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Tabata-Kelly M, Ruan M, Dey T, Sheu C, Kerr E, Kaafarani H, Ornstein KA, Kelley A, Gray TF, Salim A, Joseph B, Cooper Z. Postdischarge Caregiver Burden Among Family Caregivers of Older Trauma Patients. JAMA Surg 2023; 158:945-952. [PMID: 37405733 PMCID: PMC10323760 DOI: 10.1001/jamasurg.2023.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/30/2023] [Indexed: 07/06/2023]
Abstract
Importance Caregiver burden, characterized by psychological distress and physical morbidity, affects more than 50 million family caregivers of older adults in the United States. Risk factors for caregiver burden among caregivers of older trauma patients have not been well characterized. Objective To characterize postdischarge caregiver burden among caregivers of older trauma patients and identify targets that can inform interventions to improve their experience. Design, Setting, and Participants This study used a repeated cross-sectional design. Participants were family caregivers for adults 65 years or older with traumatic injury who were discharged from 1 of 2 level I trauma centers. Telephone interviews were conducted at 1 month and 3 months postdischarge with family caregivers (identified by the patient as family or friends who provided unpaid care). Admissions occurred between December 2019 and May 2021, and data were analyzed from June 2021 to May 2022. Exposure Hospital admission for geriatric trauma. Main Outcome and Measures High caregiver burden was defined by a score of 17 or higher on the 12-item Zarit Burden Interview. Caregiver self-efficacy and preparedness for caregiving were assessed via the Revised Scale for Caregiving Self-Efficacy and Preparedness for Caregiving Scale, respectively. Associations between caregiver self-efficacy, preparedness for caregiving, and caregiver burden were tested via mixed-effect logistic regression. Results There were 154 family caregivers enrolled in the study. Their mean (SD) age was 60.6 (13.0) years (range, 18-92 years), 108 of 154 were female (70.6%). The proportion of caregivers experiencing high burden (Zarit Burden Interview score ≥17) was unchanged over time (1 month, 38 caregivers [30.9%]; 3 months, 37 caregivers [31.4%]). Participants with lower caregiver self-efficacy and preparedness for caregiving were more likely to experience greater caregiver burden (odds ratio [OR], 7.79; 95% CI, 2.54-23.82; P < .001; and OR, 5.76; 95% CI, 1.86-17.88; P = .003, respectively). Conclusion and Relevance This study found that nearly a third of family caregivers of older trauma patients experience high caregiver burden up to 3 months after the patients' discharge. Targeted interventions to increase caregiver self-efficacy and preparedness may reduce caregiver burden in geriatric trauma.
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Affiliation(s)
- Masami Tabata-Kelly
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Mengyuan Ruan
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Tanujit Dey
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Christina Sheu
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Emma Kerr
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Haytham Kaafarani
- Division of Trauma & Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Amy Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Institute, Boston, Massachusetts
| | - Ali Salim
- Department of Surgery, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Bellal Joseph
- Department of Surgery, University of Arizona, Tucson
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
- Department of Surgery, Brigham and Woman’s Hospital, Boston, Massachusetts
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2
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Joung SY, Lee CW, Choi YS, Kim SM, Park SW, Mo ES, Park JH, Shin J, Lee HJ, Park HS. Analysis of the Time Interval between the Physician Order for Life-Sustaining Treatment Completion and Death. Korean J Fam Med 2020; 41:392-397. [PMID: 32429012 PMCID: PMC7700825 DOI: 10.4082/kjfm.19.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This study aimed to explore the time interval distribution pattern between the Physicians Order for Life-Sustaining Treatment (POLST) form completion and death at a tertiary hospital in South Korea. It also examined the association between various independent parameters and POLST form completion timing. METHODS A total of 150 critically ill patients admitted to Korea University Guro Hospital between June 1, 2018 and December 31, 2018 who completed the POLST form were retrospectively analyzed and included in this study. Data were analyzed with descriptive statistics, and group comparisons were performed using the chi-square test for categorical variables. Fisher's exact test was also used to compare cancer versus non-cancer groups. RESULTS More than half the decedents (54.7%) completed their POLST within 15 days of death and 73.4% within 30 days. The non-cancer group had the highest percentage of patients (77.8%) who died within 15 days of POLST form completion while the colorectal (39.1%) and other cancer (37.5%) groups had the lowest (P=0.336). CONCLUSION Our findings demonstrated a current need for more explicit guidance to assist physicians with initiating more timely, proactive end-of-life discussions.
