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Lounsbury DW, Nichols S, Asuzu C, Odiyo P, Alis A, Qadir M, Nichols S, Parker PA, Henry M. Communicating bad news to patients and families in African oncology settings. Psychooncology 2023; 32:47-57. [PMID: 36045548 PMCID: PMC10496515 DOI: 10.1002/pon.6025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/19/2022] [Accepted: 08/23/2022] [Indexed: 02/04/2023]
Abstract
AIMS To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings. METHODS A cross-sectional study of cancer care providers in African oncology settings (N = 125) was conducted. Factor analysis was used to assess cross-cultural adaptation and uptake of an evidence-based protocol for disclosing bad news to patients with cancer and of providers' perceived barriers to disclosing bad news to patients with cancer. Analysis of Various (ANOVA) was used to assess strength of association with each dimension of these two measurement models by various categorical variables. RESULTS Providers from Nigeria, Kenya, Ghana, and Rwanda represented 85% of survey respondents. Two independent, psychometrically reliable, multi-dimensional measurement models were derived to assess providers' personal communication practices and providers' perceived barriers to disclosing a cancer diagnosis. Forty percent (40%) of respondent nurses but only 20% of respondent physicians had had formal communications skills training. Approximately 20%-25% of respondent physicians and nurses reported having a consistent plan or strategy for communicating bad news to their cancer patients. CONCLUSIONS Results show that effective communication about cancer diagnosis and prognosis requires an appreciation and clinical skill set that blends an understanding of cancer-related internalized stigmas harbored by patient and family, dilemmas posed by treatment affordability, and the need to navigate family wishes about cancer-related diagnoses in the context of African oncology settings. Findings underscore the need for culturally grounded communications research and program design.
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Affiliation(s)
| | | | | | | | - Ali Alis
- McGill University, Montreal, Quebec, Canada
| | - Myrha Qadir
- Princeton University, Princeton, New Jersey, USA
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2
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Tilly AE, Evans A, Chen JS, Manda A, Salima A, Bingo S, Chikasema M, Westmoreland KD. Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi. Palliat Med Rep 2023; 4:127-132. [PMID: 37138948 PMCID: PMC10150710 DOI: 10.1089/pmr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Background Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients. Methods In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making. Results Most participants (70%, n = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, n = 24) did not feel that their medical team involved them in decision making and 64% (n = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, n = 47) preferred to have their medical team inform them how likely treatments are to lead to cure. Conclusions Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication.
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Affiliation(s)
- Alyssa E. Tilly
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Address correspondence to: Alyssa E. Tilly, MD, UNC Project-Malawi, Lilongwe A-104, Malawi,
| | - April Evans
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jane S. Chen
- UNC Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Katherine D. Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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3
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Madundo F, Hübner J, Pollok I, Gündel S, Männle H, Münstedt K. Survey on the Necessity, Sensibility, and Timing of Psycho-Oncological Counseling and the Willingness to Discuss Various Topics During the Inpatient Stay in the Case of Breast Cancer. Clin Nurs Res 2022; 31:1510-1519. [PMID: 35536175 DOI: 10.1177/10547738221092104] [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: 01/27/2023]
Abstract
After the diagnosis of cancer patients require a lot of information because the disease affects all aspects of life. Some important issues regarding optimal counseling remain to be determined. This includes the time-related relevance of various topics and questions regarding who and when to consult on the topics. We analyzed the answers of 155 women with non-metastatic breast cancer undergoing primary surgery, primary chemotherapy, and having completed adjuvant treatment regarding the above-mentioned issues. We found that counseling must consider the treatment situation. Breast cancer patients in the follow-up phase reported that they preferred being counseled by female consultants. Our results largely support a counseling concept which puts the breast care nurse at the center of interest rather than psychologists and social service workers. A breast care nurse centered counseling system for women with non-metastatic breast cancer appears to meet patients' needs best.
