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Maccallum F, Breen LJ, Phillips JL, Agar MR, Hosie A, Tieman J, DiGiacomo M, Luckett T, Philip J, Ivynian S, Chang S, Dadich A, Grossman CH, Gilmore I, Harlum J, Kinchin I, Glasgow N, Lobb EA. The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis. Psychol Med 2024; 54:1361-1372. [PMID: 38179660 DOI: 10.1017/s0033291723003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.
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Affiliation(s)
- F Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - L J Breen
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - J L Phillips
- Faculty of Health and Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - M R Agar
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Hosie
- School of Nursing & Midwifery, University of Notre Dame Australia and St Vincent's Health Network Sydney, Australia
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - M DiGiacomo
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - T Luckett
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Philip
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - S Ivynian
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - S Chang
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Dadich
- School of Business, Western Sydney University, Penrith, NSW, Australia
| | - C H Grossman
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | - I Gilmore
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Harlum
- District Palliative Care Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - I Kinchin
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - N Glasgow
- Australian National University College of Health and Medicine, Canberra, ACT, Australia
| | - E A Lobb
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
- Department of Palliative Care, Calvary Health Care, Kogarah, NSW, Australia
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Abstract
OBJECTIVES Despite there being many models for how spiritual care should be provided, the way nurses actually provide spiritual care often differs from these models. Based on the premise that the way a person enacts their work role is related to how they understand that role, this study aims to describe the qualitatively different ways that nurses understand their spiritual care role. METHODS A convenience sample of 66 American nurses completed an anonymous, online questionnaire about what spiritual care means for them and what they generally do to provide spiritual care. Their responses were analyzed phenomenographically. RESULTS Four qualitatively different ways of understanding emerged: active management of the patient's experience, responsive facilitation of patient's wishes, accompaniment on the patient's dying journey, and empowering co-action with the patient. Each understanding was found to demonstrate a specific combination of 5 attributes that described the spiritual care role: nurse directivity, the cues used for spiritual assessment, and the nurse's perception of intimacy, the patient, and the task. SIGNIFICANCE OF RESULTS The findings of this study may explain why nurses vary in their spiritual care role and can be used to assess and develop competence in spiritual care.
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Affiliation(s)
- Rita Mascio
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Sandra Lynch
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Annmarie Hosie
- Palliative Care Nursing, University of Notre Dame, Broadway, NSW, Australia
| | - Megan Best
- Institute of Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
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Fereydooni S, Lorenz K, Azarfar A, Luckett T, Phillips JL, Becker W, Giannitrapani K. Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers. BMJ Open 2024; 14:e082033. [PMID: 38514141 PMCID: PMC10961503 DOI: 10.1136/bmjopen-2023-082033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.
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Affiliation(s)
| | - Karl Lorenz
- Stanford University, Stanford, California, USA
| | - Azin Azarfar
- University of Florida, Gainesville, Florida, USA
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology, Sydney, New South Wales, Australia
| | - William Becker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Karleen Giannitrapani
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Kochovska S, Murtagh FE, Agar M, Phillips JL, Dudgeon D, Lujic S, Johnson MJ, Currow DC. Creating more comparable cohorts in observational palliative care studies: A proposed framework to improve applicability and replicability of research. Palliat Med 2024:2692163241234227. [PMID: 38454317 DOI: 10.1177/02692163241234227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Palliative care is characterised by heterogeneous patient and caregiver populations who are provided care in different health systems and a research base including a large proportion of observational, mostly retrospective studies. The inherent diversity of palliative care populations and the often inadequate study descriptions challenge the application of new knowledge into practice and reproducibility for confirmatory studies. Being able to define systematically study populations would significantly increase their generalisability and effective translation into practice. PROPOSAL Based on an informal consensus process by active palliative care researchers challenged by this problem and a review of the current evidence, we propose an approach to creating more comparable cohorts in observational (non-randomised) palliative care studies that relies on defining the study population in relation to a fixed, well-defined event from which analyses are built ('anchoring'). In addition to providing a detailed and complete description of the study population, anchoring is the critical step in creating more comparable cohorts in observational palliative care studies. Anchoring can be done with respect to a single or multiple data points, and can support both prospective and retrospective data collection and analysis. DISCUSSION Anchoring the cohort to reproducible data points will help create more comparable cohorts in palliative care whilst mitigating its inherent heterogeneity. This, in turn, will help optimise the generalisability, applicability and reproducibility of observational palliative care studies to strengthen the evidence base and improve practice.
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Affiliation(s)
- Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, University of Technology Queensland, Brisbane, QLD, Australia
| | - Deborah Dudgeon
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Sanja Lujic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Ballard A, Thamm C, Ogle T, Phillips JL. Influences Shaping Clinicians' Monoclonal Antibody and Immune Checkpoint Inhibitor Preparation and Administration Management Practices: A Systematic Review. Semin Oncol Nurs 2024:151583. [PMID: 38336551 DOI: 10.1016/j.soncn.2024.151583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/16/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES In 30 years, monoclonal antibodies (mAbs) and immune checkpoint inhibitors (ICPIs) have enhanced cancer survival and quality of life. Limited knowledge exists regarding the long-term risks of repeated exposure, especially for cancer nurses, who prepare and administer them. This systematic review aimed to identify influences shaping clinicians' awareness and practices in the safe preparation and administration of mAbs and ICPIs. DATA SOURCES This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases CINAHL, EMBASE, Joanna Briggs Institute, OVID, MEDLINE, and Cochrane were searched. Eligibility and risk of bias were assessed by four reviewers. RESULTS Of 7301 identified studies, 481 duplicates were removed, and 6673 were excluded after title and abstract review. A full-text review was conducted on 147 studies; six studies were included. A narrative synthesis generated two themes: (1) ambiguity contributes to variation in handling practices and (2) continuing professional development (CPD) is vital but hard to implement without evidence. CONCLUSION Lack of evidence regarding long-term risks and consensus creates uncertainty about the hazardous nature of unconjugated mAbs and ICPIs. Resulting in varied risk reduction strategies during preparation and administration, and inconsistent CPD. Protecting the long-term health of clinicians necessitates consensus on risk reduction strategies. This will be challenging without compelling evidence or international agreement on their hazardous classification. IMPLICATIONS FOR NURSING PRACTICE In nursing, policy gaps and inconsistent CPD related to unconjugated mAbs and ICPIs may expose nurses to risks. Understanding the educational needs of nurses and global standardized guidelines are urgently needed.
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Affiliation(s)
- Angela Ballard
- Ph.D Candidate, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland; Lecturer, Federation University, Institue of Health and Wellbeing, Berwick, Victoria, Australia.
| | - Carla Thamm
- Senior Research Fellow, Caring Futures Institute, School of Nursing and Health Sciences, Flinders University, Adelaide, South Australia; Senior Lecturer, School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
| | - Theodora Ogle
- Lecturer, School of Nursing, Queensland University of Technology (QUT) Brisbane, Queensland, Australia
| | - Jane L Phillips
- Professor, Head of School, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Mitchell RJ, Delaney GP, Arnolda G, Liauw W, Phillips JL, Lystad RP, Harrison R, Braithwaite J. Potentially burdensome care at the end-of-life for cancer decedents: a retrospective population-wide study. BMC Palliat Care 2024; 23:32. [PMID: 38302965 PMCID: PMC10835903 DOI: 10.1186/s12904-024-01358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Variation persists in the quality of end-of-life-care (EOLC) for people with cancer. This study aims to describe the characteristics of, and examine factors associated with, indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. METHOD A population-based retrospective cohort study of people aged ≥ 20 years who died with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, consisting of > 1 ED presentation or > 1 hospital admission or ≥ 1 ICU admission within 30 days of death, or died in acute care. RESULTS Of the 80,005 cancer-related deaths, 86.9% were hospitalised in the 12 months prior to death. Fifteen percent had > 1 ED presentation, 9.9% had > 1 hospital admission, 8.6% spent ≥ 14 days in hospital, 3.6% had ≥ 1 intensive care unit admission, and 1.2% received mechanical ventilation on ≥ 1 occasion in the last 30 days of life. Seventeen percent died in acute care. The potentially burdensome care composite measure identified 20.0% had 1 indicator, and 10.9% had ≥ 2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥ 55 years), females, people with 1 or ≥ 2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Compared to people with head and neck cancer, people with all cancer types (except breast and neurological) were more likely to experience ≥ 2 indicators of potentially burdensome care versus none. CONCLUSION This study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Geoffrey P Delaney
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
- Collaboration for Cancer Outcomes Research and Evaluation, South-Western Sydney Clinical School, UNSW, Sydney, Australia
- University of New South Wales School of Clinical Medicine, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Winston Liauw
- University of New South Wales School of Clinical Medicine, Sydney, Australia
- Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Jane L Phillips
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia
- Faculty of Health, School of Nursing, QUT, Brisbane, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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7
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Lobb E, Maccallum F, Phillips JL, Agar M, Hosie A, Breen LJ, Tieman J, DiGiacomo M, Luckett T, Philip J, Ivynian S, Chang S, Dadich A, Harlum J, Gilmore I, Kinchin I, Grossman C, Glasgow N. The COVID-19 Pandemic: Bereavement Experiences Between Hospital and Home Deaths in Palliative Care. J Pain Symptom Manage 2024; 67:147-156. [PMID: 37972719 DOI: 10.1016/j.jpainsymman.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Australian COVID-19 public health measures reduced opportunities for people to communicate with healthcare professionals and be present at the death of family members/friends. AIM To understand if pandemic-specific challenges and public health measures during the COVID-19 pandemic impacted end-of-life and bereavement experiences differently if the death, supported by palliative care, occurred in a hospital or at home. DESIGN A cross-sectional online survey was completed by bereaved adults during 2020-2022. Analyses compared home and in-patient palliative care deaths and bereavement outcomes. Additional analyses compared health communication outcomes for those identified as persons responsible or next of kin. SETTING/PARTICIPANTS Of 744 bereaved people; 69% (n = 514) had a death in hospital and 31% (n = 220) at home. RESULTS The COVID-19 public health measures influenced people's decision to die at home. Compared to hospital deaths, the home death group had higher levels of grief severity and grief-related functional impairment. Only 37% of bereaved people received information about bereavement and support services. 38% of participants who were at least 12 months postdeath scored at a level suggestive of possible prolonged grief disorder. Levels of depression and anxiety between the two groups were not significantly different. CONCLUSIONS These findings highlight the need for health services to recognize bereavement as fundamental to palliative and health care and provide pre- and post death grief and bereavement care to ensure supports are available particularly for those managing end-of-life at home, and that such supports are in place prior to as well as at the time of the death.