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Affiliation(s)
- Sung Yoon Joung
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chung-woo Lee
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seok Won Park
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eun Shik Mo
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Hyun Park
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jean Shin
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Jin Lee
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
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3
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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: 10] [Impact Index Per Article: 2.5] [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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Rance S, Westlake D, Brant H, Holme I, Endacott R, Pinkney J, Byng R. Admission Decision-Making in Hospital Emergency Departments: The Role of the Accompanying Person. Glob Qual Nurs Res 2020; 7:2333393620930024. [PMID: 32596418 PMCID: PMC7303774 DOI: 10.1177/2333393620930024] [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: 08/02/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/15/2022] Open
Abstract
In resource-stretched emergency departments, people accompanying patients
play key roles in patients’ care. This article presents analysis of
the ways health professionals and accompanying persons talked about
admission decisions and caring roles. The authors used an ethnographic
case study design involving participant observation and
semi-structured interviews with 13 patients, 17 accompanying persons
and 26 health care professionals in four National Health Service
hospitals in south-west England. Focused analysis of interactional
data revealed that professionals’ standardization of the patient–carer
relationship contrasted with accompanying persons’ varied connections
with patients. Accompanying persons could directly or obliquely
express willingness, ambivalence and resistance to supporting
patients’ care. The drive to avoid admissions can lead health
professionals to deploy conversational skills to enlist accompanying
persons for discharge care without exploring the meanings of their
particular relationship with the patients. Taking a
relationship-centered approach could improve the attention to
accompanying persons as co-producers of health care and participants
in decision-making.
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Affiliation(s)
| | | | - Heather Brant
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Ruth Endacott
- University of Plymouth, Plymouth, United Kingdom.,Monash University, Frankston, Victoria, Australia
| | | | - Richard Byng
- University of Plymouth, Plymouth, United Kingdom
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5
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Gupta R, Eady K, Moreau K, Frank JR, Writer HK. Resident duty hours: Families' knowledge and perceptions in the paediatric intensive care unit. Paediatr Child Health 2019; 25:467-472. [PMID: 33173558 DOI: 10.1093/pch/pxz092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members' perspectives on duty hours in the paediatric context. This study aimed to explore family members' knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. METHODS We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. RESULTS One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). CONCLUSIONS Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient-provider relationships, and further study is warranted.
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Affiliation(s)
- Ronish Gupta
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Kaylee Eady
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | | | - Jason R Frank
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario
| | - Hilary K Writer
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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6
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Semantic and Cultural Equivalence of the Working Alliance Inventory Short-revised Scale for Therapeutic Alliance in Family Medicine: Lessons Learned in Slovenia. Zdr Varst 2019; 58:21-30. [PMID: 30745947 PMCID: PMC6368669 DOI: 10.2478/sjph-2019-0003] [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] [Received: 08/09/2018] [Accepted: 11/26/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction Therapeutic alliance is a term most commonly associated with psychotherapeutic treatment, but recently its use has become increasingly significant in the other fields of medicine. An increasing amount of evidence implies that the quality of the therapeutic alliance between the doctor and patient substantially affects treatment outcomes. A European consensus chose the Working Alliance Inventory – Short Revised (WAI-SR) scale as the most efficient for European primary care. This paper presents the process of establishing the semantic and cultural equivalence of the two WAI-SR scales in Slovene. Method As a part of a larger international project, a group of four experts translated the two WAI SR scales (physician and patient versions) from English into Slovene. Twenty-six Slovenian family medicine doctors participated in the process of obtaining semantic, idiomatic, experiential and conceptual equivalence in translation using a Delphi consensus procedure. Afterward, a cultural equivalence was made to adapt the translations within the national context. Results Agreement on translation was achieved after two Delphi rounds. The back-translation and cultural equivalence were accomplished without major problems, with some minor additional linguistic corrections. Conclusion A Slovene version of the WAI-SR scale was successfully adapted and is available for further scale validation and research on therapeutic alliance.
