cure were more likely in younger patients and in those who did not endorse discussing their hopes with primary care physicians. CONCLUSION Advanced cancer patients harbor a range of treatment hopes. These hopes often are not discussed with key members of the health care team. Younger age and lack of discussion of hopes with primary care physicians may lead to less realistic hopes for cure.
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Affiliation(s)
- Jeremy DeMartini
- Department of Psychiatry, University of California, Davis, Sacramento, California, USA.
| | - Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester, Rochester, New York, USA; Department of Psychiatry, University of Rochester, Rochester, New York, USA; Wilmot Cancer Center, University of Rochester, Rochester, New York, USA; Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Paul Duberstein
- Department of Family Medicine, University of Rochester, Rochester, New York, USA; Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Paul Kaesberg
- Division of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Richard L Kravitz
- Division of General Medicine, University of California, Davis, Sacramento, California, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
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39
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Trevino KM, Maciejewski PK, Shen MJ, Prigerson HG, Mohile S, Kamen C, Epstein RM, Duberstein P. How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers. Support Care Cancer 2018; 27:2487-2496. [PMID: 30387051 PMCID: PMC6494724 DOI: 10.1007/s00520-018-4533-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/26/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE It is unclear whether life-expectancy estimates of patients with advanced cancer and their caregivers are associated with patient existential, social, or emotional quality of life (QOL) or caregiver emotional QOL. METHODS Patients with advanced cancer and their caregivers (n = 162 dyads) reported estimates of the chance the patient would live for 2 years or more from 0% (most pessimistic) to 100% (most optimistic). They also completed self-report measures of QOL. RESULTS Adjusting for sociodemographic confounds and multiple comparisons, more pessimistic caregiver and patient life-expectancy estimates were associated with worse caregiver emotional QOL and worse patient existential QOL. Discrepancies between patient and caregiver estimates were not associated with patient or caregiver QOL. CONCLUSIONS Pessimistic life-expectancy estimates are associated with worse existential QOL in patients and worse emotional QOL in caregivers. Prospective research to establish causal relationships is needed, and interventions to address the relationship between beliefs about life expectancy and existential and emotional QOL should be considered. Providing these interventions to patients and caregivers receiving information on life expectancy may mitigate the negative impact of life-expectancy information on patient existential quality of life.
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Affiliation(s)
- Kelly M Trevino
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA.
| | - Paul K Maciejewski
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Megan Johnson Shen
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Holly G Prigerson
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Supriya Mohile
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Charles Kamen
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Ronald M Epstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Paul Duberstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Siegle A, Villalobos M, Bossert J, Krug K, Hagelskamp L, Krisam J, Handtke V, Deis N, Jünger J, Wensing M, Thomas M. The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis <12 months: protocol for a mixed-methods study including a randomized controlled trial. Trials 2018; 19:438. [PMID: 30107809 PMCID: PMC6092809 DOI: 10.1186/s13063-018-2814-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background The care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory. This study aims to evaluate these aspects of MCA: (1) the training of healthcare professionals, (2) implementation context and outcomes, (3) patient outcomes, and (4) effects on interprofessional collaboration. Methods/design A multiphase mixed-methods design will be used for the study. A total of 100 patients and 120 healthcare professionals in a specialized oncology hospital will be involved. The training outcomes will be documented using a questionnaire. Implementation context and outcomes will be explored through semi-structured interviews and written questionnaires with healthcare professionals and with the training participants and through a content analysis of patient files. Patient outcomes will be assessed in a pragmatic non-blinded randomized controlled trial and in qualitative interviews with patients and caregivers. Trial outcomes are supportive care needs (SCNS-SF34-G), quality of life (SeiQol and Fact-L), depression and anxiety symptoms (PHQ-4), and distress (Distress Thermometer). Qualitative semi-structured interviews on patients’ views will focus on shared decision-making, communication needs, feeling empathy, and further utilization of healthcare services. Interprofessional collaboration will be explored using the UWE-IP-D before the implementation of MCA (t0) and after 3 (t1), 9 (t2), and 12 (t3) months. Discussion Using guideline-concordant early palliative care, MCA aims to foster patient-centered communication with shared decision-making and facilitation of advance care planning including end-of-life decisions, thus increasing patient quality of life and decreasing aggressive medical care at the end of life. It is assumed that the communication skills training and interprofessional coaching will improve the communication behavior of healthcare providers and influence team communications and team processes. Trial registration German Clinical Trials Register, DRKS00013649 and DRKS00013469. Registered on 22 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2814-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Siegle
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany. .,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Matthias Villalobos
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Laura Hagelskamp
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany.,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Violet Handtke
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Nicole Deis
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Jana Jünger
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
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Choi J, Cho Y, Woo H. mHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping. JMIR Mhealth Uhealth 2018; 6:e164. [PMID: 30072362 PMCID: PMC6096168 DOI: 10.2196/mhealth.8554] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/26/2017] [Accepted: 06/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology. Objective The purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum. Methods A systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis. Results Of the 18 studies, 5 (28%) evaluated prevention interventions, 6 (33%) assessed diagnostic accuracy, and 7 (39%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research. Conclusions This review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews.
