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Boström K, Dojan T, Thölking T, Gehrke L, Rosendahl C, Voltz R, Kremeike K. Talking about desire to die: Talking past each other? A framework analysis of interview triads with patients, informal caregivers, and health professionals. Palliat Support Care 2025; 23:e83. [PMID: 40123491 DOI: 10.1017/s1478951524002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2025]
Abstract
OBJECTIVES Up to 40% of seriously ill patients develop a (temporary) desire to die which can lead to requests for assisted dying. Health professionals often feel uncertain about addressing these topics, while informal caregivers may feel guilty and left out. Open and respectful communication proves beneficial. It remains unclear how this communication ideal realizes within the lived experience of all 3 parties. Therefore, we conducted in-depth analysis of communication strategies about desire to die from triangulated perspectives of patients, informal caregivers, and health professionals. METHODS We conducted semi-structured interviews with purposefully sampled triads consisting of seriously ill patients, their respective informal caregivers and health professionals. Interviews were part of the qualitative evaluation of a 3-phase mixed-methods study on the effects of communication about desire to die on seriously ill patients. We followed a framework analysis approach to build communication types. RESULTS From the N = 13 patients, 54% suffered from oncological diseases. Health professionals (N = 13) were multiprofessional. Informal caregivers (N = 13) were partners, children, or another relation. All in all, we conducted N = 14 interview triads (n = 3 incomplete; N = 39 individual interviews).Four key themes emerged from analysis: (a) how open communication was perceived, (b) whether participants reported shared reality, (c) how they talked about death, and (d) their communication strategies.Ultimately, 3 communication types were inductively derived at from these key themes. Type 1 "Between the Lines," type 2 "Past each Other" and type 3 "Matter of Fact" show differing expressions on the key themes, especially on (b) shared reality. Specific type characteristics produce suggestions for health professionals' communicative practice. SIGNIFICANCE OF RESULTS Awareness of typical communication strategies is necessary to foresee potential pitfalls such as loss of information or acting on unchecked assumptions. To reduce distress and increase information flow, health professionals should actively approach informal caregivers for desire to die conversations.
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Affiliation(s)
- Kathleen Boström
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Thessa Thölking
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leonie Gehrke
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Carolin Rosendahl
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Kerstin Kremeike
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
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Pratiwi IN, Nursalam N, Widyawati IY, Ramoo V. Spousal Involvement in Collaborative Management and Glycemic Behavior Change among Patients with Diabetes Mellitus: A Systematic Review. SAGE Open Nurs 2024; 10:23779608241245196. [PMID: 38638412 PMCID: PMC11025446 DOI: 10.1177/23779608241245196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/01/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The marked increase in the number of individuals with diabetes mellitus (DM) worldwide each year has resulted in the importance of the spouse's contribution to the promotion and support of patient self-management programs. Objectives This study aimed to systematically explore the role or involvement of spouses in collaborative management and glycemic behavior change in DM. Methods Five databases including Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, SAGE, and Web of Science were reviewed for relevant articles retrieved from 2017 to 2022. Literature search used keywords, including "Spouse," "Support," "Self-management," "Glycemic Control," and "Diabetes mellitus." The Joanna Briggs Institute guidelines were used for appraisal review of journals. The component of partner support in the self-management of patients with DM is associated with an increase in the patient's glycemic level. Results Twenty-five studies were identified that describe the different spousal roles and strategies in the promotion and support of DM management. Overall, spouses' involvement positively impacted healthy diets, higher self-efficacy, improved quality of psychological well-being, increased perceived support, and changes in glycemic-influenced behavior. Adaptation in the spouse patient relationship including maintaining cohesiveness can result in positive coping is essential in normalizing and contextualizing the chronic condition of DM. Partner-based collaboration is important for diabetes management, overcoming management barriers, and generating communal coping. Conclusion This systematic review observed that the involvement of a spouse is important in improving collaborative management and results in better glycemic behavior in patients with DM. A better understanding of the relationship between spousal involvement, coping strategies, and adherence in daily management and the subsequent use of this information are highly useful for creating targeted and effective interventions.
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Affiliation(s)
- Ika Nur Pratiwi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Nursalam Nursalam
- Advanced Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Ika Yuni Widyawati
- Advanced Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Vimala Ramoo
- Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Ingadottir B, Jaarsma T, Norland K, Ketilsdóttir A. Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:537-545. [PMID: 37816081 DOI: 10.1097/jcn.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Promoting patients' sense of security is among the goals of nursing care within heart failure management. OBJECTIVE The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. METHODS Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. RESULTS The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. CONCLUSIONS Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.
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Ingadottir B, Bragadottir B, Zoëga S, Blondal K, Jonsdottir H, Hafsteinsdottir EJG. Sense of security during COVID-19 isolation improved with better health literacy - A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2023; 114:107788. [PMID: 37173221 PMCID: PMC10159664 DOI: 10.1016/j.pec.2023.107788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess sense of security, health literacy, and the association between sense of security and health literacy during COVID-19 self-isolation. METHODS In this cross-sectional survey all adults who caught COVID-19 from the onset of the pandemic until June 2020 in Iceland and received surveillance from a special COVID-19 outpatient clinic, were eligible. Participants retrospectively answered the Sense of Security in Care - Patients' Evaluation and the European Health Literacy Survey Questionnaire. Data were analysed with parametric and non-parametric tests. RESULTS Participants' (N = 937, 57% female, median age 49 (IQR=23)) sense of security during isolation was Med 5.5 (IQR=1) and 90% had sufficient health literacy. The proposed regression model (R2 =.132) indicated that those with sufficient health literacy had, on average, higher sense of security than those with inadequate health literacy. CONCLUSION Sense of security was high among individuals who received surveillance from an outpatient clinic during isolation and was associated with health literacy. The high health literacy rate may be an indication of a high COVID-19 specific health literacy rather than general health literacy. PRACTICE IMPLICATIONS Healthcare professionals can improve the sense of security of patients through measures to improve their health literacy, including their navigation health literacy, by practising good communication, and providing effective patient education.
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Affiliation(s)
- Brynja Ingadottir
- University of Iceland, Faculty of Nursing and Midwifery, Eiriksgata 34, 105 Reykjavik, Iceland; Landspítali - University Hospital of Iceland, Skaftahlid 24, 105 Reykjavik, Iceland.
| | - Bjork Bragadottir
- Primary Care of the Capital Area, Alfabakka 16, 109 Reykjavik, Iceland
| | - Sigridur Zoëga
- University of Iceland, Faculty of Nursing and Midwifery, Eiriksgata 34, 105 Reykjavik, Iceland; Landspítali - University Hospital of Iceland, Skaftahlid 24, 105 Reykjavik, Iceland
| | - Katrin Blondal
- University of Iceland, Faculty of Nursing and Midwifery, Eiriksgata 34, 105 Reykjavik, Iceland; Landspítali - University Hospital of Iceland, Skaftahlid 24, 105 Reykjavik, Iceland
| | - Helga Jonsdottir
- University of Iceland, Faculty of Nursing and Midwifery, Eiriksgata 34, 105 Reykjavik, Iceland; Landspítali - University Hospital of Iceland, Skaftahlid 24, 105 Reykjavik, Iceland
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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