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Almaiman W, Alfattani A, Alshareef TA. Breaking bad news to children with chronic kidney disease: A questionnaire-based study and literature review. Int J Pediatr Adolesc Med 2021; 8:87-93. [PMID: 34084878 PMCID: PMC8144853 DOI: 10.1016/j.ijpam.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/03/2020] [Indexed: 10/27/2022]
Abstract
Introduction Breaking bad ne ws to caregivers of children with (CKD) [I can't comment in the box] Title says to breaking bad news to children but in here, breaking bad news to caregivers. Please clarify and edit accordingly. is an important role of nephrologists. In our practice there has been a thought about parental dissatisfaction from breaking bad news to CKD patients. Caregiver's preferences on how to be told the bad news in CKD children has not been studied adequately. Our objective was to identify how much is the emotional and knowledge satisfaction of CKD caregivers and the relation of their socioeconomic and educational levels with their preferences in breaking bad news. Methods A questionnaire based study was conducted for caregivers of CKD children, in the outpatient clinics, and peritoneal dialysis and hemodialysis units at the King Faisal Specialist Hospital and Research Centre for three months. Results 83 questionnaires from caregivers of CKD patients age (1-14) years, mean age of 8.5 ± 3.9 years. (47.6%) were emotionally very satisfied, 29.5% were very satisfied about the knowledge they had. Conclusion Caregivers of CKD patients are satisfied emotionally more than the satisfaction about the amount of information they got. Different demographic data might affect their preferences in the way of receiving the bad news. The dissatisfaction suggesting that physicians' communication skills needs improvement.
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Affiliation(s)
- Weiam Almaiman
- Section of Nephrology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Areej Alfattani
- Department of Biostatistics and Epidemiology, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Turki A Alshareef
- Section of Nephrology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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5
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Lee JL, Matthias MS, Huffman M, Frankel RM, Weiner M. Insecure messaging: how clinicians approach potentially problematic messages from patients. JAMIA Open 2020; 3:576-582. [PMID: 33758796 PMCID: PMC7969962 DOI: 10.1093/jamiaopen/ooaa051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/14/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients. METHODS In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes. RESULTS Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content. CONCLUSION Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice. PRACTICAL IMPLICATIONS We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients.
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Affiliation(s)
- Joy L Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Marianne S Matthias
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Monica Huffman
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Richard M Frankel
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Michael Weiner
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
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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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7
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Prip A, Møller KA, Nielsen DL, Jarden M, Olsen MH, Danielsen AK. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting: A Systematic Review. Cancer Nurs 2019; 41:E11-E22. [PMID: 28753191 PMCID: PMC6259679 DOI: 10.1097/ncc.0000000000000533] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Today, cancer care and treatment primarily take place in an outpatient setting where encounters between patients and healthcare professionals are often brief. OBJECTIVE The aim of this study was to summarize the literature of adult patients' experiences of and need for relationships and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. METHODS The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs Institute Evidence Based Practice Database. RESULTS Nine studies were included, qualitative (n = 5) and quantitative (n = 4). The studies identified that the relationship between patients and healthcare professionals was important for the patients' ability to cope with cancer and has an impact on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. CONCLUSIONS The relationship and communication between patients and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. IMPLICATIONS FOR PRACTICE Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More research is needed to investigate the type of interaction and intervention that would be the most effective in supporting adult patients' coping during chemotherapy in an outpatient clinic.
