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Wang Y, Koffman J, Gao W, Zhou Y, Chukwusa E, Curcin V. Social media for palliative and end-of-life care research: a systematic review. BMJ Support Palliat Care 2024; 14:149-162. [PMID: 38594059 PMCID: PMC11103321 DOI: 10.1136/spcare-2023-004579] [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: 08/28/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Social media with real-time content and a wide-reaching user network opens up more possibilities for palliative and end-of-life care (PEoLC) researchers who have begun to embrace it as a complementary research tool. This review aims to identify the uses of social media in PEoLC studies and to examine the ethical considerations and data collection approaches raised by this research approach. METHODS Nine online databases were searched for PEoLC research using social media published before December 2022. Thematic analysis and narrative synthesis approach were used to categorise social media applications. RESULTS 21 studies were included. 16 studies used social media to conduct secondary analysis and five studies used social media as a platform for information sharing. Ethical considerations relevant to social media studies varied while 15 studies discussed ethical considerations, only 6 studies obtained ethical approval and 5 studies confirmed participant consent. Among studies that used social media data, most of them manually collected social media data, and other studies relied on Twitter application programming interface or third-party analytical tools. A total of 1 520 329 posts, 325 videos and 33 articles related to PEoLC from 2008 to 2022 were collected and analysed. CONCLUSIONS Social media has emerged as a promising complementary research tool with demonstrated feasibility in various applications. However, we identified the absence of standardised ethical handling and data collection approaches which pose an ongoing challenge. We provided practical recommendations to bridge these pressing gaps for researchers wishing to use social media in future PEoLC-related studies.
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Affiliation(s)
- Yijun Wang
- Department of Population Health Sciences, King's College London, London, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Wei Gao
- Epidemiology & Health Statistics, Nanchang University, Nanchang, China
| | - Yuxin Zhou
- Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Vasa Curcin
- Department of Population Health Sciences, King's College London, London, UK
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2
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McFarlane PG, Bunce C, Sleeman KE, Orlovic M, Koffman J, Rosling J, Bearne A, Powell M, Riley J, Droney J. Advance care planning before and during COVID-19: evaluation of 73,675 patients' records. BJGP Open 2024:BJGPO.2023.0145. [PMID: 38688533 DOI: 10.3399/bjgpo.2023.0145] [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: 08/09/2023] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) was encouraged by policymakers throughout the COVID-19 pandemic. Little is known about use of ACP during this time. AIM To compare use of ACP before and during the COVID-19 pandemic. DESIGN & SETTING Retrospective, observational cohort study, comparing the creation, use and content of Electronic Palliative Care Co-ordination System records in London. Individuals aged 18+ with a Coordinate My Care Record, created and published in the pre-pandemic period (01/01/2018-31/12/2019), Wave1 (W1) (20/03/2020-04/07/2020), and Wave2 (W2) (01/10/2020-05/03/2021). METHOD Patient demographics and components of ACP were compared using descriptive and comparative statistics. RESULTS 73,675 records were included; 35,108 pre-pandemic, 21,235 W1, 9,925 W2. Most records were created in primary care (56% pre-COVID, 76% in W1 and 48% in W2).Compared to the pre-pandemic period, the average weekly number of records created increased by 297% W1 (P<0.005) and 29.1% W2 (P<0.005). Patients with records created during the pandemic were younger (61% aged 80+ W1, 59% W2, 65% pre-pandemic (P<0.005)). Patients with records created in W1 had longer estimated prognoses at record creation (73% had an estimated prognosis of 1 year+ W1 vs 53% pre-pandemic (P<0.005)) and were more likely to be "For Resuscitation" (38% W1 vs 30% pre-pandemic (P<0.005)). CONCLUSION During the COVID-19 pandemic, increased ACP activity was observed, especially in primary care, and for younger people and those not imminently dying. Further research is needed to identify training and planning requirements as well as organisational and system changes to support sustained high-quality ACP within primary care.
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Affiliation(s)
- Philippa G McFarlane
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- The Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Katherine E Sleeman
- The Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Martina Orlovic
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Heslington, United Kingdom
| | - John Rosling
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alastair Bearne
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Margaret Powell
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julia Riley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Joanne Droney
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
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3
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Gross J, Koffman J. Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One 2024; 19:e0299933. [PMID: 38498549 PMCID: PMC10947705 DOI: 10.1371/journal.pone.0299933] [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: 09/12/2023] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patient involvement in goals of care decision-making has shown to enhance satisfaction, affective-cognitive outcomes, allocative efficiency, and reduce unwarranted clinical variation. However, the involvement of patients in goals of care planning within hospitals remains limited, particularly where mismatches in shared understanding between doctors and patients are present. AIM To identify and critically examine factors influencing goals of care conversations between doctors and patients during acute hospital illness. DESIGN Realist systematic review following the RAMESES standards. A protocol has been published in PROSPERO (CRD42021297410). The review utilised realist synthesis methodology, including a scoping literature search to generate initial theories, theory refinement through stakeholder consultation, and a systematic literature search to support program theory. DATA SOURCES Data were collected from Medline, PubMed, Embase, CINAHL, PsychINFO, Scopus databases (1946 to 14 July 2023), citation tracking, and Google Scholar. Open-Grey was utilized to identify relevant grey literature. Studies were selected based on relevance and rigor to support theory development. RESULTS Our analysis included 52 papers, supporting seven context-mechanism-output (CMO) hypotheses. Findings suggest that shared doctor-patient understanding relies on doctors being confident, competent, and personable to foster trusting relationships with patients. Low doctor confidence often leads to avoidance of discussions. Moreover, information provided to patients is often inconsistent, biased, procedure-focused, and lacks personalisation. Acute illness, medical jargon, poor health literacy, and high emotional states further hinder patient understanding. CONCLUSIONS Goals of care conversations in hospitals are nuanced and often suboptimal. To improve patient experiences and outcome of care interventions should be personalised and tailored to individual needs, emphasizing effective communication and trusting relationships among patients, families, doctors, and healthcare teams. Inclusion of caregivers and acknowledgment at the service level are crucial for achieving desired outcomes. Implications for policy, research, and clinical practice, including further training and skills development for doctors, are discussed.
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Affiliation(s)
- Jamie Gross
- Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, Harrow, United Kingdom
- King’s College London, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, United Kingdom
| | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
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4
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Etkind SN, Barclay S, Spathis A, Hopkins SA, Bowers B, Koffman J. Uncertainty in serious illness: A national interdisciplinary consensus exercise to identify clinical research priorities. PLoS One 2024; 19:e0289522. [PMID: 38422036 PMCID: PMC10903860 DOI: 10.1371/journal.pone.0289522] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Serious illness is characterised by uncertainty, particularly in older age groups. Uncertainty may be experienced by patients, family carers, and health professionals about a broad variety of issues. There are many evidence gaps regarding the experience and management of uncertainty. AIM We aimed to identify priority research areas concerning uncertainty in serious illness, to ensure that future research better meets the needs of those affected by uncertainty and reduce research inefficiencies. METHODS Rapid prioritisation workshop comprising five focus groups to identify research areas, followed by a ranking exercise to prioritise them. Participants were healthcare professionals caring for those with serious illnesses including geriatrics, palliative care, intensive care; researchers; patient/carer representatives, and policymakers. Descriptive analysis of ranking data and qualitative framework analysis of focus group transcripts was undertaken. RESULTS Thirty-four participants took part; 67% female, mean age 47 (range 33-67). The highest priority was communication of uncertainty, ranked first by 15 participants (overall ranking score 1.59/3). Subsequent priorities were: 2) How to cope with uncertainty; 3) healthcare professional education/training; 4) Optimising clinical approaches to uncertainty; and 5) exploring in-depth experiences of uncertainty. Research questions regarding optimal management of uncertainty were given higher priority than questions about experiences of uncertainty and its impact. CONCLUSIONS These co-produced, clinically-focused research priorities map out key evidence gaps concerning uncertainty in serious illness. Managing uncertainty is the most pressing issue, and researchers should prioritise how to optimally manage uncertainty in order to reduce distress, unlock decision paralysis and improve illness and care experience.
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Affiliation(s)
- Simon N. Etkind
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Anna Spathis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah A. Hopkins
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ben Bowers
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan Koffman
- Hull York Medical School, University of Hull, Hull, United Kingdom
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5
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Bryans A, Siddiqi N, Burry L, Clarke M, Koffman J, Agar MR, Rose L. A Core Outcome Set for Interventions to Prevent and/or Treat Delirium in Palliative Care. J Pain Symptom Manage 2023; 66:293-300.e8. [PMID: 37311495 DOI: 10.1016/j.jpainsymman.2023.05.013] [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: 01/13/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
CONTEXT Delirium is a serious neurocognitive syndrome which is highly prevalent in people approaching the end of life. Existing trials of interventions to prevent or treat delirium in adults receiving palliative care report heterogeneous outcomes. OBJECTIVES To undertake an international consensus process to develop a core outcome set for trials of interventions, designed to prevent and/or treat delirium, for adults receiving palliative care. METHODS The core outcome set development process included a systematic review, qualitative interviews, modified Delphi method and virtual consensus meetings using nominal group technique (Registration http://www.comet-initiative.org/studies/details/796). Participants included family members, clinicians, and researchers with experience of delirium in palliative care. RESULTS Forty outcomes were generated from the systematic review and interviews informing the Delphi Round one survey. The international Delphi panel comprised 92 participants including clinicians (n = 71, 77%), researchers (n = 13, 14%), and family members (n = 8, 9%). Delphi Round two was completed by 77 (84%) participants from Round one. Following the consensus meetings, four outcomes were selected for the core outcome set: 1) delirium occurrence (incidence and prevalence); 2) duration of delirium until resolution defined as either no further delirium in this episode of care or death; 3) overall delirium symptom profile (agitation, delusions or hallucinations, delirium symptoms and delirium severity); 4) distress due to delirium (person with delirium, and/or family and/or carers [including healthcare professionals]). CONCLUSION Using a rigorous consensus process, we developed a core outcome set comprising four delirium-specific outcomes for inclusion in future trials of interventions to prevent and/or treat delirium in palliative care.
