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Quality of life of older persons in nursing homes after the implementation of a knowledge-based palliative care intervention

BOKBERG, Christina ; BEHM, Lina ; AHLSTROM, Gerd
International journal of older people nursing, 12/07/2019, p. 1-11

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Thème : Age de la vie, situations spécifiques liées à la fin de vie. Cote : eD05.04

QUALITE VIE ; PERSONNE AGEE ; MAISON RETRAITE ; DEMARCHE PALLIATIVE ; QUESTIONNAIRE ; FORMATION PROFESSIONNELLE

BACKGROUND: The goals of palliative care are to relieve suffering and promote quality of life. Palliative care for older persons has been less prioritised than palliative care for younger people with cancer, which may lead to unnecessary suffering and decreased quality of life at the final stage of life.
AIM: To evaluate whether a palliative care intervention had any influence on the perceived quality of life of older persons (=65 years).
METHODS: This study was conducted as a complex intervention performed with an experimental crossover design. The intervention was implemented in 20 nursing homes, with a six-month intervention period in each nursing home. Twenty-three older persons (=65 years) in the intervention group and 29 in the control group were interviewed using the WHOQOL-BREF and WHOQOL-OLD questionnaires at both baseline and follow-up. The collected data were analysed using the Wilcoxon signed-rank test to compare paired data between baseline and follow-up.
RESULTS: In the intervention group, no statistically significant increases in quality of life were found. This result contrasted with the control group, which revealed statistically significant declines in quality of life at both the dimension and item levels. Accordingly, this study showed a trend of decreased health after nine months in both the intervention and control groups.
CONCLUSION: It is reasonable to believe that quality of life decreases with age as part of the natural course of the ageing process. However, it seems that the palliative care approach of the intervention prevented unnecessary quality of life decline by supporting sensory abilities, autonomy and social participation among older persons in nursing homes. From the ageing perspective, it may not be realistic to strive for an increased quality of life in older people living in nursing homes; maybe the goal should be to delay or prevent reduced quality of life. Based on this perspective, the intervention prevented decline in quality of life in nursing home residents.
IMPLICATIONS FOR PRACTICE: The high number of deaths shows the importance to identify palliative care needs in older persons at an early stage to prevent or delay deterioration of quality of life.

Origine : PubMed

Présence d'un chat en unité de soins palliatifs - bénéfices et satisfaction pour les patients et les proches

BOESPFLUG, Olivia ; ADAM, Anne ; DUBOIS, Jocelyne ; SINCLAIR, Catherine ; ASTIER, Elsa
MEDECINE PALLIATIVE, 06/2019, vol.18, n°3, p. 143-148

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Thème : Soins.

ANIMAL DOMESTIQUE ; UNITE SOINS PALLIATIFS ; QUESTIONNAIRE ; SATISFACTION

Période de vulnérabilité, la fin de vie est marquée par une appétence relationnelle des malades, qui concerne l’entourage, les soignants mais aussi éventuellement un animal, celui du malade ou inscrit dans un projet de service de médiation animale. Un tel projet a été mis en place au sein de l’unité de soins palliatifs, dont l’un des volets est relatif à la présence d’un chat résident permanent de l’unité. L’impact de sa présence a été étudié par un questionnaire de satisfaction auprès des patients et des familles. Trente-six questionnaires sur une période de trois mois ont été étudiés. Les résultats montrent que la chatte a fréquenté presque toutes les chambres et circulé dans les parties communes. Patients et entourage ont des eu interactions avec elle, sous forme de caresses. Elle a apporté distraction, détente et réconfort pour plus de la moitié des personnes interrogées, et dans une moindre mesure diminution de l’anxiété. La satisfaction globale a été majeure : 84,4 % des personnes ont estimé la présence de la chatte très satisfaisante et 15,6 % satisfaisante. Les limites étaient notamment la faiblesse de l’échantillon et la brièveté de la période d’étude. D’autres items auraient pu être étudiés : impact sur l’humeur, la fatigue, l’appétit, la perception de l’état de santé. L’impact sur les soignants serait une autre piste de réflexion.