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Affiliation(s)
- Anne Prip
- Author Affiliations: Institute of Nursing, Metropolitan University College, Copenhagen (Mss Prip and Møller); Departments of Oncology (Dr Nielsen and Ms Olsen) and Gastroenterology (Dr Danielsen), Herlev and Gentofte Hospital, University of Copenhagen; and University Hospitals Center for Health Research, Copenhagen University Hospital and University of Copenhagen (Dr Jarden), Denmark
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8
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van Vliet LM, de Veer AJ, Raijmakers NJ, Francke A. Is Information Provision about Benefits and Risks of Treatment Options Associated with Receiving Person-Centered Care?: A Survey among Incurably Ill Cancer Patients. J Palliat Med 2019; 22:797-803. [DOI: 10.1089/jpm.2018.0591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Anke J.E. de Veer
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
| | - Natasja J.H. Raijmakers
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Anneke Francke
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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9
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Stoewen DL, Coe JB, MacMartin C, Stone EA, Dewey CE. Identification of Illness Uncertainty in Veterinary Oncology: Implications for Service. Front Vet Sci 2019; 6:147. [PMID: 31231663 PMCID: PMC6560059 DOI: 10.3389/fvets.2019.00147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/29/2019] [Indexed: 12/04/2022] Open
Abstract
Uncertainty has been identified as the central psychological feature of illness experiences, necessitating a variety of coping strategies to effectively manage it and successfully adapt. The purpose of this qualitative study was to determine the expectations of veterinary clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. The study consisted of 43 dog owners participating in 30 independent in-person single and dyadic interviews conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis (supplemented with content analysis) was performed on transcripts of the interview discussions. Uncertainty was inadvertently identified as a central theme of the clients' experience. The diagnosis of a serious, life-limiting cancer and its treatment appeared to move clients into a world of uncertainty, which affected their feelings, thoughts, behaviors, attitudes, and personal expectations in relation to their dog, and their expectations of the oncology service. With uncertainty appraised mostly as a danger, clients appeared to employ multiple coping strategies to reduce uncertainty in the effort to adapt to the new reality of living with and caring for a dog with cancer. The need to manage uncertainty influenced their expectations of the service, specifically for information, ongoing relationships, 24-h access, and timely care. Our findings have implications for the delivery of specialty oncology services and for client welfare. When working with owners of dogs with life-limiting cancer, results suggest health care providers can facilitate the management of uncertainty to enhance clients' psychological well-being, thereby supporting clients' successful adaptation to the cancer experience.
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Affiliation(s)
- Debbie L Stoewen
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Jason B Coe
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Clare MacMartin
- Department of Family Relations and Applied Nutrition, College of Social & Applied Human Sciences, University of Guelph, Guelph, ON, Canada
| | - Elizabeth A Stone
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Catherine E Dewey
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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10
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Lee JL, Matthias MS, Menachemi N, Frankel RM, Weiner M. A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations. J Am Med Inform Assoc 2019; 25:413-418. [PMID: 29025086 DOI: 10.1093/jamia/ocx089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective To understand how existing guidelines align with current practice, evidence, and technology. Methods We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Results Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Conclusion Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care.
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Affiliation(s)
- Joy L Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Marianne S Matthias
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Nir Menachemi
- Regenstrief Institute, Indianapolis, IN, USA.,Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Richard M Frankel
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michael Weiner
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Center for Health Information and Communication, US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
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11
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Atherton K, Young B, Kalakonda N, Salmon P. Perspectives of patients with haematological cancer on how clinicians meet their information needs: “Managing” information versus “giving” it. Psychooncology 2018; 27:1719-1726. [DOI: 10.1002/pon.4714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Kirsten Atherton
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
| | - Bridget Young
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, First floor, The Sherrington Building, New Medical School; Liverpool UK
| | - Peter Salmon
- Division of Clinical Psychology, Department of Psychological Sciences; Liverpool UK
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12
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Low LF, McGrath M, Swaffer K, Brodaty H. Communicating a diagnosis of dementia: A systematic mixed studies review of attitudes and practices of health practitioners. DEMENTIA 2018; 18:2856-2905. [PMID: 29544345 DOI: 10.1177/1471301218761911] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to systematically review practitioners’ practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis. Euphemistic terms such as ‘memory problems’ are more often used to describe dementia than medical terms. Practitioners’ decision to diagnose and communicate the diagnosis of dementia are influenced by (a) their own beliefs regarding dementia and treatment efficacy and their confidence in diagnosis and communication; (b) patient circumstances including level of awareness, level of severity and family support; (c) the health and social care system including access to specialist and diagnostic services, reimbursement for diagnosis/management and availability of services and (d) cultural norms in relation to dementia including stigma, labels, and common clinical practice. The diagnosis and communication of diagnosis of dementia are intertwined processes and should be concurrently addressed in interventions. Multicomponent approaches to address these practices could include guideline development, practitioner education, anti-stigma public health campaigns, offering post-diagnosis treatments and support and sufficient reimbursement for practitioners for time spent managing dementia.