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Affiliation(s)
- Anna Bryans
- Department of Health Sciences (A.B.), University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School (N.S.), University of York, York, UK; Bradford District Care NHS Foundation Trust (N.S.), Bradford, UK
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy (L.B.), University of Toronto, Toronto, Ontario, Canada; Sinai Health System (L.B.), Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences (M.C.), Queen's University Belfast, Belfast, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School (J.K.), University of Hull, Hull, UK
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health (M.R.A.), University of Technology Sydney, Sydney, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing (L.R.), Midwifery and Palliative Care, King's College London, London, UK.
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6
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Kishino M, Koffman J, Nagatomi H, Yuasa M, Ellis-Smith C. Complexity and function of family involvement in advance care planning: A qualitative study of perspectives from people living with advanced cancer, family members and healthcare professionals. Palliat Med 2023; 37:1434-1446. [PMID: 37723885 PMCID: PMC10548778 DOI: 10.1177/02692163231194202] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Family members can support advance care planning conversations. However, how family involvement in advance care planning operates to achieve goal-concordant care remains unclear. AIM To explore how family involvement impacts the process of advance care planning for advanced cancer patients and their family members to achieve goal-concordant care in Japan. DESIGN Qualitative study incorporating semi-structured in-depth interviews with thematic analysis informed by Family Systems Theory. SETTING/PARTICIPANTS Medical oncology departments at two tertiary hospitals in Japan. A purposive sample of 13 advanced cancer patients, 10 family members and 9 healthcare professionals who cared for them. RESULTS Twenty-five interviews were conducted, comprising 7 dyads of patients and their family members and 18 individual interviews. Four themes were identified: characteristics of patients and family members and their views on illness and advance care planning; family context and communication; interactions with healthcare professionals and societal and cultural influences; and family members' acceptance, preparation and confidence. Family involvement was observed as being variable at an individual level and also across generations. Family members provided patients with the instrumental and emotional support that facilitated the advance care planning process. Family involvement enabled family members to better prepare for realising patients' wishes. It increased family members' confidence in surrogate decision-making. CONCLUSIONS Two mechanisms of how family involvement may enable goal-concordant care were identified: family members' support provision and their preparation for realising patients' wishes. Healthcare professionals should assess family's readiness to engage in advance care planning, and the time required to prepare them for the process.
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Affiliation(s)
- Megumi Kishino
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Hiroaki Nagatomi
- Department of Nursing, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Misuzu Yuasa
- Hospice Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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7
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Wang Y, Chukwusa E, Koffman J, Curcin V. Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis. JMIR Form Res 2023; 7:e44774. [PMID: 37368840 PMCID: PMC10408639 DOI: 10.2196/44774] [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: 12/04/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. OBJECTIVE This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. METHODS This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information-based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). RESULTS Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. CONCLUSIONS Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post-COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media's potential in acting as an effective tool to reflect public opinions in the context of PEoLC.
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Affiliation(s)
- Yijun Wang
- Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, King's College London, London, United Kingdom
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Vasa Curcin
- Department of Population Health Sciences, King's College London, London, United Kingdom
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8
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McFarlane P, Sleeman KE, Bunce C, Koffman J, Orlovic M, Rosling J, Bearne A, Powell M, Riley J, Droney J. Advance Care Planning and Place of Death During the COVID-19 Pandemic: A Retrospective Analysis of Routinely Collected Data. J Patient Exp 2023; 10:23743735231188826. [PMID: 37534192 PMCID: PMC10391687 DOI: 10.1177/23743735231188826] [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] [Indexed: 08/04/2023] Open
Abstract
Increased advance care planning was endorsed at the start of the Coronavirus disease 2019 (COVID-19) pandemic with the aim of optimizing end-of-life care. This retrospective observational cohort study explores the impact of advanced care planning on place of death. 21,962 records from patients who died during the first year of the pandemic and who had an Electronic Palliative Care Coordination System record were included. 11,913 (54%) had a documented place of death. Of these 5,339 died at home and 2,378 died in hospital. 9,971 (45%) had both a documented place of death and a preferred place of death. Of these, 7,668 (77%) died in their preferred location. Documented elements of advance care planning, such as resuscitation status and ceiling of treatment decisions, were associated with an increased likelihood of dying in the preferred location, as were the number of times the record was viewed. During the COVID-19 pandemic, advanced care planning and the use of digital care coordination systems presented an opportunity for patients and healthcare staff to personalize care and influence end-of-life experiences.
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Affiliation(s)
- Philippa McFarlane
- The Royal Marsden NHS Foundation Trust, London, England
- The Cicely Saunders Institute, King's College London, London, England
| | | | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, England
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, York, England
| | | | - John Rosling
- The Royal Marsden NHS Foundation Trust, London, England
| | | | | | - Julia Riley
- The Royal Marsden NHS Foundation Trust, London, England
- Imperial College London, London, England
| | - Joanne Droney
- The Royal Marsden NHS Foundation Trust, London, England
- Imperial College London, London, England
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9
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Koffman J, Shapiro GK, Schulz-Quach C. Enhancing equity and diversity in palliative care clinical practice, research and education. BMC Palliat Care 2023; 22:64. [PMID: 37271813 DOI: 10.1186/s12904-023-01185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023] Open
Abstract
Health disparities in palliative care are preventable consequences of structural discrimination and marginalization. The first step in addressing a problem is recognizing there is one and devotion to fully understanding its multifaceted nature. Palliative care clinicians, educators and researchers must prioritize investigating and mitigating the effects of racial, social, and intersectional injustice.
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Affiliation(s)
- Jonathan Koffman
- Hull York Medical School , Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
| | - Gilla K Shapiro
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Christian Schulz-Quach
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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10
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Orlovic M, Droney J, Vickerstaff V, Rosling J, Bearne A, Powell M, Riley J, McFarlane P, Koffman J, Stone P. Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records. BMC Palliat Care 2023; 22:51. [PMID: 37101274 PMCID: PMC10131555 DOI: 10.1186/s12904-023-01155-y] [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: 11/21/2022] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease. METHODS Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010-2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic. RESULTS Overall, 3% were predicted to live "days"; 13% "weeks"; 28% "months"; and 56% "year/years". The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians' estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of "weeks" or "months" (32% accuracy). CONCLUSION Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for "years".
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Affiliation(s)
- M Orlovic
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
- Imperial College London, London, United Kingdom
| | - J Droney
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom.
- Imperial College London, London, United Kingdom.
| | - V Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | - J Rosling
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
| | - A Bearne
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
| | - M Powell
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
| | - J Riley
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
- Imperial College London, London, United Kingdom
| | - P McFarlane
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, United Kingdom
| | - J Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, University of York, York, United Kingdom
| | - P Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
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11
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van der Smissen D, van Leeuwen M, Sudore RL, Koffman J, Heyland DK, van der Heide A, Rietjens JAC, Korfage IJ. Newspaper coverage of advance care planning during the COVID-19 pandemic: Content analysis. Death Stud 2023; 48:33-42. [PMID: 36892315 PMCID: PMC10491734 DOI: 10.1080/07481187.2023.2180693] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
COVID-19 may cause sudden serious illness, and relatives having to act on patients' behalf, emphasizing the relevance of advance care planning (ACP). We explored how ACP was portrayed in newspapers during year one of the pandemic. In 'LexisNexis Uni', we identified English-language newspaper articles about ACP and COVID-19, published January-November 2020. We applied content analysis; unitizing, sampling, recording or coding, reducing, inferring, and narrating the data. We identified 131 articles, published in UK (n = 59), Canada (n = 32), US (n = 15), Australia (n = 14), Ireland (n = 6), and one each from Israel, Uganda, India, New-Zealand, and France. Forty articles (31%) included definitions of ACP. Most mentioned exploring (93%), discussing (71%), and recording (72%) treatment preferences; 28% described exploration of values/goals, 66% encouraged engaging in ACP. No false or sensationalist information about ACP was provided. ACP was often not fully described. Public campaigns about ACP might improve the full picture of ACP to the public.
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Affiliation(s)
- Doris van der Smissen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marleen van Leeuwen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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12
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Fei F, J Siegert R, Zhang X, Gao W, Koffman J. Symptom clusters, associated factors and health-related quality of life in patients with chronic obstructive pulmonary disease: A structural equation modelling analysis. J Clin Nurs 2023; 32:298-310. [PMID: 35098602 PMCID: PMC10078635 DOI: 10.1111/jocn.16234] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To identify symptom clusters and develop a symptom cluster model among people living with chronic obstructive pulmonary disease (COPD). BACKGROUND The examination of symptom clusters in COPD patients is an emerging field of scientific inquiry directed towards symptom management. However, no studies have modelled the relationships among symptom clusters, associated factors and health-related quality of life. DESIGN A cross-sectional design with convenience sampling following STROBE guidelines. METHODS Data were collected from 450 COPD participants in three university teaching hospitals. Participants were invited to complete a structured questionnaire comprised of a socio-demographic/clinical questionnaire, Integrated Palliative Care Outcome Scale and Clinical Respiratory Questionnaire. Exploratory factor analysis and confirmatory factor analysis were used to identify symptom clusters. Structural equation modelling was used to examine the proposed model. RESULTS The respiratory related symptom cluster, psychological symptom cluster and cough-insomnia related symptom cluster were identified. The final model demonstrated a good fit with the data. Gender, stage of disease and monthly income were significant factors associated with symptom clusters. Respiratory related and cough-insomnia related symptom clusters had a direct negative impact on health-related quality of life, while the psychological symptom cluster was found to have a direct and indirect negative effect on health-related quality of life. CONCLUSIONS Final COPD symptom cluster model should serve as a framework to guide intervention research targeting symptom clusters to improve health-related quality of life of people living with COPD. RELEVANCE TO CLINICAL PRACTICE Nurses should be especially attuned to identify those at most risk of facing a higher symptom burden in this case those who are female, have advanced stage COPD and/or lower income. During the clinical symptom assessment, nurses should pay attention to the close relationships among symptoms within a cluster to identify any 'trigger' symptom that could cause the development or exacerbation of other symptoms.