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Affiliation(s)
- Jihye Choi
- Graduate School of Public Health, Department of Public Health Science, Seoul National University, Seoul, Republic Of Korea
| | - Youngtae Cho
- Graduate School of Public Health, Department of Public Health Science, Seoul National University, Seoul, Republic Of Korea
| | - Hyekyung Woo
- Graduate School of Public Health, Department of Public Health Science, Seoul National University, Seoul, Republic Of Korea
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Norton SA, Wittink MN, Duberstein PR, Prigerson HG, Stanek S, Epstein RM. Family caregiver descriptions of stopping chemotherapy and end-of-life transitions. Support Care Cancer 2018; 27:669-675. [PMID: 30056528 DOI: 10.1007/s00520-018-4365-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/18/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to describe family caregivers' perspectives of the final month of life of patients with advanced cancer, particularly whether and how chemotherapy was discontinued and the effect of clinical decision-making on family caregivers' perceptions of the patient's experience of care at the end of life (EOL). METHODS Qualitative descriptive design using semi-structured interviews collected from 92 family caregivers of patients with end-stage cancer enrolled in a randomized clinical trial. We used a phased approach to data analysis including open coding, focused coding, and within and across analyses. RESULTS We identified three patterns of transitions characterizing the shift away from active cancer treatment: (1) "We Pretty Much Knew," characterized by explicit discussions about EOL care, seemingly shared understanding about prognosis and seamless transitions from disease-oriented treatment to comfort-oriented care, (2) "Beating the Odds," characterized by explicit discussions about disease-directed treatment and EOL care options, but no shared understanding about prognosis and often chaotic transitions to EOL care, and (3) "Left to Die," characterized by no recall of EOL discussions with transitions to EOL occurring in crisis. CONCLUSIONS As communication and palliative care interventions continue to develop to improve care for patients with advanced cancer, it is imperative that we take into account the different patterns of transition and their unique patient and caregiver needs near the end of life. Our findings reveal considerable, and potentially unwarranted, variation in transitions from active treatment to death.
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Affiliation(s)
- S A Norton
- School of Nursing, University of Rochester, Rochester, NY, USA. .,Department of Medicine, Division of Palliative Care, University of Rochester, Rochester, NY, USA.
| | - M N Wittink
- Department of Family Medicine, University of Rochester, Rochester, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - P R Duberstein
- Department of Medicine, Division of Palliative Care, University of Rochester, Rochester, NY, USA.,Department of Family Medicine, University of Rochester, Rochester, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - H G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - S Stanek
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - R M Epstein
- Department of Medicine, Division of Palliative Care, University of Rochester, Rochester, NY, USA.,Department of Family Medicine, University of Rochester, Rochester, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA.,Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Saeed F, Hoerger M, Norton SA, Guancial E, Epstein RM, Duberstein PR. Preference for Palliative Care in Cancer Patients: Are Men and Women Alike? J Pain Symptom Manage 2018; 56:1-6.e1. [PMID: 29581034 PMCID: PMC6015521 DOI: 10.1016/j.jpainsymman.2018.03.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
CONTEXT Men and those with low educational attainment are less likely to receive palliative care. Understanding these disparities is a high priority issue. OBJECTIVES In this study of advanced cancer patients, we hypothesized that men and those with lower levels of educational attainment would have less favorable attitudes toward palliative care. METHODS We performed a cross-sectional analysis of data collected from 383 patients at study entry in the Values and Options in Cancer Care (VOICE) clinical trial. Patients were asked about their preferences for palliative care if their oncologist informed them that further treatment would not be helpful. Palliative care was defined as "comfort care" that focuses on "quality of life, but not a cure." Response options were definitely no, possibly no, unsure, possibly yes, and definitely yes. Those preferring palliative care (definitely or possibly yes) were compared to all others. Predictors were patient gender and education level. Covariates included age, race, disease aggressiveness, and financial strain. RESULTS Women were more likely [odds ratio (95% CI)] than men to prefer palliative care [3.07 (1.80-5.23)]. The effect of education on preferences for palliative care was not statistically significant [0.85 (0.48-1.48)]. CONCLUSION Significant gender differences in patients' preferences for palliative care could partially account for gender disparities in end-of-life care. Interventions to promote palliative care among men could reduce these disparities.