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13
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Development of the Japanese version of an information aid to provide accurate information on prognosis to patients with advanced non-small-cell lung cancer receiving chemotherapy: a pilot study. BMC Palliat Care 2018; 17:38. [PMID: 29482526 PMCID: PMC5828180 DOI: 10.1186/s12904-018-0292-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background Without explicit prognostic information, patients may overestimate their life expectancy and make poor choices at the end of life. We sought to design the Japanese version of an information aid (IA) to provide accurate information on prognosis to patients with advanced non–small-cell lung cancer (NSCLC) and to assess the effects of the IA on hope, psychosocial status, and perception of curability. Methods We developed the Japanese version of an IA, which provided information on survival and cure rates as well as numerical survival estimates for patients with metastatic NSCLC receiving first-line chemotherapy. We then assessed the pre- and post-intervention effects of the IA on hope, anxiety, and perception of curability and treatment benefits. Results A total of 20 (95%) of 21 patients (65% male; median age, 72 years) completed the IA pilot test. Based on the results, scores on the Distress and Impact Thermometer screening tool for adjustment disorders and major depression tended to decrease (from 4.5 to 2.5; P = 0.204), whereas no significant changes were seen in scores for anxiety on the Japanese version of the Support Team Assessment Schedule or in scores on the Hearth Hope Index (from 41.9 to 41.5; p = 0.204). The majority of the patients (16/20, 80%) had high expectations regarding the curative effects of chemotherapy. Conclusion The Japanese version of the IA appeared to help patients with NSCLC maintain hope, and did not increase their anxiety when they were given explicit prognostic information; however, the IA did not appear to help such patients understand the goal of chemotherapy. Further research is needed to test the findings in a larger sample and measure the outcomes of explicit prognostic information on hope, psychological status, and perception of curability. Electronic supplementary material The online version of this article (10.1186/s12904-018-0292-6) contains supplementary material, which is available to authorized users.
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Ko E, Zúñiga ML, Peacher D, Palomino H, Watson M. Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:116-127. [PMID: 27558475 DOI: 10.1007/s13187-016-1100-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
| | - María Luisa Zúñiga
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, 6386 Alvarado Court Ste 224, San Diego, CA, 92120, USA
| | - Diana Peacher
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
| | - Helen Palomino
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
| | - Mercedes Watson
- Cancer Resource Center of the Desert, 444 S. 8th Street, Suite B3, El Centro, CA, 92243, USA
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Gilligan T, Coyle N, Frankel RM, Berry DL, Bohlke K, Epstein RM, Finlay E, Jackson VA, Lathan CS, Loprinzi CL, Nguyen LH, Seigel C, Baile WF. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 2017; 35:3618-3632. [PMID: 28892432 DOI: 10.1200/jco.2017.75.2311] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Timothy Gilligan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nessa Coyle
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard M Frankel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donna L Berry
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald M Epstein
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Esme Finlay
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicki A Jackson
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Lathan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles L Loprinzi
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne H Nguyen
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carole Seigel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walter F Baile
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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17
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Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar AR. Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication. J Caring Sci 2015; 4:165-78. [PMID: 26161370 DOI: 10.15171/jcs.2015.017] [Citation(s) in RCA: 466] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/01/2014] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example. METHODS We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity. RESULTS From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93. CONCLUSION This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.