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Affiliation(s)
- Fei Fei
- Florence Nightingale Faculty of NursingMidwifery and Palliative CareCicely Saunders InstituteKing’s College LondonLondonUK
- School of Nursing and MidwiferyJiangsu College of NursingHuai'anJiangsuChina
| | - Richard J Siegert
- Faculty of Health and Environmental SciencesAuckland University of TechnologyAucklandNew Zealand
| | - Xiaohan Zhang
- School of Nursing and MidwiferyJiangsu College of NursingHuai'anJiangsuChina
| | - Wei Gao
- Florence Nightingale Faculty of NursingMidwifery and Palliative CareCicely Saunders InstituteKing’s College LondonLondonUK
| | - Jonathan Koffman
- Florence Nightingale Faculty of NursingMidwifery and Palliative CareCicely Saunders InstituteKing’s College LondonLondonUK
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13
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Abstract
OBJECTIVES Informal caregivers of dependants with dementia commence their bereavement experience long before the physical death of their dependant, a process referred to as "anticipatory grief". This represents an ambiguous state that has been acknowledged as a measurable variable among informal caregivers. The use of assessment tools for the identification of anticipatory grief is important for timely intervention to promote well-being and positive bereavement experiences. The aim of this systematic review is to identify and examine existing tools for assessing anticipatory grief among caregivers of dependants with dementia. METHODS MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science were searched to July 2021. Studies focusing on the development/evaluation of instruments for measuring anticipatory grief in dementia caregivers were eligible. The quality of each measurement was graded as positive, fair, poor or no information based on defined criteria. RESULTS 100 studies were identified. 33 papers were selected for full-text assessment and 12 papers met the eligibility criteria. Seven assessment tools were identified for measurement of pre-death grief caregivers - the Anticipatory Grief Scale (AGS), Marwit-Meuser Caregiver Grief Inventory (MM-CGI), MM-CGI-short-form (MM-CGI-SF), MM-CGI-brief (MM-CGI-BF), Prolonged Grief Scale (PG-12), Caregiver Grief Scale (CGS) and Caregiver Grief Questionnaire (CGQ). Based on content/construct validity, internal consistency and test-retest reliability the MM-CGI/MM-CGI-SF scored highest for quality followed by the CGS. CONCLUSION Anticipatory grief in dementia has multiple facets that can be measured using self-scoring questionnaires. Our findings provide support for different measures of anticipatory grief. Further research is needed for the evaluation of the responsiveness and interpretability of these instruments.
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Affiliation(s)
- Tara Dehpour
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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14
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Abstract
BACKGROUND Palliative care access, experiences and outcomes of care disadvantage those from ethnically diverse, Indigenous, First nation and First people communities. Research into this field of inquiry raises unique theoretical, methodological, and moral issues. Without the critical reflection of methods of study and reporting of findings, researchers may inadvertently compromise their contribution to reducing injustices and perpetuating racism. AIM To examine key evidence of the place of minoritised communities in palliative care research to devise recommendations that improve the precision and rigour of research and reporting of findings. METHODS Narrative review of articles identified from PubMed, CINAHL and Google Scholar for 10 years augmented with supplementary searches. RESULTS We identified and appraised 109 relevant articles. Four main themes were identified (i) Lack of precision when working with a difference; (ii) 'black box epidemiology' and its presence in palliative care research; (iii) the inclusion of minoritised communities in palliative care research; and (iv) the potential to cause harm. All stymie opportunities to 'level up' health experiences and outcomes across the palliative care spectrum. CONCLUSIONS Based on the findings of this review palliative care research must reflect on and justify the classification of minoritised communities, explore and understand intersectionality, optimise data quality, decolonise research teams and methods, and focus on reducing inequities to level up end-of-life care experiences and outcomes. Palliative care research must be forthright in explicitly indentifying instances of structural and systemic racism in palliative care research and engaging in non-judgemental debate on changes required.
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Affiliation(s)
- Jonathan Koffman
- University of Hull, Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Sabrina Bajwah
- King's College London, Cicely Saunders Institute, London, UK
| | - Joanna M Davies
- King's College London, Cicely Saunders Institute, London, UK
| | - Jamilla Akhter Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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15
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Boland JW, Koffman J, Boland EG. What do we do with all the evidence for symptoms in palliative care? Palliat Med 2022; 36:892-894. [PMID: 35658645 DOI: 10.1177/02692163221098005] [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: 11/17/2022]
Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England, UK
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England, UK
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16
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Koffman J, Penfold C, Cottrell L, Farsides B, Evans CJ, Burman R, Nicholas R, Ashford S, Silber E. “I wanna live and not think about the future” what place for advance care planning for people living with severe multiple sclerosis and their families? A qualitative study. PLoS One 2022; 17:e0265861. [PMID: 35617268 PMCID: PMC9135191 DOI: 10.1371/journal.pone.0265861] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Little is known about how people with multiple sclerosis (MS) and their families comprehend advance care planning (ACP) and its relevance in their lives.
Aim
To explore under what situations, with whom, how, and why do people with MS and their families engage in ACP.
Methods
We conducted a qualitative study comprising interviews with people living with MS and their families followed by an ethical discussion group with five health professionals representing specialties working with people affected by MS and their families. Twenty-seven people with MS and 17 family members were interviewed between June 2019 and March 2020. Interviews and the ethical discussion group were audio-recorded and transcribed verbatim. Data were analysed using the framework approach.
Results
Participants’ narratives focused on three major themes: (i) planning for an uncertain future; (ii) perceived obstacles to engaging in ACP that included uncertainty concerning MS disease progression, negative previous experiences of ACP discussions and prioritising symptom management over future planning; (iii) Preferences for engagement in ACP included a trusting relationship with a health professional and that information then be shared across services. Health professionals’ accounts from the ethical discussion group departed from viewing ACP as a formal document to that of an ongoing process of seeking preferences and values. They voiced similar concerns to people with MS about uncertainty and when to initiate ACP-related discussions. Some shared concerns of their lack of confidence when having these discussions.
Conclusion
These findings support the need for a whole system strategic approach where information about the potential benefits of ACP in all its forms can be shared with people with MS. Moreover, they highlight the need for health professionals to be skilled and trained in engaging in ACP discussions and where information is contemporaneously and seamlessly shared across services.
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Affiliation(s)
- Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, United Kingdom
- King’s College London, Cicely Saunders Institute, London, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, United Kingdom
| | | | - Bobbie Farsides
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Catherine J. Evans
- King’s College London, Cicely Saunders Institute, London, United Kingdom
| | - Rachel Burman
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Nicholas
- United Kingdom Multiple Sclerosis Tissue Bank, Burlington Danes, Imperial College London, London, United Kingdom
| | - Stephen Ashford
- King’s College London, Cicely Saunders Institute, London, United Kingdom
- Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, North West University, Harrow, United Kingdom
| | - Eli Silber
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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17
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [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: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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18
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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19
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Fei F, Koffman J, Zhang X, Gao W. Synergistic Impact of the Symptom Cluster on Health-Related Quality of Life in Patients With Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis. Clin Nurs Res 2022; 31:991-999. [PMID: 35362332 PMCID: PMC9266057 DOI: 10.1177/10547738221085765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022]
Abstract
This study aimed to quantify the synergistic impact of symptom clusters on health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD). We conducted a secondary analysis of a cross-sectional data collected via convenience sampling from patients with COPD. Multiple linear regressions were used to quantify the relationships between symptom clusters and HRQoL. The sample included 106 COPD patients from whom three symptom clusters were identified comprising of dyspnea depression, anxiety-sleep, and depression-anxiety. Depression-anxiety (psychological symptom cluster) was significantly associated with poorer HRQoL (β = 13.88, 95% CI [7.94, 19.82]), while no significant associations were detected with HRQoL for either depression or anxiety alone (β = 6.66, 95% CI [-2.99, 16.31]; β = 7.29, 95% CI [-0.78, 15.35]). Assessment and early intervention led by nurses targeting the psychological symptom cluster may represent an initial approach to improve HRQoL. Understanding the phenomenon of symptom clusters that are present in patients with COPD provides a breakthrough insight to devise strategies for their management.
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Affiliation(s)
- Fei Fei
- King's College London, UK.,Jiangsu College of Nursing, Huai'an, P.R. China
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20
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Abstract
BACKGROUND Advance care planning is important for people with advanced cancer. Family involvement in advance care planning may be instrumental to achieving goal-concordant care since they frequently become surrogate decision-makers. AIM To examine components, contexts, effects and linkages with intended outcomes of involving family members in advance care planning. DESIGN A mixed-methods systematic review, in which quantitative and qualitative data were extracted and synthesised using thematic synthesis leading to a logic model. Prospectively registered on PROSPERO (CRD42020208143). DATA SOURCES Primary quantitative and qualitative research regarding family-involved advance care planning for people with advanced cancer were identified using Medline, Embase, PsycINFO and CINAHL from inception to September 2020. Quality appraisal was performed with 'QualSyst'. RESULTS Fourteen articles were included. The synthesis identified perceptions of individuals and family members concerning family involvement in advance care planning and presents components for family-integrated advance care planning intervention. The logic model includes (i) addressing family members' concerns and emotions and (ii) facilitating communication between individuals and family members which are distinctive when healthcare professionals engage with individuals as well as family members. CONCLUSIONS This review provides a comprehensive understanding of family involvement in advance care planning and could inform its assessment and implementation in clinical practice. The number of included articles was limited. Therefore future research must focus on family integration and exploration of stakeholders' perceptions to identify additional components and linkages between them within family-integrated advance care planning.