Critical care nurses' perceptions of parenteral and enteral nutrition at the end-of-life in South Korea

SEOL, Eun-Mi ; KOH, Chin Kang ; KIM, Eun Kyung
JOURNAL OF PALLIATIVE CARE, 18/07/2019, Pagination inconnue

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Thème : Soins.

REPUBLIQUE DE COREE ; SOIN INTENSIF ; PERCEPTION ; NUTRITION ENTERALE ; NUTRITION PARENTERALE ; FIN VIE ; ETHIQUE SOIN ; QUESTIONNAIRE

PURPOSE: The purpose of this study was to explore the perceptions of critical care nurses regarding the withdrawal or withholding of enteral nutrition (EN) and parenteral nutrition (PN) at the end-of-life, which is not allowed according to the current law in South Korea.
METHODS: This was a cross-sectional study utilizing a self-report survey. The participants in the study were 141 nurses working in the intensive care units of a tertiary university hospital. The critical care nurses' general attitudes about EN and PN at the end-of-life were measured using the questionnaires developed by Lubart, Leibovitz, and Habot. The nurses responded to additional questions on whether withdrawal or withholding of EN or PN at the end-of-life should be legally allowed.
RESULTS: The mean scores of the general attitude items on EN ranged between 3.03 and 3.35 on a 5-point Likert scale where a value of 1 represents "strongly disagree" and a value of 5 represents "strongly agree," while those for PN ranged between 2.89 and 3.65. Respecting attitudes toward EN and PN, critical care nurses had more negative attitudes about stopping PN than EN. Regarding attitudes about whether patients should be legally able to refuse EN, 34.3% agreed, while 25.7% disagreed. For PN, 40.0% agreed, while 24.3% disagreed.
CONCLUSION: Discussions about making the withdrawal and withholding of artificial nutrition legal should be initiated. Moreover, education regarding evidence about the outcomes of EN and PN during end-of-life care and up-to-date clinical guidelines about it should be provided.

Origine : PubMed

Which symptoms and problems do advanced cancer patients admitted to specialized palliative care report in addition to those included in the EORTC QLQ-C15-PAL? - a register-based national study

ROJAS-CONCHA, Leslye ; HANSEN, Maiken Bang ; PETERSEN, Morten Aagaard ; GROENVOLD, Mogens
Supportive care in cancer, 11/07/2019, p. 1-11

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Thème : Recherche - Evaluation - Méthodologie.

CANCER ; DEMARCHE PALLIATIVE ; QUESTIONNAIRE ; OUTIL ; SYMPTOME ; DANEMARK ; EVALUATION

PURPOSE: Patients in palliative care are willing to answer short questionnaires, like the EORTC QLQ-C15-PAL; however, patients may suffer from other symptoms and problems (S/Ps) not covered by such questionnaires. Therefore, to identify which other S/Ps patients experience, in addition to those already included in the EORTC QLQ-C15-PAL, we developed a brief instrument to supplement this questionnaire named WISP (Write In three Symptoms/Problems), permitting patients to report 1-3 additional S/Ps and their severity. We aim to investigate the nature, prevalence, and severity of S/Ps reported on WISP.
METHODS: A register-based study with data obtained from the Danish Palliative Care Database. This study included adults with advanced cancer admitted to specialized palliative care in Denmark, who reported S/Ps on WISP. S/Ps were categorized qualitatively, and their prevalence and severity were calculated.
RESULTS: Of the 5447 patients who completed the EORTC QLQ-C15-PAL, 1788 (32.8%) reported at least one symptom/problem using WISP. In total, 2796 S/Ps were reported; 24.8% were already covered by EORTC QLQ-C15-PAL; 63.6% were new, 10.1% were diagnoses and 1.6% could not be coded. S/Ps already covered and new were grouped into 61 categories. The most prevalent S/Ps reported were (in decreasing order) pain, edema, dizziness, impaired physical or emotional function, cough, and sweats. Overall, 85% of the S/Ps were rated as moderate to severe.
CONCLUSIONS: The WISP instrument strongly improves the recognition of S/Ps by combining standardization with individualization. We recommend its use for comprehensive symptom assessment alongside the EORTC QLQ-C15-PAL, and potentially also alongside the EORTC QLQ-C30.