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Affiliation(s)
- Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rassouli
- Department of Pediatrics Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Abbaszadeh
- Department of Pediatrics Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, Faculty of Para Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Reza Nikanfar
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Di Leo S, Romoli V, Higginson IJ, Bulli F, Fantini S, Sguazzotti E, Costantini M. 'Less ticking the boxes, more providing support': A qualitative study on health professionals' concerns towards the Liverpool Care of the Dying Pathway. Palliat Med 2015; 29:529-37. [PMID: 25690601 DOI: 10.1177/0269216315570408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite being widely used, research into the effectiveness of the Liverpool Care of the Dying Pathway (LCP) and associated cases of malpractice does not match dissemination. No study exists focusing on concerns voiced by professionals. AIM To explore the views of professionals who, during the hospital implementation of the Italian version of the Liverpool Care of the Dying Pathway (LCP-I), voiced or showed concerns towards it. DESIGN A qualitative study nested within the LCP-I randomized cluster trial, with semi-structured interviews analysed using thematic analysis. SETTING AND PARTICIPANTS Six nurses and five physicians from six out of the eight hospital wards who completed the LCP-I implementation were interviewed. Eligibility criteria were having taken part in all steps of the LCP-I Programme, voiced or somehow shown concerns, or failed to fully engage with the implementation process. RESULTS A total of 12 categories were identified, referring to four topics: the Implementation Programme, the LCP-I clinical documentation, the hospital environment and the educational and professional background of hospital healthcare staff. Issues raised by participants concerned both 'real' characteristics of the LCP-I and a misinterpretation of the LCP-I approach and clinical documentation. Furthermore, difficulties were reported which were not linked to the Programme but rather to end-of-life care. CONCLUSION This study provides insights into the experience of professionals with negative opinions of or concerns with the LCP-I. A more comprehensive approach to professional training in palliative care is needed and may envisage the development of new interventions aimed at improving the quality of care throughout the illness trajectory.
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Affiliation(s)
- Silvia Di Leo
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Vittoria Romoli
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Francesco Bulli
- Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - Susanna Fantini
- Istituto di Tanatologia e Medicina Psicologica, Bologna, Italy
| | - Erica Sguazzotti
- Departments of Mental Health and Clinical and Biological Sciences, University of Turin, Turin, Italy Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Jarrett N, Porter K, Davis C, Lathlean J, Duke S, Corner J, Addington-Hall J. Palliative care patients' perceptions of the work involved in understanding and managing the network of care provision surrounding them. BMJ Support Palliat Care 2015; 7:133-139. [PMID: 25829381 DOI: 10.1136/bmjspcare-2014-000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/17/2015] [Accepted: 03/11/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the work carried out for cancer palliative care patients in understanding and dealing with the often large network of care provision surrounding them. METHOD Qualitative thematic analysis of interviews with 24 patients (aged 48-85 years) with 15 different types/sites of cancer and palliative care needs. RESULTS The main theme of 'patient work-their strategies and project management' is presented. Subthemes included: being organised and keeping records; planning ahead and coordinating care; information gathering; understanding the hierarchy and knowing who the key people are; strategies to remember names and roles; understanding and 'working the system'. Insights are given into the work carried out on patients' behalf by family, although it was unclear who would do this work if no family was available. Some of the challenges faced by patients and families are identified. These included limited information; uncertainty when care is transferred between different teams or locations; deciding who to contact and how; and negotiating through gatekeepers. CONCLUSIONS The number and variety of people contributing to the care of a cancer palliative care patient can be difficult for patients and family to comprehend. Work is required by patients or family on their behalf to achieve the level of understanding required to become accomplished at navigating the system and project managing their care organisation, and is probably influenced by role expectations and previous experience. Much of this additional, often hidden, workload for patients and family could probably be reduced with clear, timely information provision by health professionals.