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Affiliation(s)
- Megumi Kishino
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Oladayo Afolabi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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21
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Bajwah S, Koffman J, Hussain J, Bradshaw A, Hocaoglu MB, Fraser LK, Oluyase A, Allwin C, Dunleavy L, Preston N, Cripps R, Maddocks M, Sleeman KE, Higginson IJ, Walshe C, Murtagh FEM. Specialist palliative care services response to ethnic minority groups with COVID-19: equal but inequitable-an observational study. BMJ Support Palliat Care 2021:bmjspcare-2021-003083. [PMID: 34511409 DOI: 10.1136/bmjspcare-2021-003083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/28/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To develop insights into response of palliative care services caring for people from ethnic minority groups during COVID-19. METHODS Cross-sectional online survey of UK palliative care services response to COVID-19. Quantitative data were summarised descriptively and χ2 tests used to explore relationships between categorical variables. Free text comments were analysed using reflexive thematic analysis. RESULTS 277 UK services responded. 168 included hospice teams (76% of all UK hospice teams). Services supporting those from ethnic minority groups were more likely to include hospital (p<0.001) and less likely to include hospice (p<0.001) or home care teams (p=0.008). 34% (93/277) of services had cared for patients with COVID-19 or families from ethnic minority groups. 66% (61/93) of these services stated no difference in how they supported or reached these groups during the pandemic.Three themes demonstrated impact of policy introduced during the pandemic, including: disproportionate adverse impact of restricted visiting, compounded communication challenges and unmet religious and faith needs. One theme demonstrated mistrust of services by ethnic minority groups, and the final theme demonstrated a focus on equal and individualised care. CONCLUSIONS Policies introduced during the COVID-19 pandemic may have adversely impacted those from ethnic minority groups making these at-risk populations even more vulnerable. The palliative care response may have been equal but inequitable. During the para-COVID-19 period, systemic steps, including equality impact assessments, are urgently needed.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Jamilla Hussain
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Adejoke Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Caitlin Allwin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Rachel Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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22
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Nicholas R, Nicholas E, Hannides M, Gautam V, Friede T, Koffman J. Influence of individual, illness and environmental factors on place of death among people with neurodegenerative diseases: a retrospective, observational, comparative cohort study. BMJ Support Palliat Care 2021:bmjspcare-2021-003105. [PMID: 34489324 DOI: 10.1136/bmjspcare-2021-003105] [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] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In long-term neurological conditions, location of death is poorly understood but is seen as a marker of quality of dying. OBJECTIVE To examine individual, illness and environmental factors on place of death among people with multiple sclerosis (MS) and Parkinson's disease (PD) in isolation or in combination and compare them with people without either condition. METHODS Retrospective, observational, comparative cohort study of 582 people with MS, 579 people with PD and 95 controls from UK Multiple Sclerosis and Parkinson's Disease Tissue Bank. A subset of people with MS and PD were selected for analysis of individual clinical encounters 2 years before death and further subset of all groups for analysis of impact of advance care planning (ACP) and recognition of dying. RESULTS People with MS died more often (50.8%) in hospital than those with PD (35.3%). Examining individual clinical encounters over 2 years (4931 encounters) identified increased contact with services 12 months before death (F(1, 58)=69.71, p<0.0001) but was not associated with non-hospital deaths (F(1, 58)=1.001, p=0.321). The presence of ACPs and recognition of dying were high among people with MS and PD and both associated with a non-hospital death. ACPs were more likely to prevent hospital deaths when initiated by general practitioners (GPs) compared with other professional groups (χ2=68.77, p=0.0007). CONCLUSIONS For people with MS and PD, ACPs contribute to reducing dying in hospital. ACPs appear to be most effective when facilitated by GPs underlining the importance of primary care involvement in delivering holistic care at the end of life.
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Affiliation(s)
- Richard Nicholas
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Emma Nicholas
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Mike Hannides
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Vishal Gautam
- UK Multiple Sclerosis Tissue Bank, Imperial College London, London, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabiltation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Affiliation(s)
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
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Fei F, Koffman J, Zhang X, Gao W. Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review. West J Nurs Res 2021; 44:395-415. [PMID: 33682534 PMCID: PMC8894625 DOI: 10.1177/0193945921995773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/17/2022]
Abstract
This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients' subjective experience to inform which clusters are clinically relevant.
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Affiliation(s)
- Fei Fei
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Jonathan Koffman
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Xiaohan Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Wei Gao
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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25
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Bradshaw A, Bayly J, Penfold C, Lin CP, Oluyase AO, Hocaoglu MB, Murtagh FEM, Koffman J. Comment on: "Advance" care planning reenvisioned. J Am Geriatr Soc 2021; 69:1177-1179. [PMID: 33521929 DOI: 10.1111/jgs.17058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Joanne Bayly
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK.,St Barnabas Hospices, Worthing, UK
| | - Clarissa Penfold
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Cheng-Pei Lin
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK.,Institute of Community Health Care, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Adejoke O Oluyase
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Mevhibe B Hocaoglu
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
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Wakefield D, Dewhurst F, Koffman J, Chamberlain C. Palliative Medicine Specialist Trainee Research experience, interest and opportunities: a national survey. BMJ Support Palliat Care 2021:bmjspcare-2020-002609. [PMID: 33558305 DOI: 10.1136/bmjspcare-2020-002609] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/06/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite the acknowledged benefits of research, Palliative Medicine receives minimal research funding and has few dedicated research training posts. This study investigated the opportunities and barriers to participating in research for the current cohort of UK Palliative Medicine Specialist Trainees (PMSTs), to better understand the opportunities to improve evidence-based practice within the specialty. METHODS Two surveys, one for PMSTs and a second for training programme directors (TPDs), were developed. Surveys were piloted and then reviewed by the UK Palliative trainee Research Collaborative and the Palliative Medicine Specialty Advisory Committee (SAC) before distribution. All current PMSTs and TPDs representing all of the UK training regions (n=13) were invited to complete the appropriate survey. RESULTS Overall, 85% (11/13) and 45% (102/225) of TPDs and PMSTs responded, respectively. Almost all (92%) PMSTs reported that they were either 'very interested' or 'quite interested' in taking part in clinical research. PMSTs generally felt that educationaland clinical supervisors were supportive of them taking part in research; however, few (35%) believed they had access to personnel with adequate research experience to provide practical support. Opportunity for appropriate research supervision varied considerably by training region. Where research was being conducted, it was often conducted in trainees' personal time due to the wide regional variation in dedicated research time. CONCLUSION Despite significant interest in clinical research and support by TPDs and clinical supervisors, access to experienced researchers and equitable protected research time by region needs urgent attention to enhance progress in evidence-based palliative medicine.
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Affiliation(s)
- Donna Wakefield
- Specialist Palliative Care Team, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Felicity Dewhurst
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Jonathan Koffman
- Department of Palliative Care, King's College London, London, UK
| | - Charlotte Chamberlain
- Palliative & End of Life Care, Faculty of Health Sciences, University of Bristol, Bristol, UK
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27
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Johnson H, Ogden M, Brighton LJ, Etkind SN, Oluyase AO, Chukwusa E, Yu P, de Wolf-Linder S, Smith P, Bailey S, Koffman J, Evans CJ. Patient and public involvement in palliative care research: What works, and why? A qualitative evaluation. Palliat Med 2021; 35:151-160. [PMID: 32912087 PMCID: PMC7797607 DOI: 10.1177/0269216320956819] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Public involvement is increasingly considered a prerequisite for high-quality research. However, involvement in palliative care is impeded by limited evidence on the best approaches for populations affected by life-limiting illness. AIM To evaluate a strategy for public involvement in palliative care and rehabilitation research, to identify successful approaches and areas for improvement. DESIGN Co-produced qualitative evaluation using focus groups and interviews. Thematic analysis undertaken by research team comprising public contributors and researchers. SETTING/PARTICIPANTS Researchers and public members from a palliative care and rehabilitation research institute, UK. RESULTS Seven public members and 19 researchers participated. Building and maintaining relationships, taking a flexible approach and finding the 'right' people were important for successful public involvement. Relationship building created a safe environment for discussing sensitive topics, although public members felt greater consideration of emotional support was needed. Flexibility supported involvement alongside unpredictable circumstances of chronic and life-limiting illness, and was facilitated by responsive communication, and opportunities for in-person and virtual involvement at a project- and institution-level. However, more opportunities for two-way feedback throughout projects was suggested. Finding the 'right' people was crucial given the diverse population served by palliative care, and participants suggested more care needed to be taken to identify public members with experience relevant to specific projects. CONCLUSION Within palliative care research, it is important for involvement to focus on building and maintaining relationships, working flexibly, and identifying those with relevant experience. Taking a strategic approach and developing adequate infrastructure and networks can facilitate public involvement within this field.