Origine : PubMed

Elements of intensive care bereavement follow-up services - a European survey

EGEROD, Ingrid ; KALDAN, Gudrun ; ALBARRAN, John ; COOMBS, Maureen ; MITCHELL, Marion ; LATOUR, Jos M.
Nursing in critical care, 07/2019, vol.24, n°4, p. 201-208

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Thème : Deuil et travail du deuil.

DEUIL ; CHAGRIN ; FAMILLE ; SOIN INFIRMIER ; SOIN INTENSIF ; QUESTIONNAIRE ; ENQUETE ; SOUTIEN DEUIL ; ETUDE INTERNATIONALE

Background: Despite technological innovations and continuous improvement in evidence-based treatments, mortality in the intensive care unit (ICU) remains high. Consequently, a large group of family members may be in need of, and could benefit from, bereavement follow-up support.
Aims and Objectives: To explore the elements, organization, and evaluation of ICU bereavement services in European countries. Specific objectives were to investigate: (a) the model of bereavement follow-up services (elements of support), (b) the workforce model (organization of staff), and (c) the evaluation model (evaluation strategies).
Design: This was a cross-sectional survey of conference delegates.
Methods: A paper-and-pen questionnaire, including a cover letter assuring the respondents of anonymity and confidentiality, was distributed to 250 delegates during the opening ceremony of the 2017 European federation of Critical Care Nurses associations Congress in Belfast. The questionnaire was developed from a previously validated tool describing bereavement care practices in ICUs, including questions about the content and organization of bereavement follow-up services. Frequencies were calculated using yes/no questions, and content analysis was applied in additional free-text comments.
Results: We received 85 responses from publicly employed nurses, mainly in mixed adult ICUs. Respondents were 48 (56.5%) bedside nurses, and the remaining respondents represented clinical nurse specialists, researchers, managers, or academic nurses. Bereavement follow up had existed for about 1 to 15 years. Important follow-up elements were: viewing the deceased in the unit, 77 (90.6%); providing follow-up information, 67 (79.8%); sending a letter of sympathy, 17 (20%); and calling the family to arrange a meeting, 27 (31%).
Conclusions: Bereavement follow up is common but variable in European ICUs. We recommend the development, implementation, and evaluation of evidence-based, but culture-specific, bereavement follow-up guidelines for European ICUs.
Relevance to clinical practice: More critical care nurses are realizing the need for bereavement follow-up guidelines. This paper provides an overview of common elements that might be considered.

Origine : PubMed

How and how much is spirituality discussed in palliative care consultations for advanced cancer patients with and without a question prompt list?

BEST, Megan ; MCARDLE, Madeleine B. ; HUANG, Yi-Jing ; CLAYTON, Josephine ; BUTOW, Phyllis
Patient education and counseling, 19/06/2019, Pagination inconnue

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Thème : Religions, spiritualité.

DEMARCHE PALLIATIVE ; COMMUNICATION ; SPIRITUALITE ; RELATION MEDECIN PATIENT ; QUESTIONNAIRE

Objective: Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC).
Methods: This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors.
Results: 174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion.
Conclusion: Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns.
Practice implications: Doctors caring for patients at the end of life should routinely raise spiritual issues.

Origine : PubMed

Attitude of nurses towards euthanasia - a cross-sectional study in Iran

SAFARPOUR, Hamid ; KEYKHA, Roghayeh ; VARASTEH, Saeideh ; SARGAZI, Venus ; MIRMORTAZAVI, Mahan ; TAVAKOLIAN, Najmeh
International Journal of Palliative Nursing, 02/06/2019, vol.25, n°6, p. 274-282

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Thème : Soins.