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Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - K Porter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Davis
- Countess Mountbatten House, Moorgreen Hospital and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Lathlean
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - S Duke
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Addington-Hall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Stoewen DL, Coe JB, MacMartin C, Stone EA, Dewey CE. Qualitative study of the information expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer. J Am Vet Med Assoc 2014; 245:773-83. [DOI: 10.2460/javma.245.7.773] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stoewen DL, Coe JB, MacMartin C, A. Stone E, E. Dewey C. Qualitative study of the communication expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer. J Am Vet Med Assoc 2014; 245:785-95. [DOI: 10.2460/javma.245.7.785] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The communication experiences of patients with palliative care needs: A systematic review and meta-synthesis of qualitative findings. Palliat Support Care 2014; 13:369-83. [PMID: 24784479 DOI: 10.1017/s1478951514000455] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optimal communication is essential in ensuring that the palliative care needs of patients are met. This continues to be an area of concern for healthcare providers. The goal of our present review was to gain a deeper understanding of the communication experiences of patients with palliative care needs that have been identified within the qualitative literature. METHOD A systematic search for qualitative research papers was undertaken in February of 2012. Five databases (ASSIA, CINAHL, MEDLINE, PsychArticles, and PsychINFO) were searched using the search terms ["palliative care" OR "terminal care" OR "end of life care"] AND ["experience" OR "perspective" OR "qualitative" OR "interview"] AND ["patients" OR "clients" OR "service-user"]. Meta-synthesis was conducted on the data within the found papers. RESULTS A line-of-argument synthesis of 15 studies yielded four overarching themes: talking-facilitating and inhibiting factors; the importance of humanitarian qualities within communication encounters; perceptions of autonomy within communication experiences; and individual differences in preferences for honesty within interactions. SIGNIFICANCE OF RESULTS Our findings are discussed in relation to existing literature and offer a deeper insight into the communication experiences of this clinical population. A number of clinical implications are offered for the healthcare professionals who are providing support to patients with palliative care needs.
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Sutherland J. Patient information in radiation therapy: strategies to meet patient needs. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13566-013-0138-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Seror V, Cortaredona S, Bouhnik AD, Meresse M, Cluze C, Viens P, Rey D, Peretti-Watel P. Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery. Psychooncology 2013; 22:2546-56. [PMID: 23749441 DOI: 10.1002/pon.3316] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). METHODS A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. RESULTS The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. CONCLUSIONS Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.
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Affiliation(s)
- Valérie Seror
- INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France
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Elit LM, Charles C, Gafni A, Ranford J, Tedford-Gold S, Gold I. How oncologists communicate information to women with recurrent ovarian cancer in the context of treatment decision making in the medical encounter. Health Expect 2013; 18:1066-80. [PMID: 23663240 DOI: 10.1111/hex.12079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women with recurrent ovarian cancer depend on their physicians to provide them with information about their diagnosis and available treatment options if they wish to participate in the process of choosing the treatment. There is no information on how oncologists give information to women during the physician-patient encounter at the time the disease recurs. OBJECTIVES To explore from the oncologists' perspective (i) the extent to which oncologists provide their own patients who are experiencing their first recurrence of ovarian cancer with the same information about management options, and (ii) any explicit or implicit criteria they use to decide whether and how to tailor the information to individual patients. METHODS We adopted a qualitative, exploratory descriptive approach to begin to understand oncologists' perspectives on how they gave information to patients within the context of their clinical practice. Individual interviews were used to identify themes related to the study objectives. RESULTS Fifteen gynaecologic and five medical oncologists participated. Theme 1 describes the extent to which oncologists give information to their patients in the same way or in different ways. This section describes how the same oncologist may modify the depth of information transfer based on several factors. Theme 2 focuses on the factors that influence what information is given. For example, the amount and type of information given is based on the oncologist's on-going assessment of how the patient is assimilating the information shared during the medical encounter, the oncologists' perception of their relationship with the patient and the oncologist's assessment of what role they should take in decision making. Theme 3 involves the factors that influenced how information is given. For example, the information shared may vary based on the oncologist's perception of the patient's vitality, the patient's comprehension of the information, the patient's emotional well-being. In addition, the oncologist may make the information relevant for the patient by using analogies. Different types of information may be shared based on the oncologist's perception of patient- or family-initiated question. The information relay may be curtailed based on competing demands for the oncologist. DISCUSSION AND CONCLUSIONS Oncologists provide women with information on their disease status, their treatment options and the side effects of treatment. The oncologists use perceptions to determine what information and how to provide information. The question this paper raises is whether the oncologist's perceptions reflect the individual patient's information and decision-making needs.