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Affiliation(s)
- Elizabeth Lobb
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology (E.L.), Sydney, New South Wales, Australia; Department of Palliative Care, Calvary Health Care (E.L.), Kogarah, New South Wales, Australia.
| | - Fiona Maccallum
- School of Psychology (F.M.), University of Queensland, Queensland, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health (J.L.P.), Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Meera Agar
- Research Institute for Innovative Solutions for Wellbeing and Health (M.A.), IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Annmarie Hosie
- School of Nursing, Midwifery, Health Sciences & Physiotherapy (A.H.), The University of Notre Dame Australia & St Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia
| | - Lauren J Breen
- Curtin School of Population Health (L.J.B.), enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care (J.T.), Death and Dying (RePaDD), College of Nursing and Health Science I RePaDD, Bedford Park, South Australia, Australia
| | - Michelle DiGiacomo
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (T.L., S.I., S.C., I.G.), Ultimo, New South Wales, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (T.L., S.I., S.C., I.G.), Ultimo, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital (J.P.), University of Melbourne, Parkville, Victoria, Australia
| | - Serra Ivynian
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (T.L., S.I., S.C., I.G.), Ultimo, New South Wales, Australia
| | - Sungwon Chang
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (T.L., S.I., S.C., I.G.), Ultimo, New South Wales, Australia
| | - Ann Dadich
- Western Sydney University, School of Business (A.D.), Parramatta, New South Wales, Australia
| | - Janeane Harlum
- District Palliative Care Manager & Service Development (J.H.), District Palliative Care Service, Liverpool Hospital, New South Wales, Australia
| | - Imelda Gilmore
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (T.L., S.I., S.C., I.G.), Ultimo, New South Wales, Australia
| | - Irina Kinchin
- Centre for Health Policy and Management, Discipline of Public Health & Primary Care, School of Medicine (I.K.), Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | | | - Nicholas Glasgow
- Australian National University College of Health and Medicine (N.G.), Canberra ACT, Australia
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White S, Turbitt E, Rogers K, Tucker K, McEwen A, Best M, Phillips JL, Jacobs C. A survey of genetic and palliative care health professionals' views of integrating genetics into palliative care. Eur J Hum Genet 2024; 32:109-116. [PMID: 37344570 PMCID: PMC10772073 DOI: 10.1038/s41431-023-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/14/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Genetic counselling and testing have utility for people with palliative care needs and their families. However, genetic and palliative care health professionals have described difficulties initiating palliative-genetic discussions. Between March and July 2022, we received n = 73 surveys (6% response rate) from genetic and palliative care health professionals in Australia and New Zealand that assessed and compared barriers and facilitators. The main perceived barrier to both groups was palliative care health professionals' lack of genetic knowledge (44%). Most palliative care health professionals were 'not at all confident' performing several activities, including discussing DNA banking (52%) and knowing their legal responsibilities when sharing genetic information (58%). The most frequently selected facilitator for genetic health professionals was fostering close relationships with palliative care health professionals (52%), while palliative care health professionals indicated a genetic referral template (51%) would be of assistance. Almost all participants agreed genetic discussions do not undermine the central ethos of palliative care (87%). Fewer palliative care health professionals considered themselves well situated to have genetic discussions with a palliative patient's family compared to genetic health professionals (p = 0.014). Our results suggest that genetic and palliative care health professionals support integrating genetics into palliative care, although refinement of the palliative care health professionals' role in this process is required. We have identified intervention targets to overcome barriers related to knowledge and confidence, which ought to be integrated into future interventions designed to support health professionals deliver the benefits of genetic information to people with palliative care needs and their families.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, Division of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Virdun C, Button E, Phillips JL, Yates P, Luckett T. Perspectives of inpatients with palliative care needs, their families, clinicians and key stakeholders on measuring quality of hospital care via patient experience measures: A qualitative study. Palliat Med 2023; 37:1498-1508. [PMID: 37920917 PMCID: PMC10657505 DOI: 10.1177/02692163231209845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Globally there are high numbers of patients with palliative care needs receiving care in hospitals. Patient reported experience measures (PREMs) provide useful data to guide improvement work. How to implement PREMs within palliative care populations is unclear. AIM To explore the perspectives of inpatients with palliative care needs, their family members, and the clinical team regarding the use of a generic PREM as compared with a PREM designed for people with palliative care needs and related implementation factors. DESIGN A qualitative study was undertaken using semi-structured interviews and focus groups and integrated thematic analysis. SETTING/PARTICIPANTS Inpatients with palliative care needs, their family members, and clinical team members were recruited from three wards in an Australian metropolitan hospital. RESULTS Twenty-seven interviews and three focus groups were conducted. Six themes emerged: (1) PREMs for people with palliative care needs ought to be tailored to the needs of this population; (2) PREMs should appraise whether the needs of families have been met in addition to those of patients; (3) PREMs for inpatients with palliative care needs ought to be easy to use, brief and incorporate space for free text alongside each question; (4) Implementation of PREMs for people with palliative care needs ought to consider who administers these, when and how often; (5) PREM data need to be specific enough to inform process change and/or care provision; (6) Patients and families require meaningful feedback to encourage PREM completion. CONCLUSIONS This study provides practical guidance for PREM selection and implementation to inform improvements to care for inpatients with palliative care needs.
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Affiliation(s)
- Claudia Virdun
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Elise Button
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Services, Herston, QLD, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Patsy Yates
- Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
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Janssen A, Shah K, Rabbets M, Nagrial A, Pene C, Zachulski C, Phillips JL, Harnett P, Shaw T. Feasibility of Microlearning for Improving the Self-Efficacy of Cancer Patients Managing Side Effects of Chemotherapy. J Cancer Educ 2023; 38:1697-1709. [PMID: 37452227 PMCID: PMC10509055 DOI: 10.1007/s13187-023-02324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Lung cancer patients have a high symptom burden that negatively affects their quality of life. Increasing patient self-efficacy to deal with treatment side effects can ameliorate their symptom burden. Education programs can help enhance patient self-efficacy by giving patients more control over their condition through increased disease literacy. This study aimed to evaluate the feasibility of microlearning for delivering lung cancer patients' information on side effects of chemotherapy. Secondary objectives of the program are to understand the acceptability of microlearning for delivery this type of education to lung cancer patients and the potential impact of microlearning on patient self-efficacy, knowledge and confidence managing side effects of chemotherapy. A mixed-methods prepost test (or quasi-experimental) study design was used to better enable patients to identify and manage the side effects of their condition and chemotherapy. Participants were patients diagnosed with stage II to stage IV lung cancer, who had a life expectancy of greater than 3 months and were aged 18 years or older. Multiple validated scales were used to assess patient self-efficacy pre- and post-intervention. The online program was evaluated using quantitative data of completion rates extracted from the online platform. Semi-structured interviews were used to explore the impact of the online program on perceived self-efficacy and quality of life. Twenty-three participants agreed to participate in the study and five agreed to complete a semi-structured interview. Participants found the content comprehensive, relevant and engaging. The program improved perceived disease literacy and helped participants develop coping strategies to manage side effects. Participants also found the platform easy to use and navigate. Additional courses and features were requested. Patients with a diagnosis of cancer receive a large amount of information about the side effects of chemotherapy and how to manage them. This information is often provided soon after diagnosis or upon commencement of therapy, which can be overwhelming for some patients. Microlearning, a method of online learning that spaces distributing of content over several weeks, may be a useful tool for supporting delivering of health information to this group of patients.