ATTITUDE ; INFIRMIERE ; EUTHANASIE ; IRAN ; QUESTIONNAIRE ; ECHELLE MESURE

BACKGROUND: Nurses play a major role in providing end-of-life care, and euthanasia is considered to be one of the most important ethical challenges that care providers can face.
AIM: To assess the nurses' attitude towards euthanasia in Iran.
METHODS: The cross-sectional study included nurses who worked in intensive and critical care, as well as dialysis units of a teaching hospital affiliated to Zahedan University of Medical Sciences, who were selected by the census sampling technique. Data were collected using a two-part questionnaire encompassing the demographic characteristics of nurses and the 20-item Euthanasia Attitude Scale.
RESULTS: The overall score of nurses' attitudes towards euthanasia, ranging from one to five, was 2.71±0.45, indicating a negative attitude and opposition towards euthanasia. Alongside this, the results demonstrated that there was no significant relationship between demographic characteristics and nurses' attitudes toward euthanasia.
CONCLUSION: In general, nurses in Iran oppose euthanasia. This can be attributed to the context of religious beliefs and culture in Iran as an Islamic country.

Origine : PubMed

Grief reactions and coping strategies of trainee doctors working in paediatric intensive care

FFRENCH-O'CARROLL, Robert ; FEELEY, Tara ; CROWE, Suzanne ; DOHERTY, Eva M.
British journal of anaesthesia, 07/2019, vol.123, n°1, p. 74-80

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Thème : Psychologie, psychanalyse.

CHAGRIN ; DEUIL ; PERCEPTION MORT ; ENQUETE ; QUESTIONNAIRE ; PERSONNEL SANTE ; MEDECIN ; ETUDIANT ; ETUDE LONGITUDINALE ; COPING ; IRLANDE ; SOIN INTENSIF ; PEDIATRIE ; STRESS

Background: The death of a child can have significant emotional effects on doctors responsible for their care. Trainee doctors working in the paediatric intensive care unit (PICU) may be particularly vulnerable. The aim of this study was to examine the emotional impact of, and grief reactions to, a child's death in PICU trainee doctors, along with coping strategies they used.
Methods: In a prospective, cross-sectional, observational study, qualitative and quantitative data were recorded on anonymised, written questionnaires. Grief severity was assessed using the Texas Revised Inventory of Grief. Emotional impact was assessed using the shortened Impact of Event Scale. The BriefCOPE tool was used to assess coping strategies. Qualitative data was analysed using conventional content analysis. Data are presented as median (inter-quartile range) or number (%).
Results: All invited trainee doctors (23 anaesthetists; 5 paediatricians) completed the questionnaire (age, 30 [29-34] yr; 13/28 [46%] female). Two (7%) doctors experienced severe grief (Texas Revised Inventory of Grief score <39), with five (18%) doctors severely affected by the deaths as measured by the Impact of Event Scale. Qualitative analysis revealed prominent themes of sadness, helplessness, guilt, shock, and concern for the bereaved family. There was limited use of coping strategies. Speaking with another trainee doctor was the principal coping strategy. Requests for debriefing sessions, greater psychological support and follow-up with the patient's family were frequently suggested.
Conclusions: Paediatric deaths evoke significant grief and emotional reactions in a subset of PICU trainee doctors. Trainee PICU doctors highlighted a lack of professional support and tailored debriefs.

Origine : PubMed

Stigma in the context of pregnancy termination after diagnosis of fetal anomaly - associations with grief, trauma, and depression

HANSCHMIDT, Franz ; TREML, Julia ; KLINGNER, Johanna ; STEPAN, Holger ; KERSTING, Anette
Archives of women's mental health, 08/2018, vol.21, n°4, p. 391-399

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Thème : Deuil et travail du deuil.