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Affiliation(s)
- Halle Johnson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Margaret Ogden
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Susanne de Wolf-Linder
- Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Pam Smith
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Sylvia Bailey
- Patient and Public Contributor, Cicely Saunders Institute, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
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28
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Koffman J, Yorganci E, Murtagh F, Yi D, Gao W, Barclay S, Pickles A, Higginson I, Johnson H, Wilson R, Bailey S, Ewart C, Evans C. The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31594555 DOI: 10.3310/hta23550] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients admitted to hospital with a terminal illness and uncertain recovery often receive inconsistent care and do not have the opportunity to die in their preferred place of death. Previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, have sometimes been badly implemented. The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle was developed to remedy this. It has not been evaluated in a randomised trial, but a definitive trial would face many hurdles. OBJECTIVE To optimise the design of and determine the feasibility of a pragmatic, multicentre, cluster randomised controlled trial of the AMBER care bundle compared with best standard care. DESIGN A feasibility cluster randomised controlled trial including semistructured interviews with patients and relatives, focus groups with health-care professionals, non-participant observations of multidisciplinary team meetings, a standard care survey, heat maps and case note reviews. Retrospective data were collected from the family or close friends of deceased patients via a bereavement survey. SETTING Four general medical wards at district general hospitals in England. PARTICIPANTS There were 65 participants (control, n = 36; intervention, n = 29). There were 24 interviews, four focus groups, 15 non-participant meeting observations, six case note reviews and three heat maps, and 15 of out 23 bereavement, standard care surveys were completed. INTERVENTION The AMBER care bundle is implemented by a nurse facilitator. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status and daily plan revisiting. The AMBER care bundle encourages staff, patients and families to talk openly about their preferences and priorities should the worst happen. MAIN OUTCOME MEASURES Two 'candidate' primary outcomes were selected to be evaluated for a future definitive trial: Integrated Palliative care Outcome Scale patient/family anxiety and communication subscale and 'howRwe'. The secondary outcome measures were Integrated Palliative care Outcome Scale symptoms, Australian-modified Karnofsky Performance Status scale, EuroQol-5 Dimensions, five-level version, Client Service Receipt Inventory, recruitment rate, intervention fidelity and intervention acceptability. RESULTS Data were collected for 65 patients. This trial was not powered to measure clinical effectiveness, but variance and changes observed in the Integrated Palliative care Outcome Scale subscale indicated that this measure would probably detect differences within a definitive trial. It was feasible to collect data on health, social and informal care service use and on quality of life at two time points. The AMBER care bundle was broadly acceptable to all stakeholders and was delivered as planned. The emphasis on 'clinical uncertainty' prompted health-care professional awareness of often-overlooked patients. Reviewing patients' AMBER care bundle status was integrated into routine practice. Refinements included simplifying the inclusion criteria and improving health-care professional communication training. Improvements to trial procedures included extending the time devoted to recruitment and simplifying consent procedures. There was also a recommendation to reduce data collected from patients and relatives to minimise burden. LIMITATIONS The recruitment rate was lower than anticipated. The inclusion criteria for the trial were difficult to interpret. Information sheets and consent procedures were too detailed and lengthy for the target population. Health-care professionals' enthusiasm and specialty were not considered while picking trial wards. Participant recruitment took place later during hospital admission and the majority of participants were lost to follow-up because they had been discharged. Those who participated may have different characteristics from those who did not. CONCLUSIONS This feasibility trial has demonstrated that an evaluation of the AMBER care bundle among an acutely unwell patient population, although technically possible, is not practical or feasible. The intervention requires optimisation. TRIAL REGISTRATION Current Controlled Trials ISRCTN36040085. National Institute for Health Research (NIHR) Portfolio registration number 32682. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 55. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Emel Yorganci
- Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Deokhee Yi
- Cicely Saunders Institute, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute, King's College London, London, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Irene Higginson
- Cicely Saunders Institute, King's College London, London, UK
| | - Halle Johnson
- Cicely Saunders Institute, King's College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute, King's College London, London, UK
| | | | | | - Catherine Evans
- Cicely Saunders Institute, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
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29
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Selman LE, Chao D, Sowden R, Marshall S, Chamberlain C, Koffman J. Bereavement Support on the Frontline of COVID-19: Recommendations for Hospital Clinicians. J Pain Symptom Manage 2020; 60:e81-e86. [PMID: 32376262 PMCID: PMC7196538 DOI: 10.1016/j.jpainsymman.2020.04.024] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
Deaths due to COVID-19 are associated with risk factors which can lead to prolonged grief disorder, post-traumatic stress, and other poor bereavement outcomes among relatives, as well as moral injury and distress in frontline staff. Here we review relevant research evidence and provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. For relatives, bereavement risk factors include dying in an intensive care unit, severe breathlessness, patient isolation or restricted access, significant patient and family emotional distress, and disruption to relatives' social support networks. Recommendations include advance care planning; proactive, sensitive, and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; providing excellent symptom management and emotional and spiritual support; and providing and/or sign-posting to bereavement services. To mitigate effects of this emotionally challenging work on staff, we recommend an organizational and systemic approach which includes access to informal and professional support.
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Affiliation(s)
- Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Davina Chao
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryann Sowden
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steve Marshall
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Palliative Care Service, London, UK
| | - Charlotte Chamberlain
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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30
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Evans CJ, Yorganci E, Lewis P, Koffman J, Stone K, Tunnard I, Wee B, Bernal W, Hotopf M, Higginson IJ. Processes of consent in research for adults with impaired mental capacity nearing the end of life: systematic review and transparent expert consultation (MORECare_Capacity statement). BMC Med 2020; 18:221. [PMID: 32693800 PMCID: PMC7374835 DOI: 10.1186/s12916-020-01654-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Received: 12/12/2019] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Involving adults lacking capacity (ALC) in research on end of life care (EoLC) or serious illness is important, but often omitted. We aimed to develop evidence-based guidance on how best to include individuals with impaired capacity nearing the end of life in research, by identifying the challenges and solutions for processes of consent across the capacity spectrum. METHODS Methods Of Researching End of Life Care_Capacity (MORECare_C) furthers the MORECare statement on research evaluating EoLC. We used simultaneous methods of systematic review and transparent expert consultation (TEC). The systematic review involved four electronic databases searches. The eligibility criteria identified studies involving adults with serious illness and impaired capacity, and methods for recruitment in research, implementing the research methods, and exploring public attitudes. The TEC involved stakeholder consultation to discuss and generate recommendations, and a Delphi survey and an expert 'think-tank' to explore consensus. We narratively synthesised the literature mapping processes of consent with recruitment outcomes, solutions, and challenges. We explored recommendation consensus using descriptive statistics. Synthesis of all the findings informed the guidance statement. RESULTS Of the 5539 articles identified, 91 met eligibility. The studies encompassed people with dementia (27%) and in palliative care (18%). Seventy-five percent used observational designs. Studies on research methods (37 studies) focused on processes of proxy decision-making, advance consent, and deferred consent. Studies implementing research methods (30 studies) demonstrated the role of family members as both proxy decision-makers and supporting decision-making for the person with impaired capacity. The TEC involved 43 participants who generated 29 recommendations, with consensus that indicated. Key areas were the timeliness of the consent process and maximising an individual's decisional capacity. The think-tank (n = 19) refined equivocal recommendations including supporting proxy decision-makers, training practitioners, and incorporating legislative frameworks. CONCLUSIONS The MORECare_C statement details 20 solutions to recruit ALC nearing the EoL in research. The statement provides much needed guidance to enrol individuals with serious illness in research. Key is involving family members early and designing study procedures to accommodate variable and changeable levels of capacity. The statement demonstrates the ethical imperative and processes of recruiting adults across the capacity spectrum in varying populations and settings.
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Affiliation(s)
- C J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK.
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK.
| | - E Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - P Lewis
- Centre of Medical Law and Ethics, The Dickson Poon School of Law, King's College London, London, UK
| | - J Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - K Stone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - I Tunnard
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - B Wee
- Oxford University Hospitals NHS Foundation Trust and Harris Manchester College, University of Oxford, Oxford, UK
| | - W Bernal
- King's College Hospital, London, UK
| | - M Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - I J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
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31
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Affiliation(s)
- Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Jamie Gross
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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32
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Affiliation(s)
- Jonathan Koffman
- King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Jamie Gross
- London North West University Healthcare NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | - Simon Noah Etkind
- King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Lucy Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Lin CP, Evans CJ, Koffman J, Chen PJ, Hou MF, Harding R. Feasibility and acceptability of a culturally adapted advance care planning intervention for people living with advanced cancer and their families: A mixed methods study. Palliat Med 2020; 34:651-666. [PMID: 32081076 DOI: 10.1177/0269216320902666] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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 Increasing evidence shows that advance care planning is effective in improving outcomes. However, its applicability and acceptability outside Western cultures remain unknown. Examination of relevant cultural adaptations is required prior to wider adoption. AIM To examine the feasibility and acceptability of a culturally adapted advance care planning intervention in a Taiwanese inpatient hospital for advanced cancer patients, family members and healthcare professionals. METHODS A single-group, non-controlled, mixed methods feasibility study guided by a previously developed logic model. The culturally adapted advance care planning intervention represented a one-time intervention, comprising pre-advance care planning preparation and follow-up consultation. Qualitative interviews explored participants' view on their involvement in the study. Patients' medical records were examined to assess intervention fidelity. Findings from both data sets were integrated following analysis. RESULTS N = 29 participants (n = 10 patients; n = 10 family members and n = 9 healthcare professionals) participated in the intervention, of who 28 completed follow-up interviews. Of the 10 advance care planning interventions delivered, most components (n = 10/13) were met. Key contextual moderators influencing the intervention feasibility included: (1) resource constraints resulting in increased workload; (2) care decisions informed by relatives' experiences of care; (3) the requirement for financial and policy support; and (4) a presumption for end-of-life care provision and surrogate decision-making. Six areas of intervention refinement were identified for future research. CONCLUSION Implementing a culturally adapted advance care planning intervention in an inpatient hospital setting in Taiwan is possible. The participants reported the intervention to be acceptable. However, careful attention to the conceptual underpinning using local primary data is imperative for its success.
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Affiliation(s)
- Cheng-Pei Lin
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| | - Jonathan Koffman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Ming-Feng Hou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Yorganci E, Evans CJ, Johnson H, Barclay S, Murtagh FE, Yi D, Gao W, Pickles A, Koffman J. Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach. Palliat Med 2020; 34:667-679. [PMID: 32081088 PMCID: PMC7238505 DOI: 10.1177/0269216320905064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear. AIM To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT. DESIGN Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim. SETTING/PARTICIPANTS Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge. RESULTS Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites. CONCLUSIONS We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.
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Affiliation(s)
- Emel Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Halle Johnson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Abboah-Offei M, Bristowe K, Koffman J, Vanderpuye-Donton NA, Ansa G, Abas M, Higginson I, Harding R. How can we achieve person-centred care for people living with HIV/AIDS? A qualitative interview study with healthcare professionals and patients in Ghana. AIDS Care 2019; 32:1479-1488. [PMID: 31795741 DOI: 10.1080/09540121.2019.1698708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/25/2022]
Abstract
Although person-centred care (PCC) has been identified as a means to achieve the 90-90-90 targets, limited research has considered PCC in low- or middle-income settings. We aimed to explore what constitutes PCC from the perspectives of PLWHA and healthcare professionals (HCP) in Ghana. We conducted 39 semi-structured qualitative interviews with PLWHA and HCP in two community clinics in Ghana, West Africa. Interviews were analysed deductively using thematic analysis, and sampling continued until thematic saturation was achieved. Twenty-four PLWHA (median age 42.5, 50% female) and 15 HCP (median age 34, 53% female) were interviewed. Three interconnected themes emerged across PLWHA and HCP: (1) care structures not built around the person, (2) priority outcomes and components of PCC and (3) re-engineering HIV care to be more person-centred. A conceptual model showing the overlap between PLWHA and HCP's perspectives of PCC and a framework to inform PCC delivery have been developed from these findings. Our data revealed that PLWHA want PCC to improve care outcomes, well-being and quality of life. Further testing of this model is required to inform PCC delivery for PLWHA in low- and middle-income countries.