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Affiliation(s)
- Fahad Saeed
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Sally A Norton
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Elizabeth Guancial
- Division of Hematology Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald M Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Hu Y, Hoover DR. Power Estimation in Planning Randomized Two-Arm Pre-Post Intervention Trials with Repeated Longitudinal Outcomes. ACTA ACUST UNITED AC 2018; 9. [PMID: 30386678 PMCID: PMC6207205 DOI: 10.4172/2155-6180.1000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Intervention effect on ongoing medical processes is estimated from clinical trials on units (i.e. persons or facilities) with fixed timing of repeated longitudinal measurements. All units start out untreated. A randomly chosen subset is switched to the intervention at the same time point. The pre-post switch change in the outcome between these units and unswitched controls is compared using Generalized Least Squares models. Power estimation for such studies is hindered by lack of available GLS based approaches and normative data. Methods: We derive Generalized Least Squares variance of the intervention effect. For the commonly assumed compound symmetry correlation structure, this leads to simple power formulas with important optimality properties. To maximize power given a constrained number of total time points, we investigate on the optimal pre-post allocation with the local minimization of variance. Results: In four examples from nursing home and HIV patients, the Toepltiz within-unit correlation of repeated measures differed from compound symmetry. We applied empirical Toeplitz based calculations for variance of the estimated intervention effect to these examples (each with up to seven longitudinal measures). Unlike what happened under compound symmetry, where power was often maximized with multiple observations being pre-intervention, for these examples, having one pre-intervention measure tended to maximize power. Attempts to approximate the Toeplitz variance structures with compound symmetry (to take advantage of the simpler formulas) resulted in overestimation of power for these examples. Conclusions: While compound symmetry correlation among repeated within-unit measures leads to simple power estimation formulas, this structure often did not hold. There may be strong underestimation of variance of the intervention effect estimate from incorporating short-term within-unit correlation estimates as a common compound symmetry correlation to approximate an unknown Toeplitz correlation without adequately accounting for the correlation between repeated measures declining with time.
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Affiliation(s)
- Yirui Hu
- Biomedical and Translational Informatics, Geisinger, Danville, 17821, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and the Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, 08854, USA
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Pettit SD, Kirch R. Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors? CARDIO-ONCOLOGY (LONDON, ENGLAND) 2018; 4:5. [PMID: 32154005 PMCID: PMC7048033 DOI: 10.1186/s40959-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 01/29/2023]
Abstract
The increasing efficacy of cancer therapeutics means that the timespan of cancer therapy administration is undergoing a transition to increasingly long-term settings. Unfortunately, chronic therapy-related adverse health events are an unintended, but not infrequent, outcome of these life-saving therapies. Historically, the cardio-oncology field has evolved as retrospective effort to understand the scope, mechanisms, and impact of treatment-related toxicities that were already impacting patients. This review explores whether current systemic approaches to detecting, reporting, tracking, and communicating AEs are better positioned to provide more proactive or concurrent information to mitigate the impact of AE's on patient health and quality of life. Because the existing tools and frameworks for capturing these effects are not specific to cardiology, this study looks broadly at the landscape of approaches and assumptions. This review finds evidence of increasing focus on the provision of actionable information to support long-term health and quality of life for survivors and those on chronic therapy. However, the current means to assess and support the impact of this burden on patients and the healthcare system are often of limited relevance for an increasingly long-lived survivor and patient population.
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Affiliation(s)
- Syril D. Pettit
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Health and Environmental Sciences Institute, Washington DC, USA
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington DC, USA
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Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers. Palliat Support Care 2018; 17:276-285. [PMID: 29880064 DOI: 10.1017/s1478951518000354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients' and families' emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. METHOD The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.ResultFour salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.Significance of resultsThe MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.