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Affiliation(s)
- Anna Janssen
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Kavisha Shah
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melanie Rabbets
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Christopher Pene
- Sacred Heart Service, St Vincent's Hospital, Sydney, NSW, Australia
| | - Clare Zachulski
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, School of Nursing, Queensland University of Technology, QLD, Brisbane, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Paul Harnett
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Caperchione CM, English M, Sharp P, Agar MR, Phillips JL, Liauw W, Harris CA, McCullough S, Lilian R. Exploring the practicality and acceptability a brief exercise communication and clinician referral pathway in cancer care: a feasibility study. BMC Health Serv Res 2023; 23:1023. [PMID: 37740170 PMCID: PMC10517509 DOI: 10.1186/s12913-023-10003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The majority of cancer patients and cancer care clinicians-CCCs (e.g., oncologists) believe that exercise is an important adjunct therapy that should be embedded in standard practice. Yet, CCCs do not routinely discuss exercise with their patients, nor do they regularly refer them to exercise professionals (e.g., exercise physiologists-EPs). This study evaluated the feasibility and acceptability of an evidence-based approach to improving exercise communication between CCCs and their patients, including an exercise referral pathway. METHODS Implementation and testing of the Exercise Communication and Referral Pathway (ECRP) occurred in Sydney, Australia. The ECRP included a brief oncology-initiated communication exchange with patients, CCC exercise referral to an EP, followed by EP-initiated telephone consultation with patients concerning tailored exercise advice. Participant perceptions concerning the feasibility and applicability of the ECPR were evaluated. Semi-structured interviews were conducted with CCCs (n = 3), cancer patients (n = 21), and an EP (n = 1). Inductive thematic analysis was undertaken. RESULTS Analysis generated three themes: (1) Navigating the role of CCCs in the ECRP, suggesting that oncology-initiated communication is a cue to action, however there was a lack of role clarity regarding exercise referral; (2) Implementing Patient-Orientated Care within a Standardised Pathway, highlighting the need for tailored information and advice for patients that reflects individual disease, socio-cultural, and environmental factors, and; (3) Taking Steps Towards Action, revealing the need for structural (e.g., EP initiated contact with patients) and policy changes (i.e., changes to Medicare, direct oncologist referral) to engage patients and better integrate exercise as part of standard care. CONCLUSIONS Findings provide important insights into improving oncology-patient exercise communication and developing an exercise referral pathway to increase engagement and patient reach. However, individual (e.g., experience, knowledge) and contextual factors (e.g., time, resources) need consideration when implementing an ECRP. TRIAL REGISTRATION This trial was prospectively registered with the Australian New Zealand Clinical (#ACTRN12620000358943) on March 13, 2020.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Madeleine English
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Meera R Agar
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Translational Cancer Research Network, Sydney, NSW, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Translational Cancer Research Network, Sydney, NSW, Australia
| | | | - Ruth Lilian
- Translational Cancer Research Network, Sydney, NSW, Australia
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12
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Rao A, Zecchin R, Newton PJ, Read SA, Phillips JL, DiGiacomo M, Chang S, Denniss AR, Hickman LD. Feasibility of Integrating MEditatioN inTO heaRt Disease (the MENTOR Study): A Phase II Randomized Controlled Trial. J Cardiovasc Nurs 2023; 38:492-510. [PMID: 37249544 DOI: 10.1097/jcn.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Comorbid depression and/or anxiety symptoms occur in 25% of patients attending cardiac rehabilitation (CR) programs and are associated with poorer prognosis. There is a need to evaluate psychological interventions, including meditation, that have potential to improve psychological health in CR programs. AIMS The aim of this study was to determine the feasibility and acceptability of integrating a meditation intervention into an existing Australian CR program for the reduction of depression and anxiety symptoms. METHODS This was a mixed-methods feasibility randomized controlled trial. Thirty-one patients with CVD and, at a minimum, mild depression and/or anxiety symptoms were randomized to meditation and standard CR or to standard CR alone. A 16-minute guided group meditation was delivered face-to-face once a week for 6 weeks, with daily self-guided meditation practice between sessions. Feasibility outcomes included screening, recruitment, and retention. Semistructured interviews of patients' (n = 10) and health professionals' (n = 18) perspectives of intervention participation and delivery were undertaken to assess acceptability. Between-group differences in depression, anxiety, stress, self-efficacy for mindfulness, and health status at 6 and 12 weeks were also assessed. RESULTS AND CONCLUSION Meditation was considered feasible, with 83% (12/15) of the intervention group completing an average of 3.13 (SD, 2.56) out of 6 group meditation sessions and 5.28 (SD, 8.50) self-guided sessions. Meditation was considered acceptable by patients, clinicians, and health managers. Between-group differences in the number of CR sessions completed favored the intervention group in per-protocol analyses (intervention group vs control group, 12 vs 9 sessions; P = .014), which suggests that meditation may be useful to improve patients' adherence to exercise-based CR program.
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13
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Marshall C, Virdun C, Phillips JL. Evidence-based models of rural palliative care: A systematic review. Palliat Med 2023; 37:1129-1143. [PMID: 37537971 DOI: 10.1177/02692163231183994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. AIM To identify the key care elements that optimise palliative care for people in rural communities. DESIGN AND DATA SOURCES A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. RESULTS Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. CONCLUSIONS A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.
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Affiliation(s)
- Claire Marshall
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Claudia Virdun
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
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14
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Govind N, Ferguson C, Phillips JL, Hickman L. Palliative care interventions and end-of-life care as reported by patients' post-stroke and their families: a systematic review. Eur J Cardiovasc Nurs 2023; 22:445-453. [PMID: 36443841 DOI: 10.1093/eurjcn/zvac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 07/20/2023]
Abstract
AIMS Internationally, there is an urgent need to implement guidelines supporting integration of palliative care into stroke clinical practice. Despite considerable advances in acute stroke management, ∼20% of all acute stroke patients die within the first 30 days. Palliative care is well established in diseases such as cancer or advanced heart failure, but evidence-based interventions of high quality are limited in stroke populations. This systematic review aims to identify and evaluate quantitative studies that describe palliative care interventions and end-of-life care as reported by patient's post-stroke and their families. METHODS AND RESULTS A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane, Embase, Ovid, Proquest, and Scopus from 1990 to April 2021. The National Heart, Lung and Blood Institute standardized quality rating tools for quality assessment were used. Seven studies were identified, and all used descriptive quantitative designs. There were no interventional studies. The results were synthesized narratively according to the elements of palliative care interventions and end-of-life care: symptom burden and satisfaction, loss of autonomy at the end of life, and acknowledging uncertainty. CONCLUSION This review highlights the limited empirical evidence that describes palliative care interventions and end-of-life care as reported by patient's post-stroke and their families. Most of the current evidence focuses on the provision of care during the final days and hours of life, or end-of-life care, with little evidence to guide the integration of palliative care into post-stroke clinical care, especially for patients with an uncertain prognosis. Acute stroke is sudden, unexpected, and life-changing, and patients and families would benefit from well-designed targeted interventions to determine strategies that address the diverse palliative needs of this patient population. REGISTRATION PROSPERO CRD42021254536.
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Affiliation(s)
- Natalie Govind
- IMPACCT, Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007, Australia
| | - Caleb Ferguson
- IMPACCT, Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007, Australia
- School of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007, Australia
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Louise Hickman
- IMPACCT, Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007, Australia
- School of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
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15
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Torgbenu E, Luckett T, Buhagiar M, Phillips JL. Practice points for lymphoedema care in low- and middle- income countries developed by nominal group technique. BMC Health Serv Res 2023; 23:740. [PMID: 37422616 DOI: 10.1186/s12913-023-09786-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Lymphoedema is a common, distressing, and debilitating condition affecting more than 200 million people globally. There is a small body of evidence to guide lymphoedema care which underpins several lymphoedema clinical practice guidelines developed for high-income countries (HIC). Some of these recommendations are unlikely to be feasible in low-resource settings. AIM To develop practice points for healthcare workers that optimise lymphoedema care in low- and middle-income countries (LMIC). METHODS A nominal group technique (NGT) was undertaken to gain consensus on which content from HIC guidelines was important and feasible to include in practice points for LMIC, and other important advice or recommendations. Participants included experts, clinicians, and volunteers involved in lymphoedema care in LMIC. The NGT followed five key stages: silent 'ideas' generation, round-robin rationale, clarification, refinement and verification. The first, fourth and fifth stages were completed via email, and the second and third during a video meeting in order to generate a series of consensus based prevention, assessment, diagnosis, and management of lymphoedema in LMIC practice points. RESULTS Of sixteen participants invited, ten members completed stage 1 of the NGT (ideas generation), of whom six contributed to stages 2 (round-robin) and 3 (clarification). All those who completed stage 1 also completed stages 4 (refinement) and 5 (verification). Practice points unanimously agreed on included Complex Decongestive Therapy (CDT) and good skin care, with management to be determined by lymphoedema stage. For podoconiosis-endemic areas, the use of socks and shoes was identified as very important in the prevention of non-filarial lymphoedema and other lymphoedema-causing conditions. Participants indicated that diagnosing lymphoedema using the lymphoscintigraphy and Indocyanine green (ICG) fluorescent lymphography was not possible due to unavailability and cost in LMIC. Surgical procedures for lymphoedema management were unanimously eliminated due to the unavailability of technology, limited workforce, and expensive cost in LMIC. CONCLUSION The consensus-based practice points generated by this project provide healthcare workers with guidance on caring for people with lymphoedema in LMIC. Further development of workforce capacity is needed.
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Affiliation(s)
- Eric Torgbenu
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Buhagiar
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Catholic Diocese of Parramatta, Parramatta, NSW, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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16
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Schaefer I, Heneka N, DiGiacomo M, Panozzo S, Phillips JL. Correction: The importance of developing palliative care quality indicators for the prison setting: why now, and next steps. BMC Palliat Care 2023; 22:89. [PMID: 37420209 DOI: 10.1186/s12904-023-01210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Affiliation(s)
| | - Nicole Heneka
- University of Southern Queensland, Toowoomba, QLD, Australia
| | | | | | - Jane L Phillips
- University of Technology Sydney, Sydney, NSW, Australia.
- Queensland University of Technology, Brisbane, Australia.
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17
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Schaefer I, Heneka N, DiGiacomo M, Panozzo S, Phillips JL. The importance of developing palliative care quality indicators for the prison setting: why now, and next steps. BMC Palliat Care 2023; 22:69. [PMID: 37291537 DOI: 10.1186/s12904-023-01150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/22/2023] [Indexed: 06/10/2023] Open
Abstract
Palliative care is increasingly important in the prison setting, but information about the quality and accessibility of this care is extremely limited. Developing and implementing standardised quality indicators will provide transparency, accountability, and a platform for quality improvement at both local and national levels.
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Affiliation(s)
| | - Nicole Heneka
- University of Southern Queensland, Toowoomba, QLD, Australia
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18
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Virdun C, Garcia M, Phillips JL, Luckett T. Description of patient reported experience measures (PREMs) for hospitalised patients with palliative care needs and their families, and how these map to noted areas of importance for quality care: A systematic review. Palliat Med 2023:2692163231169319. [PMID: 37092501 DOI: 10.1177/02692163231169319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The global need for focused improvements in palliative care within the acute hospital setting is well noted. A large volume of evidence exists detailing what hospitalised patients with palliative care needs and their families note as important for high quality care. Patient Reported Experience Measures (PREMs) are one mechanism that hospitals could use to inform improvement work. To date there has not been a review of PREMs available for hospitalised patients with palliative care needs and/or their family, nor how they align with noted priorities for high quality care. AIM To identify and describe PREMs designed for hospitalised patients with palliative care needs and their families; and their alignment with patient and family identified domains for high quality care. DESIGN A systematic review. DATA SOURCES A systematic search of CINAHL, Medline and PsycInfo was conducted up to September 23, 2022 and supplemented by handsearching article reference lists and internet searches. PREMs written in English and designed for patients with palliative care needs in acute hospitals were eligible for inclusion. Included PREMs were described by: summarising key characteristics; and mapping their items to domains noted to be important to hospitalised patients with palliative care needs and their families informed by outcomes from a published study completed in 2021. Evidence for psychometric properties were reviewed. RESULTS Forty-four PREMs with 827 items were included. Items per PREM varied from 2 to 85 (median 25, IQR 13-42). Two-thirds (n = 534, 65%) of the items were designed for families and a third (n = 283, 34%) for hospitalised patients, and very few (n = 10, 1%) for both. Sixty-six percent of items measured person-centred care, 30% expert care and 4% environmental aspects of care. Available PREMs address between 1 and 11 of the 14 domains of importance for quality palliative care. PREMs had a median of 38% (IQR 25.4-56.3) of items >Grade 8 measured by the Flesch-Kincaid readability test, with Grade 8 or lower recommended to ensure health information is as accessible as possible across the population. CONCLUSIONS Whilst 44 PREMs are available for hospitalised patients with palliative care needs or their families, a varied number of items are available for some domains of care provision that are important, compared to others. Few are suitable for people with lower levels of literacy or limited cognitive capacity due to illness.