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Affiliation(s)
- Lorraine M Elit
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Cathy Charles
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | | | | | - Irving Gold
- Association of Faculties of Medicine of Canada, Ottawa, ON, Canada
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Nissim R, Zimmermann C, Minden M, Rydall A, Yuen D, Mischitelle A, Gagliese L, Schimmer A, Rodin G. Abducted by the illness: a qualitative study of traumatic stress in individuals with acute leukemia. Leuk Res 2013; 37:496-502. [PMID: 23352641 PMCID: PMC3808345 DOI: 10.1016/j.leukres.2012.12.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/01/2012] [Accepted: 12/11/2012] [Indexed: 11/26/2022]
Abstract
Symptoms of traumatic stress are common in acute leukemia. The goal of the present qualitative study was to understand this traumatic stress, as perceived by patients. Participants were 43 patients with acute leukemia in Toronto, Canada. Participants were asked in serial interviews about their experience of diagnosis and treatment. A total of 65 interviews were analyzed utilizing the grounded theory method. Our findings provide insight into the traumatic experience of the diagnosis and treatment, as well as the initial psychological response to this trauma. Patients coped by surrendering control to the medical team, in whom they felt great trust. Patients also expressed a strong preference for limited information, with a preference to avoid discussions about overall prognosis. These results may inform interventions to relieve traumatic stress in this high risk population.
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Affiliation(s)
- Rinat Nissim
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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Salmon P, Young B. The validity of education and guidance for clinical communication in cancer care: evidence-based practice will depend on practice-based evidence. PATIENT EDUCATION AND COUNSELING 2013; 90:193-9. [PMID: 22632737 DOI: 10.1016/j.pec.2012.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The validity of clinical communication skills education and guidance for cancer care is sometimes portrayed as self-evident. This view needs re-examination in light of critiques of the concept of communication skills. METHODS We critically examine principles that steer communication teaching and guidance in cancer care and draw on research that can inform the next generation of development in this field. RESULTS Unlike other areas of clinical skills, communication is highly contested. Any instance of communication is open to multiple interpretations; expert principles of communication are imprecise and often contradictory. The concept of communication skills will constrain development, because of its implication that universal, expert-defined components of communication are the building blocks of clinical relationships. Research on communication in practice indicates insights that could enrich future education and guidance. CONCLUSIONS Communication experts have more to learn from practitioners and patients than is commonly appreciated. Inductive, qualitative research should incorporate patient and practitioner perspectives as well as observations of communication. PRACTICE IMPLICATIONS Solutions to communication dilemmas might be found in detailed study of communication in practice, rather than in current expert principles. Incorporating such evidence will help to ensure the continued authority of communication curricula and guidance as evidence-based and patient-centred.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
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Slort W, Schweitzer BPM, Blankenstein AH, Abarshi EA, Riphagen II, Echteld MA, Aaronson NK, van der Horst H, Deliens L. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review. Palliat Med 2011; 25:613-29. [PMID: 21273221 DOI: 10.1177/0269216310395987] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While effective general practitioner (GP)-patient communication is required for the provision of good palliative care, barriers and facilitators for this communication are largely unknown. We aimed to identify barriers and facilitators for GP-patient communication in palliative care. In a systematic review seven computerized databases were searched to find empirical studies on GP-patient communication in palliative care. Fifteen qualitative studies and seven quantitative questionnaire studies were included. The main perceived barriers were GPs' lack of availability, and patients' and GPs' ambivalence to discuss 'bad prognosis'. Main perceived facilitators were GPs being available, initiating discussion about several end-of-life issues and anticipating various scenarios. Lack of availability and failure to discuss former mistakes appear to be blind spots of GPs. GPs should be more forthcoming to initiate discussions with palliative care patients about prognosis and end-of-life issues. Empirical studies are needed to investigate the effectiveness of the perceived barriers and facilitators.