ENQUETE ; QUESTIONNAIRE ; STRESS ; CHAGRIN ; DEPRESSION ; TRAUMATISME ; ETUDE TRANSVERSALE ; GROSSESSE ; ALLEMAGNE ; DIAGNOSTIC ; FOETUS ; INTERRUPTION VOLONTAIRE GROSSESSE ; MORT PERINATALE

Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

Origine : PubMed

Workplace responses and psychologists’ needs following client suicide

FINLAYSON, Melissa ; SIMMONDS, Janette
OMEGA JOURNAL OF DEATH AND DYING, 01/05/2019, vol.79, n°1, p. 18-33

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Thème : Soins. Cote : 00.07OME

TRAVAIL ; SOUTIEN PSYCHOLOGIQUE ; SUICIDE ; PSYCHOLOGUE ; QUESTIONNAIRE

This research aimed to explore the role of workplace responses in psychologists’ adaptation to client suicides. Participants were 178 psychologists who completed an online self-report questionnaire which included both open and closed questions yielding qualitative and quantitative data. Fifty-six (31.5%) participants reported one or more client suicides. Mixed results were found in terms of perceived support from the workplace following a client suicide. Psychologists reported a need for more open communication in the workplace, peer supports, space to grieve, as well as opportunities to engage in a learning process. The findings have important implications for research and for understanding the role of the workplace postvention. It also raises the need for external support to be accessible for psychologists working in private practice.

Origine : SAGE Journals

Study protocol to investigate the efficacy of normalisation of advance care planning (ACP) for people with chronic diseases in acute and community settings - a quasi-experimental design

JEONG, Sarah ; BARRETT, Tomiko ; OHR, Se Ok ; CLEASBY, Peter ; DAVID, Michael ; CHAN, Sally ; FAIRLAMB, Helen ; DAVEY, Ryan ; SAUL, Peter
BMC health services research, 04/05/2019, vol.19, n°1, 10 p.

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Thème : Recherche - Evaluation - Méthodologie. Cote : eD15.02

COMMUNICATION ; QUESTIONNAIRE ; ENQUETE ; RECHERCHE ; ETUDE RETROSPECTIVE ; SOIN INFIRMIER ; AUSTRALIE ; PLANIFICATION ; MALADIE CHRONIQUE ; DIRECTIVE ANTICIPEE ; PRISE DECISION ; HOPITAL ; PROTOCOLE RECHERCHE

Background: Advanced care planning (ACP) is a process that involves thinking about what medical care one would like should individuals be seriously ill and cannot communicate decisions about treatment for themselves. The literature indicates that ACP leads to increased satisfaction from both patients and healthcare professionals. Despite the well-known benefits of ACP, it is still underutilised in Australia.
Methods: The aim of this study is to investigate the effects of normalising ACP in acute and community settings with the use of specially trained normalisation agents. This is a quasi-experimental study, involving 16 sites (8 intervention and 8 control) in two health districts in Australia. A minimum of total 288 participants will be recruited (144 intervention, 144 control). We will train four registered nurses as normalisation agents in the intervention sites, who will promote and facilitate ACP discussions with adult patients with chronic conditions in hospital and community settings. An audit of the prevalence of ACP and Advanced Care Directives (ACDs) will be conducted before and after the 6-month intervention period at the 16 sites to assess the effects of the ACP service delivered by these agents. We will also collect interview and survey data from patients and families who participate, and healthcare professionals who are involved in this service to capture their experiences with ACP.
Discussion: This study will potentially contribute to better patient outcomes with their health care services. Completion of ACDs will allow patients to express their wishes for care and receive the care that they wish for, as well as ease their family from the burden of making difficult decisions. The study will contribute to development of a new best practice model to normalise ACP that is sustainable and transferable in the processes of: 1) initiation of conversation; 2) discussion of important issues; 3) documentation of the wishes; 4) storage of the documented wishes; and 5) access and execution of the documented wishes. The study will generate new evidence on the challenges, strategies and benefits of normalising ACP into practice in acute and community settings.