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Affiliation(s)
- Claudia Virdun
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Maja Garcia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
| | - Tim Luckett
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, NSW, Australia
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19
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McCaffrey N, Cheah SL, Luckett T, Phillips JL, Agar M, Davidson PM, Boyle F, Shaw T, Currow DC, Lovell M. Treatment patterns and out-of-hospital healthcare resource utilisation by patients with advanced cancer living with pain: An analysis from the Stop Cancer PAIN trial. PLoS One 2023; 18:e0282465. [PMID: 36854021 PMCID: PMC9974128 DOI: 10.1371/journal.pone.0282465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND About 70% of patients with advanced cancer experience pain. Few studies have investigated the use of healthcare in this population and the relationship between pain intensity and costs. METHODS Adults with advanced cancer and scored worst pain ≥ 2/10 on a numeric rating scale (NRS) were recruited from 6 Australian oncology/palliative care outpatient services to the Stop Cancer PAIN trial (08/15-06/19). Out-of-hospital, publicly funded services, prescriptions and costs were estimated for the three months before pain screening. Descriptive statistics summarize the clinico-demographic variables, health services and costs, treatments and pain scores. Relationships with costs were explored using Spearman correlations, Mann-Whitney U and Kruskal-Wallis tests, and a gamma log-link generalized linear model. RESULTS Overall, 212 participants had median worst pain scores of five (inter-quartile range 4). The most frequently prescribed medications were opioids (60.1%) and peptic ulcer/gastro-oesophageal reflux disease (GORD) drugs (51.6%). The total average healthcare cost in the three months before the census date was A$6,742 (95% CI $5,637, $7,847), approximately $27,000 annually. Men had higher mean healthcare costs than women, adjusting for age, cancer type and pain levels (men $7,872, women $4,493, p<0.01) and higher expenditure on prescriptions (men $5,559, women $2,034, p<0.01). CONCLUSIONS In this population with pain and cancer, there was no clear relationship between healthcare costs and pain severity. These treatment patterns requiring further exploration including the prevalence of peptic ulcer/GORD drugs, and lipid lowering agents and the higher healthcare costs for men. TRIAL REGISTRATION ACTRN12615000064505. World Health Organisation unique trial number U1111-1164-4649. Registered 23 January 2015.
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Affiliation(s)
- Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood Campus, Burwood, VIC, Australia
- * E-mail:
| | - Seong Leang Cheah
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Jane L. Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove Brisbane, Queensland
| | - Meera Agar
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Patricia M. Davidson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital North Sydney, and University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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20
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Lee J, Currow D, Lovell M, Phillips JL, McLachlan A, Ritchie M, Brown L, Fazekas B, Aggarwal R, Seah D, Sheehan C, Chye R, Noble B, McCaffrey N, Aggarwal G, George R, Kow M, Ayoub C, Linton A, Sanderson C, Mittal D, Rao A, Prael G, Urban K, Vandersman P, Agar M. Lidocaine for Neuropathic Cancer Pain (LiCPain): study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e066125. [PMID: 36810169 PMCID: PMC9945039 DOI: 10.1136/bmjopen-2022-066125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Many patients experience unrelieved neuropathic cancer-related pain. Most current analgesic therapies have psychoactive side effects, lack efficacy data for this indication and have potential medication-related harms. The local anaesthetic lidocaine (lignocaine) has the potential to help manage neuropathic cancer-related pain when administered as an extended, continuous subcutaneous infusion. Data support lidocaine as a promising, safe agent in this setting, warranting further evaluation in robust, randomised controlled trials. This protocol describes the design of a pilot study to evaluate this intervention and explains the pharmacokinetic, efficacy and adverse effects evidence informing the design. METHODS AND ANALYSIS A mixed-methods pilot study will determine the feasibility of an international first, definitive phase III trial to evaluate the efficacy and safety of an extended continuous subcutaneous infusion of lidocaine for neuropathic cancer-related pain. This study will comprise: a phase II double-blind randomised controlled parallel-group pilot of subcutaneous infusion of lidocaine hydrochloride 10% w/v (3000 mg/30 mL) or placebo (sodium chloride 0.9%) over 72 hours for neuropathic cancer-related pain, a pharmacokinetic substudy and a qualitative substudy of patients' and carers' experiences. The pilot study will provide important safety data and help inform the methodology of a definitive trial, including testing proposed recruitment strategy, randomisation, outcome measures and patients' acceptability of the methodology, as well as providing a signal of whether this area should be further investigated. ETHICS AND DISSEMINATION Participant safety is paramount and standardised assessments for adverse effects are built into the trial protocol. Findings will be published in a peer-reviewed journal and presented at conferences. This study will be considered suitable to progress to a phase III study if there is a completion rate where the CI includes 80% and excludes 60%. The protocol and Patient Information and Consent Form have been approved by Sydney Local Health District (Concord) Human Research Ethics Committee 2019/ETH07984 and University of Technology Sydney ETH17-1820. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617000747325.
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Affiliation(s)
- Jessica Lee
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David Currow
- University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Melanie Lovell
- Greenwich Palliative and Supportive Care Services, HammondCare, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andrew McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan Ritchie
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Linda Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Rajesh Aggarwal
- Palliative Care, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Davinia Seah
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Richard Chye
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Beverly Noble
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Ghauri Aggarwal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Rachel George
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Marian Kow
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Chadi Ayoub
- Cardiology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Anthony Linton
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Dipti Mittal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Angela Rao
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Grace Prael
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Katalin Urban
- Palliative Care, Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care Death & Dying, Flinders University, Adelaide, South Australia, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Sydney South West Area Health Service, Liverpool, New South Wales, Australia
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Lobb EA, Halkett GKB, McDougall E, Campbell R, Dhillon HM, Phillips JL, Nowak AK. Bereavement outcomes of carers of patients with high grade glioma: Experiences of support before and after the death. Death Stud 2023:1-10. [PMID: 36786747 DOI: 10.1080/07481187.2023.2167888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Carers of people with High Grade Glioma (HGG) completed a survey assessing their anxiety, depression, and grief in addition to open-ended questions exploring their experiences of support pre- and post-death (N = 25). One-third reported borderline or clinical levels of anxiety, depression, and grief related distress. Given the poor prognosis and rapid deterioration of patients with HGG, the findings highlight the importance of sensitive communication about prognosis early in the disease trajectory, information tailored to disease stage, the initiation of a referral to psychological support services, and timely discussions about the preferred place of care and death.
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Affiliation(s)
- Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Nedlands, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
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Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
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Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
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23
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Torgbenu E, Luckett T, Buhagiar MA, Phillips JL. Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle) 2023; 12:15-27. [PMID: 35196892 DOI: 10.1089/wound.2021.0149] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Significance: Lymphedema is a common, distressing and debilitating condition with various etiologies. Effective diagnosis, assessment, and management rely on evidence-based clinical practice guidelines ("guidelines"). This study aims to describe and compare international guidelines on lymphedema diagnosis, assessment, and management. Recent Advances: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and registered on the International Prospective Register of Systematic Reviews (PROSPERO). Systematic searches of electronic literature databases and the web were completed in December 2020 for lymphedema guidelines published in English since 2000. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE)-II reporting checklist. Synthesis took a narrative approach to compare guideline recommendations and associated levels of evidence. Critical Issues: This systematic review of 1,564 articles and 159 web pages yielded 14 guidelines. All guidelines were from high-income countries. Ten focused exclusively on lymphedema, and four on cancer. Most (n = 13) guidelines recommended an integrated medical, psychological assessment, and physical examination, with a limb volume measurement of >10% in the affected limb compared, confirming a lymphedema diagnosis. Recommended management involved Complex Decongestive Therapy (CDT) followed by self-management using skincare, self-lymphatic drainage massage, exercise, and compression. Future Directions: The underlying etiology of lymphedema appeared to make little difference to guideline recommendations regarding care. High-quality guidelines are available to guide lymphedema care. However, their suitability for low-resource settings is unclear.