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Affiliation(s)
- W Slort
- Department of General Practice, and EMGO+ Institute for Health and Care Research, VU University Medical Centre, The Netherlands.
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Boyd D, Merkh K, Rutledge DN, Randall V. Nurses' perceptions and experiences with end-of-life communication and care. Oncol Nurs Forum 2011; 38:E229-39. [PMID: 21531673 DOI: 10.1188/11.onf.e229-e239] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To characterize oncology nurses' attitudes toward care at the end of life (EOL) and their experiences in caring for terminally ill patients, hospice discussions with patients and families, and the use of palliative care practices. DESIGN Descriptive correlational survey study. SETTING A Magnet®-designated hospital in southern California with more than 500 beds. SAMPLE 31 oncology nurses. METHODS Nurses completed the adapted version of the Caring for Terminally Ill Patients Nurse Survey. MAIN RESEARCH VARIABLES Attitudes toward care at EOL and care experiences with terminally ill patients. FINDINGS Despite having fairly positive attitudes toward hospice and having discussions about prognosis with terminally ill patients, nurses reported missed opportunities for discussions and patient referrals to hospice. On average, nurses cared for more than seven terminally ill patients during a three-month period while only discussing hospice care with a third of these patients and their family members. Most nurses acknowledged that patients would benefit from earlier initiation of hospice care. Specific palliative care practices used by nurses in the past three months varied, with active and passive listening and requesting increased pain medications used most frequently and aromatherapy and guided imagery used least. CONCLUSIONS Missed opportunities may reflect nurses' attitudes. However, lack of patient and family member acceptance was the most important barrier to discussion of hospice. IMPLICATIONS FOR NURSING Strategies to enable nurses to have a stronger voice during this critical time for their patients are needed and, when developed, supported in practice to ensure that they are used.
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Strohbuecker B, Gaertner J, Stock S. Informing Severely III Patients: Needs, Shortcomings and Strategies for Improvement. ACTA ACUST UNITED AC 2011; 6:8-13. [PMID: 21547020 DOI: 10.1159/000324563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SUMMARY: The scope of palliative care has expanded gradually over the last decade. Provision of palliative care is not restricted to the last months of life as in some out-dated concepts. It addresses the needs of severely ill patients in all care settings (in- and outpatients, home care, hospices). Particularly in the last years, the value of integrating palliative care early in the disease trajectory of life-threatening and incurable diseases has become increasingly acknowledged. In order for patients to fully benefit from the concept of early integration of palliative care, they need to be provided with information tailored to their disease trajectory. For example, patients and relatives need to know how symptoms such as pain, depression, fatigue, breathlessness, or anxiety can be alleviated. The patients' knowledge and understanding will support the coping process, improve comfort and enhance patient participation and autonomy. Since information needs are highly individual and vary throughout the course of the disease, an interactive approach of assessing the patients' needs and responding to them adequately is mandatory. In this article, the information needs of advanced cancer patients and their families are explained, shortcomings of the present information concepts are discussed, and an integrative approach to responding to patients' information needs throughout the care pathway is advocated.
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Affiliation(s)
- Barbara Strohbuecker
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany
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Vollrath AM, von Gunten CF. Negotiating Goals of Care. Palliat Care 2011. [DOI: 10.1016/b978-1-4377-1619-1.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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