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Affiliation(s)
- Mary Abboah-Offei
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | | | - Gloria Ansa
- University Health Services, University of Ghana Hospital, Accra, Ghana
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience King's College, London, UK
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
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Lin CP, Evans CJ, Koffman J, Sheu SJ, Hsu SH, Harding R. What influences patients' decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals. Palliat Med 2019; 33:1299-1309. [PMID: 31368854 DOI: 10.1177/0269216319866641] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 01/10/2023]
Abstract
BACKGROUND The concept of advance care planning is largely derived from Western countries. However, the decision-making process and drivers for choosing palliative care in non-Western cultures have received little attention. AIM To explore the decision-making processes and drivers of receiving palliative care in advance care planning discussions from perspectives of advanced cancer patients, families and healthcare professionals in northern Taiwan. METHOD Semi-structured qualitative interviews with advanced cancer patients, their families and healthcare professionals independently from inpatient oncology and hospice units. Thematic analysis with analytical rigour enhanced by dual coding and exploration of divergent views. RESULTS Forty-five participants were interviewed (n = 15 from each group). Three main decision-making trajectories were identified: (1) 'choose palliative care' was associated with patients' desire to reduce physical suffering from treatments, avoid being a burden to families and society, reduce futile treatments and donate organs to help others; (2) 'decline palliative care' was associated with patients weighing up perceived benefits to others as more important than benefits for themselves; and (3) 'no opportunity to choose palliative care' was associated with lack of opportunities to discuss potential benefits of palliative care, lack of staff skill in end-of-life communication, and cultural factors, notably filial piety. CONCLUSION Choice for palliative care among advanced cancer patients in Taiwan is influenced by three decision-making trajectories. Opinions from families are highly influential, and patients often lack information on palliative care options. Strategies to facilitate decision-making require staff confidence in end-of-life discussions, working with the patients and their family while respecting the influence of filial piety.
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Affiliation(s)
- Cheng-Pei Lin
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| | - Jonathan Koffman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Shuh-Jen Sheu
- Institution of Community Health Care, School of Nursing, National Yang Ming University, Taipei, Taiwan
| | - Su-Hsuan Hsu
- Centre of Long-term Care Planning and Development, Taipei City Hospital, Taipei, Taiwan
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Affiliation(s)
- Jonathan Koffman
- Department of Palliative Care & Policy, King's College School of Medicine at Guy's, King's College and St. Thomas’ Hospital, London, UK
| | - Irene J. Higginson
- Department of Palliative Care & Policy, King's College School of Medicine at Guy's, King's College and St. Thomas’ Hospital, London, UK
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Affiliation(s)
- Jonathan Koffman
- Department of Palliative Care, Guy's, King's, and St. Thomas’ Schools of Medicine, New Medical School, London, U.K
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Brighton LJ, Selman LE, Bristowe K, Edwards B, Koffman J, Evans CJ. Emotional labour in palliative and end-of-life care communication: A qualitative study with generalist palliative care providers. Patient Educ Couns 2019; 102:494-502. [PMID: 30879492 DOI: 10.1016/j.pec.2018.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 04/21/2018] [Revised: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore generalist palliative care providers' experiences of emotional labour when undertaking conversations around palliative and end-of-life care with patients and families, to inform supportive strategies. METHODS Semi-structured interviews conducted with generalist staff (those providing 'primary' or 'general' palliative care, not palliative care specialists) who had attended a communication workshop. Sampling was purposive (by gender, profession, experience). Data were analysed using a framework approach; a sample of transcripts were double-coded for rigour. Data collection and analysis were informed by theories of emotional labour, coping, and communication. RESULTS Four ambulance staff, three nurses, two speech and language therapists, and one therapy assistant were interviewed. Five themes emerged: emotions experienced; emotion 'display rules'; emotion management; support needs; and perceived impact of emotional labour. Participants reported balancing 'human' and 'professional' expressions of emotion. Support needs included time for emotion management, workplace cultures that normalise emotional experiences, formal emotional support, and palliative and end-of-life care skills training. CONCLUSION Diverse strategies to support the emotional needs of generalist staff are crucial to ensure high-quality end-of-life care and communication, and to support staff well-being. PRACTICE IMPLICATIONS Both formal and informal support is required, alongside skills training, to enable a supportive workplace culture and individual development.
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Affiliation(s)
- Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, UK.
| | - Lucy Ellen Selman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, UK.
| | - Beth Edwards
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, UK.
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, UK.
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, UK; Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK.
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Lin CP, Evans CJ, Koffman J, Armes J, Murtagh FEM, Harding R. The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials. Palliat Med 2019; 33:5-23. [PMID: 30362897 PMCID: PMC6291906 DOI: 10.1177/0269216318809582] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND: No systematic review has focused on conceptual models underpinning advance care planning for patients with advanced cancer, and the mechanisms of action in relation to the intended outcomes. AIM: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining the components, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes. DESIGN: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrative synthesis was used for data analysis. DATA SOURCES: The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGrey with reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials with advance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for quality appraisal. RESULTS: Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through which advance care planning improved outcomes comprised (1) increasing patients' knowledge of end-of-life care, (2) strengthening patients' autonomous motivation, (3) building patients' competence to undertake end-of-life discussions and (4) enhancing shared decision-making in a trustful relationship. Samples were largely highly educated Caucasian. CONCLUSION: The use of conceptual models underpinning the development of advance care planning is uncommon. When used, they identify the individual behavioural change. Strengthening patients' motivation and competence in participating advance care planning discussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels and ethnicities in non-Western countries should be a research priority.
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Affiliation(s)
- Cheng-Pei Lin
- 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,2 Sussex Community NHS Foundation Trust, Brighton, UK
| | - Jonathan Koffman
- 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Jo Armes
- 3 School of Health Sciences, University of Surrey, Guildford, UK
| | - Fliss E M Murtagh
- 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,4 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Richard Harding
- 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Bristowe K, Carey I, Hopper A, Shouls S, Prentice W, Higginson IJ, Koffman J. Seeing is believing - healthcare professionals' perceptions of a complex intervention to improve care towards the end of life: A qualitative interview study. Palliat Med 2018; 32:525-532. [PMID: 28514888 DOI: 10.1177/0269216317711336] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Methods to improve care, trust and communication are important in acute hospitals. Complex interventions aimed at improving care of patients approaching the end of life are increasingly common. While evaluating outcomes of complex interventions is essential, exploring healthcare professionals' perceptions is also required to understand how they are interpreted; this can inform training, education and implementation strategies to ensure fidelity and consistency in use. AIM To explore healthcare professionals' perceptions of using a complex intervention (AMBER care bundle) to improve care for people approaching the end of life and their understandings of its purpose within clinical practice. DESIGN Qualitative study of healthcare professionals. Analysis informed by Medical Research Council guidance for process evaluations. SETTING/PARTICIPANTS A total of 20 healthcare professionals (12 nursing and 8 medical) interviewed from three London tertiary National Health Service hospitals. Healthcare professionals recruited from palliative care, oncology, stroke, health and ageing, medicine, neurology and renal/endocrine services. RESULTS Three views emerged regarding the purpose of a complex intervention towards the end of life: labelling/categorising patients, tool to change care delivery and serving symbolic purpose indirectly affecting behaviours of individuals and teams. All impact upon potential utility of the intervention. Participants described the importance of training and education alongside implementation of the intervention. However, adequate exposure to the intervention was essential to witness its potential added value or embed it into practice. CONCLUSION Understanding differing interpretations of complex interventions is essential. Consideration of ward composition, casemix and potential exposure to the intervention is critical for their successful implementation.
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Affiliation(s)
- Katherine Bristowe
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation London, UK
| | - Irene Carey
- 2 Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adrian Hopper
- 2 Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susanna Shouls
- 2 Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wendy Prentice
- 3 Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation London, UK
| | - Jonathan Koffman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation London, UK
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Kane PM, Ellis-Smith CI, Daveson BA, Ryan K, Mahon NG, McAdam B, McQuillan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Murtagh FE, Koffman J. Understanding how a palliative-specific patient-reported outcome intervention works to facilitate patient-centred care in advanced heart failure: A qualitative study. Palliat Med 2018; 32:143-155. [PMID: 29154724 DOI: 10.1177/0269216317738161] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 11/15/2022]
Abstract
BACKGROUND Palliative care needs of patients with chronic heart failure are poorly recognised. Policy makers advise a patient-centred approach to holistically assess patients' needs and care goals. Patient-reported outcome measures are proposed to facilitate patient-centred care. AIM To explore whether and how a palliative care-specific patient-reported outcome intervention involving the Integrated Palliative care Outcome Scale influences patients' experience of patient-centred care in nurse-led chronic heart failure disease management clinics. DESIGN A feasibility study using a parallel mixed-methods embedded design was undertaken. The qualitative component which examined patients and nurses experience of the intervention is reported here. Semi-structured interviews were conducted and analysed using framework analysis. SETTING/PARTICIPANTS Eligible patients attended nurse-led chronic heart failure disease management clinics in two tertiary referral centres in Ireland with New York Heart Association functional class II-IV. Nurses who led these clinics were eligible for inclusion. RESULTS In all, 18 patients and all 4 nurses involved in the nurse-led clinics were interviewed. Three key themes were identified: identification of unmet needs, holistic assessment and patient empowerment. The intervention impacted on processes of care by enabling a shared understanding of patients' symptoms and concerns, facilitating patient-nurse communication by focusing on these unmet needs and empowering patients to become more involved in clinical discussions. CONCLUSION This Integrated Palliative care Outcome Scale-based intervention empowered patients to become more engaged in the clinical consultation and to highlight their unmet needs. This study adds to the evidence for the mechanism of action of patient-reported outcome measures to improve patient-centred care and will help inform outcome selection for future patient-reported outcome measure research.
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Affiliation(s)
- Pauline M Kane
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Clare I Ellis-Smith
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Barbara A Daveson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Karen Ryan
- 2 Palliative Medicine, St Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall G Mahon
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brendan McAdam
- 4 Department of Cardiology, Beaumont Hospital, Dublin, Ireland
| | - Regina McQuillan
- 5 Department of Palliative Medicine, St Francis Hospice and Beaumont Hospital, Dublin, Ireland
| | - Cecelia Tracey
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christine Howley
- 3 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Irene J Higginson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,6 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Bristowe K, Hodson M, Wee B, Almack K, Johnson K, Daveson BA, Koffman J, McEnhill L, Harding R. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study. Palliat Med 2018; 32:23-35. [PMID: 28502218 PMCID: PMC5758934 DOI: 10.1177/0269216317705102] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. AIM To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. DESIGN Semi-structured in-depth qualitative interviews analysed using thematic analysis. SETTING/PARTICIPANTS In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). RESULTS In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals' preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. CONCLUSION Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.