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Affiliation(s)
- Eric Torgbenu
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia.,Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Mark A Buhagiar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia.,Catholic Diocese of Parramatta, Parramatta, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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24
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White S, McErlean G, Virdun C, Phillips JL, Jacobs C. Integrating Genomics into the Care of People with Palliative Needs: A Global Scoping Review of Policy Recommendations. Public Health Genomics 2022; 26:1-15. [PMID: 36380618 DOI: 10.1159/000527963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/31/2022] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Genomics has growing relevance to palliative care, where testing largely benefits relatives. Integrating genomics into palliative care has not received the critical attention it requires. Health professionals report a lack of policy guidance to support them to overcome practice barriers to identify palliative patients who are eligible for genetic testing, provide genetic counselling, and facilitate genetic testing or DNA storage. SUMMARY To identify policy recommendations related to (1) integrating genomics into the care of patients with palliative care needs and their families and (2) care of the family unit, we performed a scoping review of palliative care and genomic policies. Two of 78 policies recommended integrating genomics into palliative care. Six palliative care policies mentioned genomics in background information but were without relevant recommendations. No genomic policies mentioned palliative care in the background information. Across all policies, "delivering family centred care" was the most frequent recommendation related to care of the family unit (n = 62/78, 79.5%). KEY MESSAGES We identified a policy gap related to integrating genomics into palliative care. Without policy guidance, health services are less likely to commit funding towards supporting health professionals. Without funding, delivering the benefits of genomics to patients and relatives is more difficult for health professionals. Framing recommendations about genomics as family centred care may resonate with genomic and palliative care stakeholders. These findings highlight an opportunity to improve the policy landscape and access to genomic information for patients with palliative care needs. We call for incorporation of appropriate recommendations into palliative care and genomic policy.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Gemma McErlean
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Claudia Virdun
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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25
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Rao A, DiGiacomo M, Phillips JL, Hickman LD. Health professionals' perspectives of integrating meditation into cardiovascular care: A descriptive qualitative study. Health Soc Care Community 2022; 30:e4450-e4460. [PMID: 35611693 PMCID: PMC10084326 DOI: 10.1111/hsc.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Preliminary research suggests that meditation may provide benefits in psychological health and well-being in people with cardiovascular disease (CVD). However, little is known about health professionals' perceptions of the barriers and facilitators to integrating meditation into CVD. A descriptive qualitative study design with semi-structured interviews was used to explore the acceptability of integrating meditation into outpatient CVD programs and the organisational factors that may affect its integration. Clinicians were recruited through purposive and snowball sampling. E-mail addresses were obtained from publicly listed profiles of cardiovascular and relevant health organisations. Interview questions included perspectives of organising or delivering meditation within a health setting, format of meditation delivery, organisational or other factors that facilitate or present barriers to integrating meditation into clinical practice, and perceived risks associated with integrating meditation in clinical settings. Verbatim transcripts were thematically analysed using an inductive approach and the Braun and Clarke (2006) method to identify themes within barriers and facilitators to implementation. Eighteen predominately female (61%) senior nursing and medical professionals (61%), as well as health managers (17%), psychologists (11%) and allied health professionals (11%), aged 40-60 years were interviewed between 18 May 2017 and 29 March 2018 in Australia via telephone, or face-to-face at a university or the participants' workplace. Three key themes were identified including: enhancing awareness of meditation within a biomedical model of care, building the evidence for meditation in CVD and finding an organisational fit for meditation in cardiovascular care. Meditation was perceived to sit outside the existing health service structure, which prioritised the delivery of medical care. Health professionals perceived that some physicians did not recognise the potential for meditation to improve cardiovascular outcomes while others acknowledged meditation's positive benefits as a safe, low-cost strategy. The benefits of meditation were perceived as subjective, based on preliminary evidence. Health professionals perceived that aligning meditation with health organisational objectives and integrating meditation into outpatient cardiac rehabilitation and community-based secondary prevention pathways is needed. A fully powered clinical trial is required to strengthen the evidence regarding the role of meditation for psychological health in CVD. Generating clinician engagement and support is necessary to enhance awareness of meditation's use in cardiovascular secondary prevention.
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Affiliation(s)
- Angela Rao
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Jane L. Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
- School of NursingQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Louise D. Hickman
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
- University of WollongongWollongongNew South WalesAustralia
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White S, Turbitt E, Phillips JL, Jacobs C. Approaching discussions about genetics with palliative patients and their families: a qualitative exploration with genetic health professionals. Eur J Hum Genet 2022:10.1038/s41431-022-01179-7. [PMID: 36064787 PMCID: PMC9441822 DOI: 10.1038/s41431-022-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
Genetic information can provide clinical benefits to families of palliative patients. However, integration of genetics into mainstream medicine has not focused on palliative populations. We explored the views and experiences of genetic health professionals in addressing genetics with palliative patients, and their families. We conducted an interpretive descriptive qualitative study with genetic counsellors and clinical geneticists using interviews and focus groups. Findings were generated using reflexive thematic analysis. Three themes were identified: (1) Focusing on the benefit to the family, (2) The discomfort of addressing genetics near end-of-life and (3) "It's always on the back-burner": Challenges to getting genetics on the palliative care agenda. Participants discussed the familial benefit of genetics in palliative care alongside the challenges when patients are near end-of-life. They perceived genetics as low priority for palliative care due to misunderstandings related to the value of genetic information. Acknowledging the challenges in the palliative care context, genetic health professionals want improved service leadership and awareness of the familial benefits of palliative genetic testing. Strong leadership to support genetic health professionals in addressing these barriers is needed for the benefits of genetic information to be realised.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Green A, Hosie A, Phillips JL, Kochovska S, Noble B, Brassil M, Cumming A, Lawlor PG, Bush SH, Davis JM, Edwards L, Hunt J, Wilcock J, Phillipson C, Wesley Ely E, Parr C, Lovell M, Agar M. Stakeholder perspectives of a pilot multicomponent delirium prevention intervention for adult patients with advanced cancer in palliative care units: A behaviour change theory-based qualitative study. Palliat Med 2022; 36:1273-1284. [PMID: 36062724 DOI: 10.1177/02692163221113163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Theory-based and qualitative evaluations in pilot trials of complex clinical interventions help to understand quantitative results, as well as inform the feasibility and design of subsequent effectiveness and implementation trials. AIM To explore patient, family, clinician and volunteer ('stakeholder') perspectives of the feasibility and acceptability of a multicomponent non-pharmacological delirium prevention intervention for adult patients with advanced cancer in four Australian palliative care units that participated in a phase II trial, the 'PRESERVE pilot study'. DESIGN A trial-embedded qualitative study via semi-structured interviews and directed content analysis using Michie's Behaviour Change Wheel and the Theoretical Domains Framework. SETTING/PARTICIPANTS Thirty-nine people involved in the trial: nurses (n = 17), physicians (n = 6), patients (n = 6), family caregivers (n = 4), physiotherapists (n = 3), a social worker, a pastoral care worker and a volunteer. RESULTS Participants' perspectives aligned with the 'capability', 'opportunity' and 'motivation' domains of the applied frameworks. Of seven themes, three were around the alignment of the delirium prevention intervention with palliative care (intervention was considered routine care; intervention aligned with the compassionate and collaborative culture of palliative care; and differing views of palliative care priorities influenced perspectives of the intervention) and four were about study processes more directly related to adherence to the intervention (shared knowledge increased engagement with the intervention; impact of the intervention checklist on attention, delivery and documentation of the delirium prevention strategies; clinical roles and responsibilities; and addressing environmental barriers to delirium prevention). CONCLUSION This theory-informed qualitative study identified multiple influences on the delivery and documentation of a pilot multicomponent non-pharmacological delirium prevention intervention in four palliative care units. Findings inform future definitive studies of delirium prevention in palliative care.Australian New Zealand Clinical Trials Registry, ACTRN12617001070325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373168.
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Affiliation(s)
- Anna Green
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Annmarie Hosie
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing & Midwifery, The University of Notre Dame Australia, Darlinghurst, NSW, Australia.,St Vincent's Health Network Sydney, Darlinghurst, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia
| | - Slavica Kochovska
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Beverly Noble
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Meg Brassil
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Anne Cumming
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Peter G Lawlor
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Jan Maree Davis
- Department of Palliative Care, Calvary Health Care Kogarah, Kogarah, NSW, Australia
| | - Layla Edwards
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane Hunt
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Julie Wilcock
- Ingham Institute, Liverpool Hospital, Liverpool, NSW, Australia
| | - Carl Phillipson
- Central Adelaide Palliative Care Service, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Eugene Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Cynthia Parr
- HammondCare, Greenwich Hospital, Greenwich, NSW, Australia
| | - Melanie Lovell
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.,HammondCare, Greenwich Hospital, Greenwich, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Meera Agar
- Faculty of Health, IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, NSW, Australia.,South West Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
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Caperchione CM, Sharp P, Phillips JL, Agar M, Liauw W, Harris CA, Marin E, McCullough S, Lilian R. Bridging the gap between attitudes and action: A qualitative exploration of clinician and exercise professional's perceptions to increase opportunities for exercise counselling and referral in cancer care. Patient Educ Couns 2022; 105:2489-2496. [PMID: 34823926 DOI: 10.1016/j.pec.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to 1) understand factors impacting the implementation of exercise communication and referral, and 2) explore integrated clinical approaches to exercise communication and referral in cancer care. METHODS Seven focus groups (N = 53) were conducted with clinicians and exercise professionals throughout Sydney, Australia. A sub-sample of participants (n = 9) attended a half-day workshop to identifying best practice approaches for moving forward. Data were analysed using thematic content analysis. RESULTS Two themes emerged: 1) Factors impacting the knowledge-to-action gap, inclusive of limited exercise specific knowledge and training opportunities, funding structure, and current referral process, and 2) Recommendations for a consistent and efficient way forward, detailing the need for oncologist-initiated communication, distribution of cancer-exercise resources, and access to exercise professionals with cancer expertise. CONCLUSIONS This study identified factors (e.g., cancer-exercise specific training, integration of exercise physiologists) influencing exercise counselling and referral. A potential implementation-referral approach accounting for these factors and how to incorporate exercise into a standard model of cancer care, is described. Future testing is required to determine feasibility and practicality of these approaches. PRACTICAL IMPLICATIONS A pragmatic model is provided to guide implementation-referral, inclusive of oncologist-initiated communication exchange, relevant resources, and access to exercise professionals with cancer expertise.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia; Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Meera Agar
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Translational Cancer Research Network Sydney, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Translational Cancer Research Network Sydney, Australia
| | - Elizabeth Marin
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Ruth Lilian
- Translational Cancer Research Network Sydney, Australia
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Luckett T, Virdun C, Rao A, Daly L, Hackl N, Willems A, Phillips JL. Improving the methods for patient-reported experience measures in palliative care: findings from a cognitive interview study. Ann Palliat Med 2022; 11:2275-2284. [DOI: 10.21037/apm-22-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
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Razmovski-Naumovski V, West PA, Bellemore F, Byfieldt N, Bellamy D, Chye R, Clark K, Martin JH, Fazekas B, Phillips JL, Agar MR. Defining the trials nurses’ role in operationalising a medicinal cannabis clinical trial. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Agar MR, Chang S, Amgarth-Duff I, Garcia MV, Hunt J, Phillips JL, Sinnarajah A, Fainsinger R. Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study. Palliat Med 2022; 36:830-840. [PMID: 35531661 DOI: 10.1177/02692163221082245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration ('hypodermoclysis') has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. AIM To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. DESIGN Multisite, multinational consecutive cohort study. SETTING/PARTICIPANTS Patients receiving hypodermoclysis in an inpatient palliative care setting. RESULTS Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). CONCLUSIONS Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis.