Origine : PubMed

Gaining an accurate reflection of the reality of palliative care through the use of free-text feedback in questionnaires - the after study

BOWYER, Anna Victoria ; FINLAY, Ilora G. ; BAILLIE, Jessica ; BYRNE, Anthony ; MCCARTHY, Jacqui ; SAMPSON, Catherine ; SNOW, Veronica ; NELSON, Annmarie
BMJ supportive and palliative care, 03/2019, vol.9, n°1, 8 p.

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Thème : Recherche - Evaluation - Méthodologie. Cote : eD15.01

DEMARCHE PALLIATIVE ; ENQUETE ; QUESTIONNAIRE ; AIDANT NATUREL ; QUALITE SOIN ; RECHERCHE QUALITATIVE ; SATISFACTION ; PAYS DE GALLES ; ETUDE RETROSPECTIVE ; ENTRETIEN ; RECHERCHE

Background: In healthcare, many service evaluation questionnaires use free-text boxes without formal mechanisms for analysis. Patients and carers spend time documenting concerns that are often ignored or managed locally in an ad hoc manner. Currently, palliative care experiences of patients and carers in Wales are measured using a service evaluation questionnaire, comprising both closed and open-ended questions. Previous research, exploring free-text responses from this questionnaire, suggests that questionnaire refinement should accommodate service users' expressed priorities and concerns, and highlights the need to incorporate free-text data analysis strategies during study design.
Methods: Results from a previous analysis of 596 free-text responses provided the basis for an expert consensus day, where the current service evaluation questionnaire was refined. The refined version was tested during cognitive interviews with patients (n=10) and carers (n=7) receiving palliative care from 1 of 2 UK hospices. Data were analysed thematically.
Results: Interviews highlighted minor areas for change within the questionnaire and provided broader insight into patients' experiences of palliative care services. Patients and carers place an emphasis on simplifying language, decreasing the numeric response range and reducing written instructions; relying instead on visual cues, including formatting and layout. Findings highlighted the importance patients attached to providing meaningful free-text contributions.
Conclusions: Questionnaire refinement should use the patient perspective to effectively facilitate respondent understanding, pertinence and usability. The importance of employing data analysis strategies during questionnaire design may reduce research waste, thus enabling a better interrogation of service provision.

Origine : PubMed

Psychiatrists', psychologists' and counselors' attitudes regarding complicated grief

DODD, Anne ; GUERIN, Suzanne ; DELANEY, Susan ; DODD, Philip
Journal of affective disorders, 04/06/2019, vol.256, p. 358-363

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Thème : Psychologie, psychanalyse.

DEUIL COMPLIQUE ; ATTITUDE ; PSYCHIATRIE ; PSYCHOLOGUE ; QUESTIONNAIRE

Background: Complicated grief encompasses various presentations where aspects of grief do not become integrated into the bereaved person's life. Professionals' attitudes to complicated grief may impact how they engage with bereaved patients/clients. The aim of this study was to empirically examine the attitudes of mental health professionals, specifically psychologists, psychiatrists and counselor/psychotherapists, regarding complicated grief and to investigate any between profession-differences.
Method: Psychiatrists, counselor/psychotherapists and psychologists were recruited using publicly available databases managed by professional bodies. A total of 185 professionals (71.8% female), returned a questionnaire containing usable data (23.8% response rate).
Results: Over two-thirds of the professionals (68.5%) supported the inclusion of complicated grief in diagnostic manuals while only a quarter (25.1%) thought that recognition of complicated grief might lead to the pathologization of 'normal' grief. The majority of respondents (83.0%) thought that diagnosing complicated grief would increase the likelihood of clients accessing support and there was no significant difference between the groups.
Limitations: Although the response rate compares favorably with other studies it is nonetheless somewhat lower than optimum, and it is possible that those who responded were more interested in bereavement and consequently, that the attitudes held by participants are different from those who did not participate.
Conclusion: The attitude to a diagnosis of complicated grief was more positive than the specialist literature suggests, with the benefits of having a diagnosis of complicated grief outweighing the risks of pathologization.