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Affiliation(s)
- Katherine Bristowe
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Bee Wee
- 3 Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kathryn Almack
- 4 Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care, The University of Nottingham, Nottingham, UK
| | - Katherine Johnson
- 5 School of Applied Social Science, University of Brighton, Brighton, UK
| | - Barbara A Daveson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | - Jonathan Koffman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Richard Harding
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
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Brighton LJ, Pask S, Benalia H, Bailey S, Sumerfield M, Witt J, de Wolf-Linder S, Etkind SN, Murtagh FEM, Koffman J, Evans CJ. Taking patient and public involvement online: qualitative evaluation of an online forum for palliative care and rehabilitation research. Res Involv Engagem 2018; 4:14. [PMID: 29744131 PMCID: PMC5928583 DOI: 10.1186/s40900-018-0097-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/22/2018] [Indexed: 05/16/2023]
Abstract
PLAIN ENGLISH SUMMARY Patient and public involvement (PPI) is increasingly recognised as important in research. Most PPI takes place face-to-face, but this can be difficult for people who are unwell or have caring responsibilities. As these challenges are particularly common in palliative care and rehabilitation research, we developed an online forum for PPI: www.csipublicinvolvement.co.uk. In this study, we explored how well the online forum worked, if it is a suitable method for PPI, and how PPI members and researchers reacted to using it. We used an existing theory about online interventions to help choose the 'right' questions to ask participants. We invited PPI members and researchers who had used the online forum to participate in focus groups, and identified the most important themes discussed. Within this study, PPI members have helped with the interview questions, analysis, and write up. Overall, four PPI members and five researchers participated in the focus groups. Participants felt the online forum worked well and had multiple benefits. From the discussions, we identified four key questions to consider when developing online methods for PPI: how does the forum work, how does it engage people, how does it empower people, and what is the impact? Participants suggested the forum could be improved by being more PPI and less researcher focused. We conclude that when developing online methods of PPI, a functioning forum is not enough: it also needs to be engaging and empowering to have an impact. Future work can use these four domains when developing their own online PPI methods. BACKGROUND Patient and public involvement (PPI) in research is increasingly recognised as important. Most PPI activities take place face-to-face, yet this can be difficult for people with ill health or caring responsibilities, and may exclude people from hard-to-reach populations (e.g. living in vulnerable social circumstances and/or remote geographical locations). These challenges are particularly pertinent in palliative care and rehabilitation research where people often live with, or care for someone with, advanced illness. In response to this, we aimed to test the functionality, feasibility, and acceptability of an online forum for PPI for palliative care and rehabilitation research (www.csipublicinvolvement.co.uk). METHODS We conducted separate focus groups with PPI members and researchers who had used the online forum. Data collection was underpinned by DeLone and Mclean's model of information systems success. Focus groups were recorded, transcribed, and analysed using inductive thematic analysis. Dual coding by two authors ensured rigour, and attention was paid to divergent cases. RESULTS Four PPI members and five researchers participated in the focus groups (two PPI focus groups, one researcher focus group). The online forum was perceived as functional, feasible, and acceptable. Our analysis identified four key questions to consider when developing online methods for PPI: (1) how does the forum work, (2) how does it engage people, (3) how does it empower people, and (4) what is the impact? PPI members felt that the online forum was too researcher led, and needed to be more PPI focussed. CONCLUSIONS When developing online methods of PPI, a functioning forum is not enough: it also needs to be engaging and empowering to have an impact. To optimise online involvement, future work should refer to these four domains and balance the needs of researchers and PPI members.
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Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - Sophie Pask
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - Hamid Benalia
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - Sylvia Bailey
- Patient/Carer Representative, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Marion Sumerfield
- Patient/Carer Representative, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Jana Witt
- Cancer Research UK, Angel Building, 407 St John Street, London, UK
| | - Susanne de Wolf-Linder
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
- Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - Fliss E. M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
- Sussex Community NHS Foundation Trust, Trust HQ Brighton General Hospital, Brighton, Elm Gove UK
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Muir D, Vat LE, Keller M, Bell T, Jørgensen CR, Eskildsen NB, Johnsen AT, Pandya-Wood R, Blackburn S, Day R, Ingram C, Hapeshi J, Khan S, Muir D, Baird W, Pavitt SH, Boards R, Briggs J, Loughhead E, Patel M, Khalil R, Cooper D, Day P, Boards J, Wu J, Zoltie T, Barber S, Thompson W, Kenny K, Owen J, Ramsdale M, Grey-Borrows K, Townsend N, Johnston J, Maddison K, Duff-Walker H, Mahon K, Craig L, Collins R, O’Grady A, Wadd S, Kelly A, Dutton M, McCann M, Jones R, Mathie E, Wythe H, Munday D, Millac P, Rhodes G, Roberts N, Simpson J, Barden N, Vicary P, Wellings A, Poland F, Jones J, Miah J, Bamforth H, Charalambous A, Dawes P, Edwards S, Leroi I, Manera V, Parsons S, Sayers R, Pinfold V, Dawson P, Gibbons B, Gibson J, Hobson-Merrett C, McCabe C, Rawcliffe T, Frith L, Gudgin B, Wellings A, Horobin A, Ewart C, Higton F, Vanhegan S, Pandya-Wood R, Stewart J, Wragg A, Wray P, Widdowson K, Brighton LJ, Pask S, Benalia H, Bailey S, Sumerfield M, Etkind S, Murtagh FEM, Koffman J, Evans CJ, Hrisos S, Marshall J, Yarde L, Riley B, Whitlock P, Jobson J, Ahmed S, Rankin J, Michie L, Scott J, Barker CR, Barlow-Pay M, Kekere-Ekun A, Mazumder A, Nishat A, Petley R, Brady LM, Templeton L, Walker E, Moore D, Shaw L, Nunns M, Thompson Coon J, Blomquist P, Cochrane S, Edelman N, Calliste J, Cassell J, Mader LB, Kläger S, Wilkinson IB, Hiemstra TF, Hughes M, Warren A, Atkins P, Eaton H, Keenan J, Poland F, Wythe H, Wellings A, Vicary P, Rhodes C, Skrybrant M, Blackburn S, Chatwin L, Darby MA, Entwistle A, Hull D, Quann N, Hickey G, Dziedzic K, Eltringham SA, Gordon J, Franklin S, Jackson J, Leggett N, Davies P, Nugawela M, Scott L, Leach V, Richards A, Blacker A, Abrams P, Sharma J, Donovan J, Whiting P, Stones SR, Wright C, Boddy K, Irvine J, Harris J, Joseph N, Kok M, Gibson A, Evans D, Grier S, MacGowan A, Matthews R, Papoulias C, Augustine C, Hoffman M, Doughty M, Surridge H, Tembo D, Roberts A, Chambers E, Beever D, Wildman M, Davies RL, Staniszewska S, Stephens R, Schroter S, Price A, Richards T, Demaine A, Harmston R, Elliot J, Flemyng E, Sproson L, Pryde L, Reed H, Squire G, Stanton A, Langley J, Briggs M, Brindle P, Sanders R, McDermott C, David C, Nicola H, Simon D, Martin W, Coldham T, Ballinger C, Kerridge L, Mullee M, Eyles C, Barlow-Pay M, Hickey G, Johns T, Paylor J, Turner K, Whiting L, Roberts S, Petty J, Meager G, Grinbergs-Saull A, Morgan N, Turner K, Collins F, Gibson S, Passmore S, Evans L, Green SA, Trite J, Matthews R, Hrisos S, Thomson R, Green D, Atkinson H, Mitchell A, Corner L, AM AMK, Nguyen R, Frank B, McNeil N, Harrison H. Abstracts from the NIHR INVOLVE Conference 2017. Res Involv Engagem 2017; 3:27. [PMCID: PMC5773864 DOI: 10.1186/s40900-017-0075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Delia Muir
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lidewij Eva Vat
- Newfoundland and Labrador’s Support for People and Patient-Oriented Research and Trials Unit, Memorial University Newfoundland, St. Johns, Newfoundland and Labrador Canada
| | - Malori Keller
- Saskatchewan Centre for Patient-Oriented Research, Health Quality Council, Saskatoon, Saskatchewan Canada
| | - Tim Bell
- Canadian Institutes of Health Research, Ottawa, Ontario Canada
| | - Clara R. Jørgensen
- Department of Disability, Inclusion and Special Needs, School of Education, University of Birmingham, Birmingham, UK
| | - Nanna B. Eskildsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Anna T. Johnsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Raksha Pandya-Wood
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Steven Blackburn
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Ruth Day
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Carol Ingram
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Julie Hapeshi
- National Institute for Health Research, Research Design Service South West, Gloucestershire Royal Hospital, Gloucester, UK
| | - Samaira Khan
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Delia Muir
- National Institute for Health Research, Research Design Service Yorkshire and Humber, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Wendy Baird
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue H. Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Richard Boards
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Janet Briggs
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Ellen Loughhead
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Mariya Patel
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Rameesa Khalil
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | | | - Peter Day
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Boards
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sophy Barber
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Kate Kenny
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Owen
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | | | | | - Katie Maddison
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Harry Duff-Walker
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Katie Mahon
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Lily Craig
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Rebecca Collins
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Alice O’Grady
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Sarah Wadd
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Adrian Kelly
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Maureen Dutton
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Michelle McCann
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Rebecca Jones
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Elspeth Mathie
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Helena Wythe
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Diane Munday
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Paul Millac
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Graham Rhodes
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Nick Roberts
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Jean Simpson
- Cambridge University Hospital (CUH) Patient and Public Involvement Panel, Cambridgeshire, UK
| | - Nat Barden
- Service User and Research Group, Cambridge and Peterborough Foundation Trust, Cambridgeshire, UK
| | - Penny Vicary
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | - Amander Wellings
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | | | - Julia Jones
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Jahanara Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Howard Bamforth
- SENSE-Cog Research User Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anna Charalambous
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness (ManCAD), Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Steven Edwards
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Valeria Manera
- CoBTeK COgnition Behaviour Technology, Universite de Nice Sophia Antipolis, Nice, France
| | - Suzanne Parsons
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Paul Dawson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | | | | | | | | | | | - Lucy Frith
- National Institute for Health Research (NIHR), Research Design Service North West, University of Liverpool, Liverpool, UK
| | | | | | - Adele Horobin
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | | | | | | | - Raksha Pandya-Wood
- National Institute for Health Research (NIHR) East Midlands Research Design Service, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jane Stewart
- National Institute for Health Research (NIHR) East Midlands Research Design Service, School of Medicine, University of Nottingham, Nottingham Health Science Partners, Queen’s Medical Centre, Nottingham, UK
| | - Andy Wragg
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, UK
| | - Paula Wray
- INVOLVE Coordinating Centre, University of Southampton, Southampton, UK
| | - Kirsty Widdowson
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Lisa Jane Brighton
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sophie Pask
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Hamid Benalia
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sylvia Bailey
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Marion Sumerfield
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Simon Etkind
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Fliss E. M. Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Department of Palliative Medicine, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Bren Riley
- Riverside Project, Newcastle upon Tyne, UK
| | | | | | - Safia Ahmed
- Health and Race Equality Forum, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lydia Michie
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Scott
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline R. Barker
- National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Megan Barlow-Pay
- National Institute for Health Research Design Service South Central, University of Southampton, Southampton, Hampshire, UK
| | - Aisha Kekere-Ekun
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Mazumder
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Nishat
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Rebecca Petley
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Louca-Mai Brady
- Kingston and St George’s Joint Faculty and Independent Research Consultant, London, UK
| | | | - Erin Walker