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Affiliation(s)
- Meera R Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Sungwon Chang
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Ingrid Amgarth-Duff
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Maja V Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Jane Hunt
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Aynharan Sinnarajah
- Department of Medicine, Lakeridge Health, Oshawa, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Robin Fainsinger
- Division of Palliative Care Medicine, University of Alberta, Edmonton, AB, Canada
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McDonagh J, Prichard R, Ferguson C, Phillips JL, Davidson PM, Macdonald PS, Newton PJ. Clinician Estimates of Frailty Compared to Formal Frailty Assessment in Adults With Heart Failure: A Cross-Sectional Analysis. Heart Lung Circ 2022; 31:1241-1246. [PMID: 35501244 DOI: 10.1016/j.hlc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/02/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as 'the end-of-the-bed' or 'eyeball' test. AIM To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure. METHODS Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study. PARTICIPANTS (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient. RESULTS A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (±13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45). CONCLUSION Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument.
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Affiliation(s)
- Julee McDonagh
- College of Health, Medicine and Wellbeing/School of Nursing and Midwifery, The University of Newcastle, Gosford, NSW, Australia.
| | - Roslyn Prichard
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Brisbane, Qld, Australia
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia; Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| | | | - Peter S Macdonald
- St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Phillip J Newton
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
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Torgbenu E, Luckett T, Buhagiar M, Requena CM, Phillips JL. Improving care for cancer-related and other forms of lymphoedema in low- and middle-income countries: a qualitative study. BMC Health Serv Res 2022; 22:461. [PMID: 35395942 PMCID: PMC8990607 DOI: 10.1186/s12913-022-07840-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC). AIM To describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators. METHODS An exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants' experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework. RESULTS Nineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care. CONCLUSION Raising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings.
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Affiliation(s)
- Eric Torgbenu
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia. .,School of Allied Sciences, Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia
| | - Mark Buhagiar
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia.,Catholic Diocese of Parramatta, Parramatta, NSW, Australia
| | | | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney NSW, Sydney, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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Luckett T, Roberts M, Smith T, Garcia M, Dunn S, Swan F, Ferguson C, Kochovska S, Phillips JL, Pearson M, Currow DC, Johnson MJ. Implementing the battery-operated hand-held fan as an evidence-based, non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD): a qualitative study of the views of specialist respiratory clinicians. BMC Pulm Med 2022; 22:129. [PMID: 35387636 PMCID: PMC8985391 DOI: 10.1186/s12890-022-01925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction The battery-operated hand-held fan (‘fan’) is an inexpensive and portable non-pharmacological intervention for chronic breathlessness. Evidence from randomised controlled trials suggests the fan reduces breathlessness intensity and improves physical activity in patients with a range of advanced chronic conditions. Qualitative data from these trials suggests the fan may also reduce anxiety and improve daily functioning for many patients. This study aimed to explore barriers and facilitators to the fan’s implementation in specialist respiratory care as a non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD). Methods A qualitative approach was taken, using focus groups. Participants were clinicians from any discipline working in specialist respiratory care at two hospitals. Questions asked about current fan-related practice and perceptions regarding benefits, harms and mechanisms, and factors influencing its implementation. Analysis used a mixed inductive/deductive approach. Results Forty-nine participants from nursing (n = 30), medical (n = 13) and allied health (n = 6) disciplines participated across 9 focus groups. The most influential facilitator was a belief that the fan’s benefits outweighed disadvantages. Clinicians’ beliefs about the fan’s mechanisms determined which patient sub-groups they targeted, for example anxious or palliative/end-stage patients. Barriers to implementation included a lack of clarity about whose role it was to implement the fan, what advice to provide patients, and limited access to fans in hospitals. Few clinicians implemented the fan for acute-on-chronic breathlessness or in combination with other interventions. Conclusion Implementation of the fan in specialist respiratory care may require service- and clinician-level interventions to ensure it is routinely recommended as a first-line intervention for chronic breathlessness in patients for whom this symptom is of concern, regardless of COPD stage.
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Affiliation(s)
- Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
| | - Mary Roberts
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
| | - Maja Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Sarah Dunn
- Respiratory Medicine Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney Local Health District, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Slavica Kochovska
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Building 10, Level 3, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston Upon Hull, Yorkshire, UK
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Schaefer I, DiGiacomo M, Heneka N, Panozzo S, Luckett T, Phillips JL. Palliative care needs and experiences of people in prison: A systematic review and meta-synthesis. Palliat Med 2022; 36:443-461. [PMID: 34965778 DOI: 10.1177/02692163211068278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the prison population is growing and ageing, as is the need for palliative care. Yet, little is known about how people in prison perceive palliative care provision in this setting. AIMS To identify the: (i) perceptions of palliative care provision and dying in custody by people in prison; and (ii) perceived barriers and facilitators of person-centred palliative care provision in prison. DESIGN A systematic review and meta-synthesis was registered and undertaken in accordance with the reporting guidelines. DATA SOURCES Keywords and MeSH headings encompassing (i) palliative care, end-of-life care, death; and (ii) prison; were used to search Pubmed, Medline, CINAHL, PsycINFO, Web of Science, CINCH and ProQuest Central. Articles published in English, from high income countries, and containing qualitative data exploring perceptions of people in prison of palliative care in custody were included. Findings were reporting using the ENTREQ guidelines. FINDINGS Of the 2193 articles identified, 12 were included. Experiences of people in prison regarding palliative care related to two themes: (1) expectations versus experiences of palliative care; and (2) prison context complicates access to and provision of palliative care. People in prison with palliative care needs want to feel safe, cared for, and acknowledged as they face an expected death. The prison environment can severely restrict access to palliative care, leaving people in prison feeling isolated and powerless. CONCLUSIONS People in prison expect to receive high-quality palliative care, but their experiences often do not match their expectations. Numerous structural and organisational challenges complicate the provision of palliative care in prisons, limiting accessibility of care.
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Affiliation(s)
| | | | - Nicole Heneka
- University of Technology Sydney, Sydney, NSW, Australia
| | | | - Tim Luckett
- University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- Queensland University of Technology, Brisbane, QLD, Australia
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Nagarajan SV, Lewis V, Halcomb E, Rhee J, Morton RL, Mitchell GK, Tieman J, Phillips JL, Detering K, Gavin J, Clayton JM. Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study. Aust J Prim Health 2022; 28:151-157. [PMID: 35131028 DOI: 10.1071/py21081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.
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Affiliation(s)
- Srivalli V Nagarajan
- Centre for Learning and Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia; and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and Corresponding author
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Vic., Australia
| | - Elizabeth Halcomb
- School of Nursing, The University of Wollongong, Wollongong, NSW, Australia
| | - Joel Rhee
- Centre for Positive Ageing and Care, HammondCare, Sydney, NSW, Australia; and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Geoffrey K Mitchell
- Mayne Academy of Primary Care, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - Jane L Phillips
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Karen Detering
- Department of Health, Arts and Design, Swinburne University, Melbourne, Vic., Australia
| | - Jennifer Gavin
- Centre for Cancer and Palliative Care Outcomes, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - Josephine M Clayton
- Centre for Learning and Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia; and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Lovell MR, Phillips JL, Luckett T, Lam L, Boyle FM, Davidson PM, Cheah SL, McCaffrey N, Currow DC, Shaw T, Hosie A, Koczwara B, Clarke S, Lee J, Stockler MR, Sheehan C, Spruijt O, Allsopp K, Clinch A, Clark K, Read A, Agar M. Effect of Cancer Pain Guideline Implementation on Pain Outcomes Among Adult Outpatients With Cancer-Related Pain: A Stepped Wedge Cluster Randomized Trial. JAMA Netw Open 2022; 5:e220060. [PMID: 35188554 PMCID: PMC8861847 DOI: 10.1001/jamanetworkopen.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE An evidence-practice gap exists for cancer pain management, and cancer pain remains prevalent and disabling. OBJECTIVES To evaluate the capacity of 3 cancer pain guideline implementation strategies to improve pain-related outcomes for patients attending oncology and palliative care outpatient services. DESIGN, SETTING, AND PARTICIPANTS A pragmatic, stepped wedge, cluster-randomized, nonblinded, clinical trial was conducted between 2014 and 2019. The clusters were cancer centers in Australia providing oncology and palliative care outpatient clinics. Participants included a consecutive cohort of adult outpatients with advanced cancer and a worst pain severity score of 2 or more out of 10 on a numeric rating scale (NRS). Data were collected between August 2015 and May 2019. Data were analyzed July to October 2019 and reanalyzed November to December 2021. INTERVENTIONS Guideline implementation strategies at the cluster, health professional, and patient levels introduced with the support of a clinical champion. MAIN OUTCOMES AND MEASURES The primary measure of effect was the percentage of participants initially screened as having moderate to severe worst pain (NRS ≥ 5) who experienced a clinically important improvement of 30% or more 1 week later. Secondary outcomes included mean average pain, patient empowerment, fidelity to the intervention, and quality of life and were measured in all participants with a pain score of 2 or more 10 at weeks 1, 2, and 4. RESULTS Of 8099 patients screened at 6 clusters, 1564 were eligible, and 359 were recruited during the control phase (mean [SD] age, 64.2 [12.1] years; 196 men [55%]) and 329 during the intervention phase (mean [SD] age, 63.6 [12.7] years; 155 men [47%]), with no significant differences between phases on baseline measures. The mean (SD) baseline worst pain scores were 5.0 (2.6) and 4.9 (2.6) for control and intervention phases, respectively. The mean (SD) baseline average pain scores were 3.5 (2.1) for both groups. For the primary outcome, the proportions of participants with a 30% or greater reduction in a pain score of 5 or more of 10 at baseline were similar in the control and intervention phases (31 of 280 participants [11.9%] vs 30 of 264 participants [11.8%]; OR, 1.12; 95% CI, 0.79-1.60; P = .51). No significant differences were found in secondary outcomes between phases. Fidelity to the intervention was low. CONCLUSIONS AND RELEVANCE A suite of implementation strategies was insufficient to improve pain-related outcomes for outpatients with cancer-related pain. Further evaluation is needed to determine the required clinical resources needed to enable wide-scale uptake of the fundamental elements of cancer pain care. Ongoing quality improvement activities should be supported to improve sustainability.