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7
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Conflict Management by Physicians: A Heavy Hand in Preference-Sensitive Decisions. Ann Am Thorac Soc 2018; 15:171-172. [PMID: 29388811 DOI: 10.1513/annalsats.201711-842ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Kalocsai C, Amaral A, Piquette D, Walter G, Dev SP, Taylor P, Downar J, Gotlib Conn L. "It's better to have three brains working instead of one": a qualitative study of building therapeutic alliance with family members of critically ill patients. BMC Health Serv Res 2018; 18:533. [PMID: 29986722 PMCID: PMC6038351 DOI: 10.1186/s12913-018-3341-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses. Methods We used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used. Results Participating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment. Conclusions Multiple opportunities exist to improve family-provider relationships in the ICU. The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment. Electronic supplementary material The online version of this article (10.1186/s12913-018-3341-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Csilla Kalocsai
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. .,Patient/Client and Family Education, Centre for Mental Health and Addiction, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada.
| | - Andre Amaral
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dominique Piquette
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Grace Walter
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Shelly P Dev
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James Downar
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Palliative Medicine, University of Toronto, Toronto, Canada
| | - Lesley Gotlib Conn
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
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The Experience of Patients with Alcohol Misuse after Surviving a Critical Illness. A Qualitative Study. Ann Am Thorac Soc 2018; 14:1154-1161. [PMID: 28406727 DOI: 10.1513/annalsats.201611-854oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
RATIONALE Alcohol misuse is common in patients admitted to the intensive care unit (ICU), but there is currently no evidence-based approach to address drinking in ICU survivors. OBJECTIVES We sought to describe the experience of ICU survivors with alcohol misuse during their hospitalization and the 3 months after hospital discharge to inform an alcohol-specific intervention for this unique population. METHODS We conducted a descriptive qualitative study of ICU survivors from medical ICUs in three separate hospitals with a positive screening result on the Alcohol Use Disorders Identification Test. Semistructured interviews were conducted 3 months after hospital discharge of patients. Patients were also allowed to nominate up to two friends or family members for enrollment to provide additional perspective on the patient's experience. RESULTS We enrolled 50 patients and 22 of their friends and/or family members. The average APACHE II score was 23, 80% of patients were male, and the average age was 50 years; 70% of patients and 77% of friends/family members completed the semistructured interview 3 months after hospital discharge. We identified three domains that could inform an alcohol-specific intervention, each with multiple themes: motivation with complications (anxiety and depression, critical illness as a catalyst, delirium and cognitive impairment); therapeutic alliance (autonomy, failure and opportunities to build a therapeutic alliance); and the return to the home milieu (lack of screening for depression and anxiety, social network support for drinking, social isolation, social network support for abstinence, lack of available and affordable treatment, and negative experiences with Alcoholics Anonymous). CONCLUSIONS An alcohol intervention for ICU survivors would account for the context in which patients are making a decision about their drinking and optimize the patient-provider interaction. Contrary to current paradigms that focus on addressing alcohol consumption only during a hospitalization, an intervention for ICU survivors should continue as patients transition from the hospital to home.
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10
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Sanders JJ, Curtis JR, Tulsky JA. Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact. J Palliat Med 2017; 21:S17-S27. [PMID: 29091522 DOI: 10.1089/jpm.2017.0459] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve "goal-concordant" care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. OBJECTIVES To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. METHODS We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. RESULTS Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. CONCLUSION Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both.