- Centre for Outcomes and Experiences Research in Child Health, Illness and Disease, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Darren Moore
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson Coon
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Paula Blomquist
- Public Health England, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Sarah Cochrane
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie Edelman
- Brighton & Sussex Medical School, Brighton, UK
- University of Brighton, Brighton, UK
| | - Josina Calliste
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Jackie Cassell
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Laura B. Mader
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sabine Kläger
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian B. Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Thomas F. Hiemstra
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mel Hughes
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Angela Warren
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Peter Atkins
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Hazel Eaton
- Research and Development, Dorset Healthcare University NHS Foundation Trust, Dorset, UK
| | | | | | - Helena Wythe
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Amander Wellings
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Penny Vicary
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Carol Rhodes
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Magdalena Skrybrant
- NIHR Collaboration for Leadership in Health Research and Care West Midlands, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Blackburn
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Lucy Chatwin
- Academic Health Science Network West Midlands, Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Mary-Anne Darby
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Andrew Entwistle
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Diana Hull
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naimh Quann
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Hickey
- INVOLVE, University of Southampton Science Park, Southampton, UK
| | - Krysia Dziedzic
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Sabrina A. Eltringham
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim Gordon
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sue Franklin
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joni Jackson
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nick Leggett
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippa Davies
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Manjula Nugawela
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren Scott
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Verity Leach
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anthony Blacker
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Jitin Sharma
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Jenny Donovan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Penny Whiting
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon R. Stones
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Catherine Wright
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Jenny Irvine
- NIHR CLAHRC North West Coast (CLAHRC NWC), Based at Division of Health Research, Lancaster University, Lancaster, UK
| | - Jim Harris
- Peninsula Public Involvement Group (PenPIG), PenCLAHRC, South West Peninsula, Exeter, UK
| | - Neil Joseph
- Public Reference Panel (PRP), CLAHRC NWC, North West Coast area, Liverpool, UK
| | - Michele Kok
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - David Evans
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Sally Grier
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Cherelle Augustine
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Maurice Hoffman
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Heidi Surridge
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Doreen Tembo
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Amanda Roberts
- Public member, NETSCC Public Involvement Virtual Network and Public member of a Trial Steering Committee, Southampton, UK
| | - Eleni Chambers
- Public member, NETSCC PPI Reference Group, Southampton, UK
| | - Daniel Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire UK
| | - Martin Wildman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire UK
| | - Rosemary L. Davies
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Warwick, UK
| | | | | | - Amy Price
- The BMJ, London, UK
- Department of Continuing Education, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Lise Sproson
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Liz Pryde
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Gill Squire
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Andy Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Moya Briggs
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Philip Brindle
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Rod Sanders
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Coyle David
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
- Renal Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Heron Nicola
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Davies Simon
- Institute for Applied Clinical Sciences, Keele University, Keele, Staffordshire UK
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | - Wilkie Martin
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | | | | | | | - Mark Mullee
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Caroline Eyles
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Megan Barlow-Pay
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Gary Hickey
- NIHR INVOLVE, University of Southampton, Southampton, UK
| | - Tracey Johns
- NIHR Research Design Service East of England, University of Essex, Essex, UK
| | - Jon Paylor
- NIHR Research Design Service London, Kings College London, London, UK
| | - Katie Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Lisa Whiting
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Sheila Roberts
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Julia Petty
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Gary Meager
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | | | | | - Kati Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Flavia Collins
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Sarah Gibson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Siobhan Passmore
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Liz Evans
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Stuart A. Green
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Jenny Trite
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Richard Thomson
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Dave Green
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Helen Atkinson
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Alex Mitchell
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Lynne Corner
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | | | - Rebecca Nguyen
- Consumer and Community Health Research Network, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Belinda Frank
- Consumer and Community Health Research Network, Perth, Australia
| | - Ngaire McNeil
- Consumer and Community Health Research Network, Perth, Australia
| | - Hayley Harrison
- Consumer and Community Health Research Network, Perth, Australia
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Brighton LJ, Selman LE, Gough N, Nadicksbernd JJ, Bristowe K, Millington-Sanders C, Koffman J. 'Difficult Conversations': evaluation of multiprofessional training. BMJ Support Palliat Care 2017; 8:45-48. [PMID: 29118100 PMCID: PMC5867425 DOI: 10.1136/bmjspcare-2017-001447] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022]
Abstract
Objectives Evidence-based communication skills training for health and social care professionals is essential to improve the care of seriously ill patients and their families. We aimed to evaluate the self-reported impact of ‘Difficult Conversations’, a multidisciplinary half-day interactive workshop, and gain feedback to inform future development and evaluation. Methods Service evaluation using questionnaire data collected before and immediately after workshops from February 2015 to August 2016 regarding participant self-assessed confidence, knowledge and skills. Qualitative free-text comments provided feedback about the workshop and were subjected to content analysis. Results Of 886 workshop participants, 655 completed baseline questionnaires and 714 postworkshop questionnaires; 550 were matched pairs. Participants were qualified or trainee general practitioners (34%), community nurses and care coordinators (32%), social care professionals (7%), care home staff (6%), advanced practice/specialist nurses (5%), care workers (5%) and allied health professionals (3%). All groups demonstrated significant increases in mean self-assessed confidence (2.46, 95% CI 2.41 to 2.51; to 3.20, 95% CI 3.17 to 3.24; P<0.001), knowledge (2.22, 95% CI 2.17 to 2.27; to 3.18, 95% CI 3.14 to 3.22; P<0.001) and skills (2.37, 95% CI 2.32 to 2.42; to 3.09, 95% CI 3.05 to 3.12; P<0.001). Qualitative findings showed participants valued role play, the communication framework acronym and opportunities for discussion. They commended workshop facilitators’ skills, the safe atmosphere and interprofessional learning. Suggested improvements included more prepared role play and greater coverage of the taught topics. Conclusions ‘Difficult Conversations’ workshops were associated with improvements in participants’ self-assessed confidence, knowledge, and skills. Our findings identify workshop characteristics that are acceptable to multidisciplinary trainees. Further testing is warranted to determine effectiveness and accurately identify workshop components leading to change.
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Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lucy Ellen Selman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicholas Gough
- Department of Palliative Care, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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St John K, Koffman J. Introducing Namaste Care to the hospital environment: a pilot study. Ann Palliat Med 2017; 6:354-364. [DOI: 10.21037/apm.2017.06.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/14/2017] [Indexed: 11/06/2022]
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48
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Brighton LJ, Koffman J, Robinson V, Khan SA, George R, Burman R, Selman LE. 'End of life could be on any ward really': A qualitative study of hospital volunteers' end-of-life care training needs and learning preferences. Palliat Med 2017; 31:842-852. [PMID: 28056642 PMCID: PMC5613806 DOI: 10.1177/0269216316679929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. AIMS To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. DESIGN Qualitative focus groups. SETTING/PARTICIPANTS Volunteers from a large teaching hospital were purposively sampled. RESULTS Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. CONCLUSION Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.
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Affiliation(s)
- Lisa Jane Brighton
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Jonathan Koffman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Vicky Robinson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | | | - Rob George
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,2 Guy's and St Thomas' NHS Foundation Trust, London, UK.,3 St Christopher's Hospice, London, UK
| | - Rachel Burman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,4 King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Ellen Selman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,5 Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Kane PM, Daveson BA, Ryan K, Ellis-Smith CI, Mahon NG, McAdam B, McQuilllan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Koffman J, Murtagh FEM. Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure. BMJ Support Palliat Care 2017; 7:470-479. [PMID: 28864449 DOI: 10.1136/bmjspcare-2017-001355] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 03/29/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 11/04/2022]
Abstract
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF. OBJECTIVES To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF. METHODS A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability. RESULTS Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable. CONCLUSIONS A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
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Affiliation(s)
- Pauline M Kane
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karen Ryan
- Palliative Care, St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clare I Ellis-Smith
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Niall G Mahon
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Cecelia Tracey
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Christine Howley
- Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | | | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
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Brighton LJ, Koffman J, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Higginson IJ, Selman LE. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance. J Pain Symptom Manage 2017; 54:417-425. [PMID: 28782701 DOI: 10.1016/j.jpainsymman.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 01/11/2017] [Revised: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. OBJECTIVES To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. METHODS Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. RESULTS From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: <30% were controlled, <15% randomized participants. Over half (n = 85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g., training duration, participant flow) was poorly reported. CONCLUSIONS Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing.
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Affiliation(s)
- Lisa Jane Brighton
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Jonathan Koffman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, UK; Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Christine McDonald
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Suzanne O'Brien
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Vicky Robinson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | | | - Rob George
- Guy's and St Thomas' NHS Foundation Trust, London, UK; St Christopher's Hospice, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Lucy Ellen Selman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK; Population Health Sciences, University of Bristol, Bristol, United Kingdom
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