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Affiliation(s)
- Melanie R. Lovell
- Palliative Care Department, HammondCare, Greenwich, Australia
- Northern Clinical School, Sydney Medical School, Sydney, Australia
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Jane L. Phillips
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Tim Luckett
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Lawrence Lam
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Frances M. Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - Patricia M. Davidson
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- University of Wollongong, Wollongong, Australia
| | - Seong L. Cheah
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Nicola McCaffrey
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Victoria, Australia
| | - David C. Currow
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Tim Shaw
- University of Sydney, Sydney, Australia
| | - Annmarie Hosie
- The University of Notre Dame Australia, School of Nursing Sydney and St Vincent’s Health Network Sydney, Sydney, Australia
| | - Bogda Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Stephen Clarke
- Northern Clinical School, Sydney Medical School, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
| | - Jessica Lee
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Sydney, NSW, Australia
- University of Sydney, Concord Clinical School, Australia
| | - Martin R. Stockler
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Caitlin Sheehan
- Palliative Care Department, South East Sydney Local Health District, Southern Sector, Sydney Australia
| | - Odette Spruijt
- Palliative Care Department, Western Health, University of Melbourne, Melbourne, Australia
| | - Katherine Allsopp
- Palliative Care Department, Westmead Hospital, Westmead, Sydney, Australia
| | - Alexandra Clinch
- Department of Palliative Care, Peter Macallum Cancer Centre, Melbourne, Australia
| | - Katherine Clark
- Northern Clinical School, Sydney Medical School, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
| | - Alison Read
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
| | - Meera Agar
- IMPACCT Centre—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation University of Technology Sydney, Sydney, Australia
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Caperchione CM, Stolp S, Phillips JL, Agar M, Sharp P, Liauw W, Harris CA, McCullough S, Lilian R. Cancer survivors' exercise beliefs, knowledge, and behaviors: An Australian National Survey. Asia Pac J Clin Oncol 2022; 18:625-633. [PMID: 35098655 DOI: 10.1111/ajco.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/03/2021] [Indexed: 11/02/2022]
Abstract
AIMS This study aimed to (1) explore the perceptions of people living with cancer about exercise in general and exercise as an adjunct form of cancer care, (2) explore their perceptions regarding exercise counselling needs and preferences, and (3) investigate how these perceptions of exercise as an adjunct form of cancer care shape survivors exercise levels postcancer diagnosis. METHODS A cross-sectional design and online survey were used to recruit cancer survivors via cancer-related networks throughout Australia. Two factor analyses were conducted to examine the structure and reduce the number of variables pertaining to exercise during and after the cancer treatment. Extracted components were used in one-way analysis of variance to compare differences in physical activity levels postcancer diagnosis. RESULTS Participants (N = 288) had very positive perceptions of exercise, yet only 50% of participants would prefer to receive exercise counselling. Those who were more active postcancer diagnosis had higher exercise beliefs than those who were similarly active (p = 0.04, r = 0.27) and less active (p = 0.03, r = 0.24) postdiagnosis. Those who were less active also had lower exercise knowledge than those who were similarly active (p = 0.01, r = 0.31) and more active (p = 0.03, r = 0.26). Safety beliefs did not significantly differ between cancer survivors' activity levels (p = 0.16) CONCLUSION: This survey highlights the potential benefits of a concentrated effort in connecting survivors to relevant services and resources, and utilizing cancer clinicians to communicate with survivors about the role of exercise in cancer care.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sean Stolp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane L Phillips
- School of Nursing, Queensland University of Technology, Brisbane, QLD.,IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meera Agar
- IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Susan McCullough
- Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Ruth Lilian
- Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
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Rahman B, McEwen A, Phillips JL, Tucker K, Goldstein D, Jacobs C. Genetic and genomic learning needs of oncologists and oncology nurses in the era of precision medicine: a scoping review. Per Med 2022; 19:139-153. [PMID: 35060769 DOI: 10.2217/pme-2021-0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic and genomic data are increasingly guiding clinical care for cancer patients. To meet the growing demand for precision medicine, patient-facing oncology staff will be a part of leading the provision of genomic testing. A scoping review was undertaken to identify the range of genetic and genomic learning needs of oncologists and oncology nurses. Learning needs were reported relating to interpretation of genomic data, clinical decision-making, patient communication and counseling, and fundamentals of genetics and genomics. There was a lack of empirical research specific to oncology nurses and their learning needs in tumor sequencing. Our findings suggest that oncologists and oncology nurses need tailored support, education and training to improve their confidence and skills in adopting genomic testing into clinical practice.
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Affiliation(s)
- Belinda Rahman
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, QLD, Australia.,IMPACCT, University of Technology Sydney, NSW, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, NSW, Australia
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Cahill PJ, Lobb EA, Sanderson CR, Phillips JL. Patients Receiving Palliative Care and Their Families' Experiences of Participating in a "Patient-Centered Family Meeting": A Qualitative Substudy of the Valuing Opinions, Individual Communication, and Experience Feasibility Trial. Palliat Med Rep 2021; 2:305-315. [PMID: 34927156 PMCID: PMC8675095 DOI: 10.1089/pmr.2020.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Family meetings are used in palliative care to facilitate discussion between palliative patients, their families, and the clinical team. However, few studies have undertaken qualitative assessment of the impact of family meetings on patients and their families. Objectives: To explore inpatients receiving palliative care and their families' experiences of participation in a patient-centered family meeting ("Meeting"), where the patient sets the Meeting agenda. Design: This qualitative study used the constant comparative method for thematic content analysis of the data. Setting/Participants: The setting was a specialist palliative care (SPC) inpatient unit in Australia. Nine palliative care inpatients and nine family members were interviewed. Measurements: Semistructured interviews were used evaluate the patients' and their families' experiences and perceptions of the Meeting. Results: Three overarching themes described the experiences of participating in a patient-focused family meeting, namely that the Meeting: (1) provides a forum for inpatients receiving SPC to speak openly about their end-of-life concerns, clarify issues, and is of comfort to patients; (2) provides the family members with a voice, and an opportunity to discuss their concerns and have their needs addressed; and (3) helps to ensure that everyone is "on the same page" and patient care plans can be discussed. Conclusions: These Meetings are a potentially effective means of supporting certain palliative care patients and their families to articulate, confront, and address end-of-life issues in the presence of the interdisciplinary team. It is important to undertake further research to further examine the evidence for this Meeting model and to identify the patients and families who would most benefit from this type of Meeting.
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Affiliation(s)
- Philippa J Cahill
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Elizabeth A Lobb
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,Department of Palliative Care Research, Calvary Palliative and End of Life Care Research Institute, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine R Sanderson
- Department of Palliative Care Research, Calvary Palliative and End of Life Care Research Institute, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.,Palliative Care Facility, Territory Palliative Care, Alice Springs Hospital, Central Australia, Northern Territory, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Tuch G, Soo WK, Luo KY, Frearson K, Oh EL, Phillips JL, Agar M, Lane H. Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review. Curr Oncol 2021; 28:3987-4003. [PMID: 34677257 PMCID: PMC8534877 DOI: 10.3390/curroncol28050339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person's cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.
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Affiliation(s)
- Gina Tuch
- Department of Geriatric Medicine, Alfred Health, Melbourne, VIC 3004, Australia
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia;
- Cancer Services, Eastern Health, Box Hill, VIC 3128, Australia
- Aged Medicine Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Ki-Yung Luo
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Kinglsey Frearson
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Ek Leone Oh
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Jane L. Phillips
- Queensland University of Technology, Brisbane City, QLD 4000, Australia;
| | - Meera Agar
- University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Heather Lane
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
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Hosie A, Agar M, Caplan GA, Draper B, Hedger S, Rowett D, Tuffin P, Cheah SL, Phillips JL, Brown L, Sidhu M, Currow DC. Clinicians' delirium treatment practice, practice change, and influences: A national online survey. Palliat Med 2021; 35:1553-1563. [PMID: 34096396 DOI: 10.1177/02692163211022183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent studies cast doubt on the net effect of antipsychotics for delirium. AIM To investigate the influence of these studies and other factors on clinicians' delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework. DESIGN Australia-wide online survey of relevant clinicians. SETTING/PARTICIPANTS Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals' organisations. RESULTS Most of the sample (n = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents' delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p < 0.001); changed delirium treatment (73% vs 53%, p = 0.017); decreased pharmacological interventions (60% vs 15%, p < 0.001); off-label medication use (86% vs 51%, p < 0.001: antipsychotics 79% vs 44%, p < 0.001; benzodiazepines 61% vs 26%, p < 0.001) and emotion as an influence (82% vs 39%, p < 0.001). CONCLUSION Clinicians' use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.
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Affiliation(s)
- Annmarie Hosie
- The University of Notre Dame Australia, School of Nursing and Midwifery, Darlinghurst, NSW, Australia.,St Vincent's Health Network Sydney, The Cunningham Centre for Palliative Care, Darlinghurst, NSW, Australia
| | - Meera Agar
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Gideon A Caplan
- Prince of Wales Hospital, Prince of Wales Clinical School, Randwick, NSW, Australia.,University of New South Wales, Department of Geriatric Medicine, Randwick, NSW Australia
| | - Brian Draper
- University of New South Wales, School of Psychiatry, Randwick, NSW Australia
| | - Stephen Hedger
- Flinders University, College of Medicine and Public Health, Adelaide, SA, Australia
| | - Debra Rowett
- University of South Australia, Clinical and Heath Sciences, Adelaide, SA, Australia
| | - Penny Tuffin
- Royal Perth Hospital, Palliative Care Department and Pain Service, Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Seong Leang Cheah
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Jane L Phillips
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia.,Queensland University of Technology, School of Nursing, Brisbane, QLD, Australia
| | - Linda Brown
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - Manraaj Sidhu
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
| | - David C Currow
- University of Technology Sydney, Faculty of Health, Improving Palliative, Aged and Chronic Care through Research and Translation, Ultimo, NSW, Australia
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Phillips JL, Schaefer I. Dying an expected death in prison: a growing reality. Int J Palliat Nurs 2021; 27:278-279. [PMID: 34459243 DOI: 10.12968/ijpn.2021.27.6.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jane L Phillips
- Head School of Nursing, Queensland University of Technology, Brisbane and Professor Emerita Nursing (Palliative Care) IMPACCT, Faculty of Health, University of Technology Sydney, Australia
| | - Isabelle Schaefer
- Palliative Care in Prisons Project, National Palliative Care Project and Doctoral Candidate, IMPACCT, Faculty of Health, University of Technology Sydney
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Rao A, Zecchin R, Byth K, Denniss AR, Hickman LD, DiGiacomo M, Phillips JL, Newton PJ. The Role of Lifestyle and Cardiovascular Risk Factors in Dropout From an Australian Cardiac Rehabilitation Program. A Longitudinal Cohort Study. Heart Lung Circ 2021; 30:1891-1900. [PMID: 34219025 DOI: 10.1016/j.hlc.2021.05.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. AIMS To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. METHODS The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. RESULTS Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0-24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9-3.0), being separated or divorced (OR 2.0; 95%CI: 1.5-2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6-2.4), obesity (OR 1.6; 95%CI: 1.3-2.0), diabetes (OR 1.6; 95%CI: 1.3-2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1-1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1-1.6). CONCLUSION To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients' ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.