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Lowenstein LM, Volk RJ, Street R, Flannery M, Magnuson A, Epstein R, Mohile SG. Communication about geriatric assessment domains in advanced cancer settings: "Missed opportunities". J Geriatr Oncol 2018; 10:68-73. [PMID: 29884597 DOI: 10.1016/j.jgo.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Older patients with advanced cancer often have age-related health issues (e.g., memory impairment) that influence their cancer treatment decisions. Communication about these age-related concerns can potentially lead to further assessment and subsequent clinical interventions to improve treatment decision-making and patients' quality of life. Yet, little is known about the communication of age-related concerns between oncologists, patients, and caregivers. MATERIALS AND METHODS This study is a secondary analysis of data from the Values and Options in Cancer Care (VOICE) study. Audio-recorded and transcribed outpatient clinical oncology encounters with 37 patients with advanced cancer ≥60 years of age were content-analyzed. Two trained coders used a structured coding scheme based on pre-specified geriatric assessment (GA) domains to examine the transcripts for the frequency and quality of communication about age-related concerns. Atlas.ti version 6 was used for all analyses. RESULTS The median age of the patients was 66 years (range = 60-90 years); patients were mostly female (26/37), married (22/37), and White (36/37). Out of 37 audio-recorded visits, 31 had at least one mention of an age-related concern with a total of 70 mentions. Oncologists initiated communication about age-related concerns half of the time (53%). When age-related concerns were mentioned, half of the time (50%) the oncologist did not implement further evidence-based interventions to address the age-related concern (e.g., conduct a cognitive screen for a memory concern). CONCLUSION Interventions are needed to improve the frequency and quality of the communication about age-related concerns to improve the care of older adults with cancer.
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Affiliation(s)
- Lisa M Lowenstein
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA.
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center. 1400 Pressler St., Unit 1444, Houston, TX, 77030, USA
| | - Richard Street
- Department of Communication, Texas A&M University. College Station, TX, 77843, USA
| | - Marie Flannery
- School of Nursing, University of Rochester. 255 Crittenden Blvd. Box SON, Rochester, NY 14642, USA
| | - Allison Magnuson
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester. 1381 South Avenue, Rochester, NY 14620, USA
| | - Supriya G Mohile
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA
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Tang CC, Draucker C, Tejani MA, Von Ah D. Patterns of interactions among patients with advanced pancreatic cancer, their caregivers, and healthcare providers during symptom discussions. Support Care Cancer 2018; 26:3497-3506. [PMID: 29696423 DOI: 10.1007/s00520-018-4202-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Effective symptom discussion is an essential step to enhance symptom management in patients with advanced pancreatic cancer (APC). However, little is known about how these patients communicate their symptoms during health encounters. The purpose of this study was to develop a typology to describe patterns of interactions between patients with APC, their caregivers, and healthcare providers as regards to symptoms and symptom management. METHODS Thematic analysis was used to analyze 37 transcripts of audio-recorded, naturally occurring encounters among APC patients, caregivers, and healthcare providers. Transcripts were drawn from the Values and Options in Cancer Care study, a larger randomized controlled communication and decision-making intervention trial, which recruited advanced cancer patients and caregivers across the USA. All transcripts from APC patients that were pre-intervention were analyzed. RESULTS Eight unique types of interaction patterns among patients, caregivers, and healthcare providers were identified as follows: collaborative interactions, explanatory interactions, agentic interactions, checklist interactions, cross-purpose interactions, empathic interactions, admonishing interactions, and diverging interactions. CONCLUSIONS Our findings provide a systematic description of a variety of types of interaction patterns regarding symptom discussion among APC patients, caregivers, and healthcare providers. These typologies can be used to facilitate effective communication and symptom management.
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Affiliation(s)
- Chia-Chun Tang
- National Taiwan University School of Nursing, No1, Sec 1, Jen-Ai Rd, Taipei, Taiwan, 10051.
| | - Claire Draucker
- Angela Barron McBride Endowed Professorship in Mental Health Nursing, Indiana University School of Nursing, 600 Barnhill Drive, NU409W, Indianapolis, IN, 46202, USA
| | - Mohamedtaki A Tejani
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Diane Von Ah
- Department of Community & Health Systems, Indiana University School of Nursing, 600 Barnhill Drive, NU 407, Indianapolis, IN, 46202, USA
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