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Affiliation(s)
- Justin J Sanders
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,3 Ariadne Labs , Boston, Massachusetts
| | - J Randall Curtis
- 4 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - James A Tulsky
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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11
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Cicekci F, Duran N, Ayhan B, Arican S, Ilban O, Kara I, Turkoglu M, Yildirim F, Hasirci I, Karaibrahimoglu A, Kara I. The communication between patient relatives and physicians in intensive care units. BMC Anesthesiol 2017; 17:97. [PMID: 28716040 PMCID: PMC5513098 DOI: 10.1186/s12871-017-0388-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. METHODS For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. RESULTS Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. CONCLUSION This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.
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Affiliation(s)
- Faruk Cicekci
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey.
| | - Numan Duran
- Scool of Foreing Languages, Selcuk University, Konya, Turkey
| | - Bunyamin Ayhan
- Department of Journalism, Selcuk University, Communication Faculty, Konya, Turkey
| | - Sule Arican
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Omur Ilban
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey
| | - Iskender Kara
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Melda Turkoglu
- Department of Internal Medicine, Gazi University, Medical Faculty, Ankara, Turkey
| | - Fatma Yildirim
- Department of Internal Medicine, Gazi University, Medical Faculty, Ankara, Turkey
| | - Ismail Hasirci
- Department of General Surgery, Konya Training and Education Hospital, Konya, Turkey
| | - Adnan Karaibrahimoglu
- Department of Biostatistics, Suleyman Demirel University, Faculty of Medicine, Konya, Turkey
| | - Inci Kara
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey
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12
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Coping as a Multifaceted Construct: Associations With Psychological Outcomes Among Family Members of Mechanical Ventilation Survivors. Crit Care Med 2017; 44:1710-7. [PMID: 27065467 DOI: 10.1097/ccm.0000000000001761] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and evaluate a preliminary multifaceted model for coping among family members of patients who survive mechanical ventilation. DESIGN AND SETTING In this multicenter cross-sectional survey, we interviewed family members of mechanically ventilated patients at the time of transfer from the ICU to the hospital ward. We constructed a theoretic model of coping that included characteristics attributable to family members, family-clinician rapport, and patients. We then explored relationships between coping factors and symptoms of psychological distress (anxiety, depression, and posttraumatic stress). SUBJECTS Fifty-six family members of survivors of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS Psychological distress measured by the Hospital Anxiety and Depression Scale and Posttraumatic Stress Scale. Optimism measured using the Life Orientation Test scale, resiliency by Conner-Davidson Resilience Scale, and social support using the Patient Reported Outcomes Measurement Information System inventory. Family members had moderate levels of psychological distress with median total Hospital Anxiety and Depression Scale equal to 14 (interquartile range, 5-20) and Posttraumatic Stress Scale equal to 22 (interquartile range, 15-31). Among family member characteristics, greater optimism (p = 0.001, Hospital Anxiety and Depression Scale; p = 0.010, Posttraumatic Stress Scale), resilience (p = 0.012, Hospital Anxiety and Depression Scale), and social support (p = 0.013, Hospital Anxiety and Depression Scale) were protective against psychological distress. On the contrary, characteristics of family-clinician rapport such as communication quality and presence of conflict did not have any associations with psychological distress. CONCLUSION To our knowledge, this is the first study to explore coping as a multifaceted construct and its relationship with family psychological outcomes among survivors of mechanical ventilation. We found certain family characteristics of coping such as optimism, resilience, and social support to be associated with less psychological distress. Further research is warranted to identify potentially modifiable aspects of coping that might guide future interventions.