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Affiliation(s)
- Angela Rao
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Calvary Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia.
| | - Robert Zecchin
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Karen Byth
- Western Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - A Robert Denniss
- Western Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - Louise D Hickman
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Parker KJ, Phillips JL, Luckett T, Agar M, Ferguson C, Hickman LD. Analysis of discharge documentation for older adults living with dementia: A cohort study. J Clin Nurs 2021; 30:3634-3643. [PMID: 34109693 DOI: 10.1111/jocn.15885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older adults living with dementia frequently transition between healthcare settings. Care transitions increase vulnerability and risk of iatrogenic harm. AIM AND OBJECTIVE To examine the quality of transitional care arrangements within discharge documentation for older people living with dementia. DESIGN Secondary analysis of cohort study data. METHOD A secondary analysis of the IDEAL Study [ACTRN12612001164886] discharge documents, following the STROBE guidelines. Participants had a confirmed diagnosis of dementia and were discharged from hospital to a nursing home. An audit tool was used to extract the data. This was developed through a synthesis of existing tools and finalised by an expert panel. The analysis assessed the quality of discharge documentation, in the context of transitional care needs, and presented results using descriptive statistics. Functional ability; physical health; cognition and mental health; medications; and socio environmental factors were assessed. RESULTS Sixty participants were included in analyses, and half were male (52%), with a total participant mean age of 83 (SD 8.7) years. There was wide variability in the quality of core discharge information, ranging from excellent (37%), adequate (43%) to poor (20%). A sub-group of these core discharge documentation elements that detailed the participants transitional care needs were rated as follows: excellent (17%), adequate (46%) and poor (37%). CONCLUSION Discharge documentation fails to meet needs of people living with dementia. Improving the quality of discharge documentation for people living with dementia transitioning from hospital to nursing home is critical to provide safe and quality care. RELEVANCE TO CLINICAL PRACTICE There is a need for safe, timely, accurate and comprehensive discharge information to ensure the safety of people living with dementia and prevent adverse harm.
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Affiliation(s)
- Kirsten J Parker
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, NSW, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, NSW, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, NSW, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown, NSW, Australia
| | - Louise D Hickman
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Bhattarai P, Newton-John T, Phillips JL. Apps for Older People's Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians. Pain Med 2021; 21:686-694. [PMID: 31502649 DOI: 10.1093/pm/pnz218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients' self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain. METHODS Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia. RESULTS The overarching theme underlying participants' views on integration of apps into older people's pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians' involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access. DISCUSSION The predominant clinician perspective of integrating apps into their older patients/clients' pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients' self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).
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Affiliation(s)
- Priyanka Bhattarai
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | | | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Garcia MV, Agar MR, Soo WK, To T, Phillips JL. Screening Tools for Identifying Older Adults With Cancer Who May Benefit From a Geriatric Assessment: A Systematic Review. JAMA Oncol 2021; 7:616-627. [PMID: 33443547 DOI: 10.1001/jamaoncol.2020.6736] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Older adults with cancer are at risk of overtreatment or undertreatment when decision-making is based solely on chronological age. Although a geriatric assessment is recommended to inform care, the time and expertise required limit its feasibility for all patients. Screening tools offer the potential to identify those who will benefit most from a geriatric assessment. Consensus about the optimal tool to use is lacking. Objective To appraise the evidence on screening tools used for older adults with cancer and identify an optimal screening tool for older adults with cancer who may benefit from geriatric assessment. Evidence Review Systematic review of 4 databases (MEDLINE, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and PubMed) with narrative synthesis from January 1, 2000, to March 14, 2019. Studies reporting on the diagnostic accuracy and use of validated screening tools to identify older adults with cancer who need a geriatric assessment were eligible for inclusion. Data were analyzed from March 14, 2019, to March 23, 2020. Findings Seventeen unique studies were included, reporting on the use of 12 screening tools. Most studies were prospective cohort studies (n = 11) with only 1 randomized clinical trial. Not all studies reported time taken to administer the screening tools. The Geriatric-8 (G8) (n = 12) and the Vulnerable Elders Survey-13 (VES-13) (n = 9) were the most frequently evaluated screening tools. The G8 scored better in sensitivity and the VES-13 in specificity. Other screening tools evaluated include the Groningen Frailty Index, abbreviated comprehensive geriatric assessment, and Physical Performance Test in 2 studies each. All other screening tools were evaluated in 1 study each. Conclusions and Relevance To date, the G8 and VES-13 have the most evidence to recommend their use to inform the need for geriatric assessment. When choosing a screening tool, clinicians will need to weigh the tradeoffs between sensitivity and specificity. Future research needs to further validate or improve current screening tools and explore other factors that can influence their use, such as ease of use and resourcing.
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Affiliation(s)
- Maja V Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Meera R Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Wee-Kheng Soo
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Cancer Services, Eastern Health, Melbourne, Australia.,Department of Aged Medicine, Eastern Health, Victoria, Australia
| | - Timothy To
- Division of Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, Australia.,Flinders University College of Nursing and Health Sciences, Bedford Park, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Donkor A, Luckett T, Aranda S, Vanderpuye V, Phillips JL. Development of the 'REadiness SElf-assessment (RESEA) guide' to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project. BMC Health Serv Res 2021; 21:268. [PMID: 33757517 PMCID: PMC7988910 DOI: 10.1186/s12913-021-06274-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/14/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs' radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services. METHODS The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation's 'Innovative Care for Chronic Conditions Framework' and 'Health System Building Blocks Framework for Action' conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously published components comprising a systematic review and two-part qualitative study (semi-structured interviews and a participant validation process). The meta-inferences enabled a series of radiotherapy readiness self-assessment requirements to be generated, formalised as a REadiness SElf-Assessment (RESEA) Guide' for use by LMICs. FINDINGS The meta-inferences identified a large number of factors that acted as facilitators and/or barriers, depending on the situation, which include: awareness and advocacy; political leadership; epidemiological data; financial resources; basic physical infrastructure; radiation safety legislative and regulatory framework; project management; and radiotherapy workforce training and education. 'Commitment', 'cooperation', 'capacity' and 'catalyst' were identified as the key domains enabling development of radiotherapy services. Across these four domains, the RESEA Guide included 37 requirements and 120 readiness questions that LMICs need to consider and answer as part of establishing a new radiotherapy service. CONCLUSIONS The RESEA Guide provides a new resource for LMICs to self-assess their capacity to establish safe and sustainable radiotherapy services. Future evaluation of the acceptability and feasibility of the RESEA Guide is needed to inform its validity. Further work, including field study, is needed to inform further refinements. Exploratory and confirmatory factor analyses are required to reduce the data set and test the fit of the four-factor structure (commitment, cooperation, capacity and catalyst) found in the current study.
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Affiliation(s)
- Andrew Donkor
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia. .,National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sanchia Aranda
- Faculty of Health and CEO, Cancer Council Australia, University of Technology Sydney, Sydney, NSW, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Kochovska S, Ferreira DH, Garcia MV, Phillips JL, Currow DC. Perspectives on palliative oxygen for breathlessness: systematic review and meta-synthesis. Eur Respir J 2021; 58:13993003.04613-2020. [PMID: 33653807 DOI: 10.1183/13993003.04613-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/15/2021] [Indexed: 12/16/2022]
Abstract
Oxygen therapy is frequently prescribed for the palliation of breathlessness, despite lack of evidence for its effectiveness in people who are not hypoxaemic. This study aimed to compare and contrast patients', caregivers' and clinicians' experiences of palliative oxygen use for the relief of chronic breathlessness in people with advanced life-limiting illnesses, and how this shapes prescribing.A systematic review and meta-synthesis of qualitative data was conducted. MEDLINE, CINAHL and PsycINFO were searched for peer-reviewed studies in English (2000-April 2019) reporting perspectives on palliative oxygen use for reducing breathlessness in people with advanced illnesses in any healthcare setting. After data extraction, thematic synthesis used line-by-line coding of raw data (quotes) to generate descriptive and analytical themes.Of 457 articles identified, 22 met the inclusion criteria by reporting perspectives of patients (n=337), caregivers (n=91) or clinicians (n=616). Themes common to these perspectives were: 1) benefits and burdens of palliative oxygen use, 2) knowledge and perceptions of palliative oxygen use beyond the guidelines, and 3) longitudinal trajectories of palliative oxygen use.There are differing perceptions regarding the benefits and burdens of using palliative oxygen. Clinicians should be aware that oxygen use may generate differing goals of therapy for patients and caregivers. These perceptions should be taken into consideration when prescribing oxygen for the symptomatic relief of chronic breathlessness in patients who do not quality for long-term oxygen therapy.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia.,These authors are joint first authors
| | - Diana H Ferreira
- Palliative and Supportive Services, Flinders University, Adelaide, Australia.,These authors are joint first authors
| | - Maja V Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia .,Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
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Kochovska S, Agar MR, Phillips JL, Tieman J, Sheehan C, Clark K, Currow DC. Applying evidence-based symptomatic treatments from other clinical disciplines to palliative care. Palliat Med 2021; 35:458-460. [PMID: 33641525 DOI: 10.1177/0269216321996984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Meera R Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jennifer Tieman
- Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia
| | | | - Katherine Clark
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Northern Sydney Local Health District Cancer and Palliative Care Network, Sydney, NSW, Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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