Origine : PubMed

Training general practitioners contributes to the identification of palliative patients and to multidimensional care provision - secondary outcomes of an RCT

THOONSEN, Bregje ; GERRITZEN, Stefanie H. M. ; VISSERS, Kris C. P. ; VERHAGEN, Stans ; VAN WEEL, Chris ; GROOT, Marieke M. ; ENGELS, Yvonne
BMJ supportive and palliative care, 03/2019, vol.9, n°1, 8 p.

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Thème : Formation. Cote : eD14.00

DEMARCHE PALLIATIVE ; CANCER ; ADULTE ; ENQUETE ; QUESTIONNAIRE ; MEDECIN GENERALISTE ; CONSULTATION ; PLANIFICATION ; INSUFFISANCE CARDIAQUE ; BRONCHITE CHRONIQUE ; FORMATION ; IDENTIFICATION ; ANTICIPATION

Introduction: To support general practitioners (GPs) in providing early palliative care to patients with cancer, chronic obstructive pulmonary disease or heart failure, the RADboud university medical centre indicators for PAlliative Care needs tool (RADPAC) and a training programme were developed to identify such patients and to facilitate anticipatory palliative care planning. We studied whether GPs, after 1 year of training, identified more palliative patients, and provided multidimensional and multidisciplinary care more often than untrained GPs.
METHODS: We performed a survey 1 year after GPs in the intervention group of an RCT were trained. With the help of a questionnaire, all 134 GPs were asked how many palliative patients they had identified, and whether anticipatory care was provided. We studied number of identified palliative patients, expected lifetime, contact frequency, whether multidimensional care was provided and which other disciplines were involved.
RESULTS: Trained GPs identified more palliative patients than did untrained GPs (median 3 vs 2; p 0.046) and more often provided multidimensional palliative care (p 0.024). In both groups, most identified patients had cancer.
CONCLUSIONS: RADPAC sensitises GPs in the identification of palliative patients. Trained GPs more often provided multidimensional palliative care. Further adaptation and evaluation of the tools and training are necessary to improve early palliative care for patients with organ failure.

Origine : PubMed

Utility of a referral letter to improve comprehensibility of cancer patients in palliative care - a single-center study

KLOEPPEL, Eva-Marie ; HANAYA, Hani ; SEILACHER, Eckart ; SCHROTH, Sarah ; LIEBL, Patrick ; KEINKI, Christian ; JOLIN KOESTER, Marie ; HUEBNER, Jutta
Journal of cancer education, 01/01/2018, vol.33, n°2, p. 487-492

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Thème : Médecine.

DEMARCHE PALLIATIVE ; COMMUNICATION ; CANCER ; ADULTE ; ENQUETE ; QUESTIONNAIRE ; MEDECIN ; PRONOSTIC ; CONSULTATION ; PLANIFICATION ; EDUCATION PATIENT ; INFORMATION MALADE

In spite of a referral letter as an important document for communicating between physicians, whether it could also be useful as a source of information for patients has not yet established. We included cancer patients in palliative care setting, all of whom completed a standardized questionnaire regarding their opinion concerning the utility of a referral letter as a source of information and its requirements to achieve a better understanding. Completed questionnaires were received from 50 cancer patients. Ninety-four percent of participants agreed that a referral letter could be of great importance for procuring medical information to them. There was only minor divergence among the participants respecting age, gender, or education. Particular requirements were diagnosis, treatment plan, prognosis, list of drugs, and contact data of involved physicians. Additional important topics were laboratory values, alternatives to current therapy, side effects and supportive therapy, and advices regarding lifestyle and naturopathy. The majority of patients also concluded to accept technical terms in doctor's letters if a glossary supported their comprehension. The majority of patients prefer a concise description of medical information in a referral letter. This form of a letter would boost patients' involvement and help them transfer medical information to other therapists or relatives.

