Factors related to advance directives completion among cancer patients: a systematic review

Enhancing proactive life-sustaining treatment preference documentation in advanced cancer care: barriers and recommendations

PURPOSE OF REVIEW

Despite guidelines, life-sustaining treatment preferences (LSTP) documentation for advanced cancer patients remains limited and reactive to clinical events. As proactive documentation is a core component of early palliative care (EPC), addressing barriers to EPC can in parallel facilitate LSTP documentation. This narrative review examines barriers to both processes and proposes recommendations to overcome them.

RECENT FINDINGS

Barriers stem from patients, oncologists, and the healthcare system. Patients and oncologists face communication challenges. For patients, knowledge gaps on illness and LSTP documentation, family dynamics prioritizing informal over formal discussions, and limited intercultural considerations, compound these challenges. For oncologists, a curative-focused medical culture reinforces them. In the healthcare system, this culture contributes to deprioritizing LSTP documentation.

SUMMARY

Addressing these barriers requires multilevel recommendations. For patients: interventions to enhance illness understanding, foster culturally sensitive oncologist communication, and optimize care organization. For oncologists: integrating communication training and palliative care (PC) knowledge into oncology fellowships while cultivating a supportive medical culture for LSTP documentation through role modeling and intervision. For healthcare systems: LSTP documentation benchmarks, proactive EPC integration through automated reminders, telehealth, standardized medical records, and reimbursement codes. Assessing the implementation and sustainability of these recommendations is crucial to enhancing proactive LSTP documentation in advanced cancer care.

The impact of educational intervention based on the theory of planned behavior on preventive behaviors for gastric cancer in obese and smoking individuals

BACKGROUND

Gastric cancer remains a significant global health issue due to its aggressive nature and high heterogeneity, making early detection and prevention critical. Obesity and smoking are established risk factors that significantly contribute to the development of gastric cancer. Despite the clear links between these risk factors and the disease, there is a lack of targeted educational interventions that address these behaviors. This study aims to fill this gap by investigating the impact of an educational intervention based on the Theory of Planned Behavior (TPB) on promoting preventive behaviors for gastric cancer among obese and smoking individuals.

METHODS

This quasi-experimental study was conducted in 2021-2022 on 150 obese or overweight individuals, more than 25 years old who smoked (cigarettes and hookah) in Fasa city, Iran. From six urban health centers, two centers were randomly selected (one as the experimental group and the other as the control group). Data collection tools included a demographic characteristics questionnaire based on the TPB model (a researcher-made questionnaire). Based on pre-test results, the educational intervention for the experimental group included 12 educational sessions for 50 min, following the TPB model, through lectures, Question and Answers, group discussions, practical demonstrations, video clips, and PowerPoint presentations. The questionnaires were completed by both groups before and six months after the intervention. Data were analyzed using SPSS 22 and descriptive and analytical statistical methods (paired t- test, McNemar test, Chi-square test, and independent t-test) (p < 0.05).

RESULTS

The results showed no significant difference between the two groups before the educational intervention. However, six months after the intervention, the experimental group showed a significant increase in TPB model cues (awareness, attitude, subjective norms, perceived behavioral control, behavioral intention, and behavior) (P < 0.001).

CONCLUSION

The findings of the present study indicate that the educational intervention based on the TPB model is useful in improving gastric cancer screening and preventive behaviors. It can also be used in planning and implementing appropriate programs to prevent and treat this disease.

Factors related to patients' readiness for advance care planning: a systematic review

BACKGROUND

Advance care planning can help to align the care provided with the values, goals and preferences of patients at the end of life. Therefore, readiness for advanced care planning is considered a prerequisite and predictor of the patient's willingness to participate in the end of life conversation. The present study was conducted with the aim of investigating the factors affecting patients' readiness for advance care planning (RACP).

METHODS

This systematic review was searched in 4 databases: PubMed, Scopus, Web of science, ProQuest using relevant keywords. No time limit was considered. The quality of the articles was assessed using Joanna Briggs Institute tool for qualitative studies and the Appraisal Tool for cross-sectional Studies. The data was analyzed based on the directed content analysis approach guided by the theory of planned behavior (TPB).

RESULTS

3227 primary article titles were identified. After removing duplicates, screening and final selection, 22 relevant articles remained for analysis. Factors affecting RACP were extracted based on the TPB. Attitude factors include "ACP training", "perceived experiences of health status", "Socio-demographic factors", and "psycho-spiritual readiness". Subjective norms include "social support and family participation" and "accessibility to health services". The perceived behavioral control includes "dialogue about ACP", "readiness actions", and "determining a proxy decision maker."

CONCLUSION

In this study, according to the theory of planning behavior, various factors have an effect on the RACP. Therefore, according to the collaborative and multifactorial nature of the factors affecting preparation for ACP, it is suggested that different effective dimensions should be considered according to the specific conditions of each patient and the stage of the disease. Therefore, health service providers should first measure the level of readiness of patients and families, and by understanding the factors affecting their readiness, they should conduct training or dialogue in the field of ACP.

Navigating end-of-life decision-making in nursing: a systematic review of ethical challenges and palliative care practices

OBJECTIVES

This systematic review aimed to synthesize evidence on the ethical dilemma's nurses encounter in end-of-life care and effective palliative care practices. The objectives were to understand key ethical issues, evaluate communication and decision-making strategies, and identify approaches to support nurses and patients.

METHODS

A comprehensive search of major databases was conducted according to the PRISMA guidelines. Studies directly relating to nursing ethics, challenges in end-of-life decision-making, and palliative care practices were included. The risk of bias was assessed using ROBVIS-II. Data on ethical issues, palliative interventions, and outcomes was extracted and analyzed thematically.

RESULTS

22 studies met the inclusion criteria. Key themes that emerged were: (1) Effective communication and involving patients in decision-making are essential but complex. (2) Nurses face dilemmas around balancing autonomy, beneficence and relational issues. (3) Integrating palliative care principles enhances symptom management and aligns care with patient values. (4) Education and organizational support are needed to equip nurses with skills and coping strategies.

CONCLUSION

Navigating end-of-life care requires addressing interconnected ethical, communication and support needs. While studies provided insights, further research is required on cultural competence training, standardized education programs and longitudinal evaluations.

Research Roundup

Synopses of a selection of recently published research articles of relevance to palliative care.