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Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs. Crit Care Med 2017; 45:e372-e378. [PMID: 27618270 DOI: 10.1097/ccm.0000000000002099] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN Mixed-methods study. SETTING Medical and surgical ICUs at three large academic hospitals. PARTICIPANTS Three hundred three nurses, intensivists, and advanced practice providers. MEASUREMENTS AND MAIN RESULTS Clinicians completed written surveys that assessed attitudes about specialist palliative care presence and integration into the ICU setting, as well as acceptability of 23 published palliative care prompts (triggers) for specialist consultation. Most (n = 225; 75%) reported that palliative care consultation was underutilized. Prompting consideration of eligibility for specialist consultation by electronic health record searches for triggers was most preferred (n = 123; 41%); only 17 of them (6%) felt current processes were adequate. The most acceptable specialist triggers were metastatic malignancy, unrealistic goals of care, end of life decision making, and persistent organ failure. Advanced age, length of stay, and duration of life support were the least acceptable. Screening led by either specialists or ICU teams was equally preferred. Central themes derived from qualitative analysis of 65 written responses to open-ended items included concerns about the roles of physicians and nurses, implementation, and impact on ICU team-family relationships. CONCLUSIONS Integration of palliative care specialists in the ICU is broadly acceptable and desired. However, the most commonly used current triggers for prompting specialist consultation were among the least well accepted, while more favorable triggers are difficult to abstract from electronic health record systems. There is also disagreement about the role of ICU nurses in palliative care delivery. These findings provide important guidance to the development of collaborative care models for the ICU setting.
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Rosemond C, Hanson LC, Zimmerman S. Goals of Care or Goals of Trust? How Family Members Perceive Goals for Dying Nursing Home Residents. J Palliat Med 2017; 20:360-365. [PMID: 27898281 PMCID: PMC5385445 DOI: 10.1089/jpm.2016.0271] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF STUDY Dementia affects more than 5 million Americans, and is a leading cause of death. Family members of nursing home (NH) residents with advanced dementia report difficulty making decisions about care toward the end of life. As part of a randomized trial testing an intervention to improve decision making, this qualitative study aimed to understand how family decision makers experienced goal-based decision making in advance of the death of their relative. DESIGN AND METHODS This qualitative study was conducted as part of the goals of care clinical trial. Study participants (n = 16) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention. Semi-structured interviews were analyzed using a qualitative description approach. RESULTS Family members' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff. Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussions. In the absence of trust, family members reported that goals of care discussions were ignored by staff or created confusion. IMPLICATIONS Among family members of persons who recently died from dementia in NHs, expressions of trust in staff were strongly related to perceptions of decision making about goals of care. Although goals of care discussions may potentially promote communication to earn trust, the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families.
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Affiliation(s)
- Cherie Rosemond
- Partnerships in Aging Program, University of North Carolina, Chapel Hill, North Carolina
| | - Laura C. Hanson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
- Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina
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Hack SM, Muralidharan A, Brown CH, Lucksted AA, Patterson J. Provider and Consumer Behaviors and their Interaction for Measuring Person-Centered Care. INTERNATIONAL JOURNAL OF PERSON CENTERED MEDICINE 2017; 7:14-20. [PMID: 31452868 PMCID: PMC6709667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Current research has found that higher rates of person-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions. OBJECTIVES The objective of the current study was to test the hypotheses that: (1) the Perceived Involvement in Care Scale (PICS) consumer information subscale and the consumer decision making subscale are not correlated with the PPPC subscales and, (2) consumer perceptions of person-centeredness and of consumer involvement in care are significant independent explanatory variables for the theoretically or quantitatively grounded outcomes of therapeutic alliance, treatment adherence, and mental health care system mistrust. METHODS Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust. RESULTS Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems. DISCUSSION AND CONCLUSIONS These findings may be a function of the locus of each outcome variable. When conducting PCC research investigators should consider how the outcomes they are examining inform the method through which they measure patient-centeredness.
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Affiliation(s)
- Samantha M Hack
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
- University of Maryland School of Social Work, Baltimore, USA
| | - Anjana Muralidharan
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
| | - Clayton H Brown
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | | | - Jennifer Patterson
- Veterans Health Administration Office of Patient Centered Care and Cultural Transformation, USA
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Disruptive Technology. Can Electronic Portals Promote Communication in the Intensive Care Unit? Ann Am Thorac Soc 2016; 13:309-10. [PMID: 26963352 DOI: 10.1513/annalsats.201512-807ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Erratum: Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians. Ann Am Thorac Soc 2016; 13:576. [PMID: 27058190 DOI: 10.1513/annalsats.134erratum2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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