Origine : PubMed

Development of palliative care attitude and knowledge (PCAK) questionnaire for physicians in Kuwait

AL-ANSARI, Ameena Mohammed ; SUROOR, Saleem Nawaf ; ABOSEREA, Sobhi Mostafa ; ABD-EL-GAWAD, Wafaa Mostafa
BMC palliative care, 06/06/2019, vol.18, n°1, p. 1-9

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Thème : Soins. Cote : eD02.03.02.00

KOWEIT ; MEDECIN ; ATTITUDE ; ROLE ; QUESTIONNAIRE ; CONNAISSANCE

BACKGROUND: Over the past five decades, palliative care has changed from helping patients at the end of life into a highly dedicated service focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. To date there is no common agreement on universally applicable measurement tool to know the areas of weakness in physicians' understanding of palliative care and identifying misconceptions about palliative care. This paper describes the development of a reliable and valid questionnaire to provide a measure of the attitude and knowledge of physicians toward palliative care (PCAK).
METHODS: Item pool was generated paying particular attention to content and face validity. The initial version of the questionnaire was piloted and assessed based on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 37 item version was administered to two groups differing in their palliative care attitude and knowledge on two occasions to assess the construct validity and test-retest reliability. Two hundred thirty two physicians working in primary care clinics and general hospitals completed the questionnaire at the piloting stage. The final version (PCAK) was administered to 35 oncologists and 76 physicians. SPSS v20 was used for statistical analysis.
RESULTS: Of the Pilot study, 20 items were excluded because didn't meet the criteria for item difficulty and discrimination. Item-to-total-score correlations (r) was ranging from 0.347 up to 0.806. Internal consistency (Cronbach's alpha) was high ranging from 0.636 to 0.824. While testing the final PCAK, oncologist scored consistently higher than the other physicians on all sections of the questionnaire (P<0.001) suggesting good construct validity. Test to retest reliability for each section was very high, ranging from 0.879 to 0.97 and the overall reliability was 0.95. The internal consistency reliability of each section was very good ranging from 0.681+/-0.893.
CONCLUSION: The findings demonstrate that PCAK meets psychometric criteria for reliability and construct validity. It provides a useful scale to assess the attitude and knowledge of physicians about palliative care helping in planning of educational programs for physicians.

Origine : PubMed

Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong

SO, C. W. ; LUI, C. T. ; TSUI, K. L. ; CHAN, K. L. ; LAW, A. K. K. ; WONG, Y. K. ; LI, T. ; WONG, C. L. ; LEUNG, S. C.
Hong Kong medical journal, 06/2019, vol.25, n°3, p. 183-191

Document en ligne

Thème : Ethique et déontologie. Cote : eD13.02

QUESTIONNAIRE ; ACHARNEMENT THERAPEUTIQUE ; SERVICE URGENCES ; MEDECIN ; HONG KONG ; REANIMATION ; HOSPITALISATION JOUR ; CONNAISSANCE ; ATTITUDE ; PRATIQUE MEDICALE

Introduction: The perceptions of medical futility and decisions about termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) are highly heterogeneous and dependent on the practice of the attending emergency physicians. The objective of this study was to report and investigate the knowledge, attitudes, and practices regarding medical futility and TOR during management of OHCA in Hong Kong.
Methods: A cross-sectional survey was conducted among emergency medicine physicians in Hong Kong. The questionnaire assessed participants’ background, knowledge, attitudes, and behaviours concerning medical futility and TOR in management of OHCA. Composite scores were calculated to reflect knowledge, attitudes, and practices of OHCA treatment. Subgroup analysis and multiple regression analysis were used to explore the relationship between participants’ background, knowledge, attitudes, and behaviours.
Results: The response rate to this survey was 57% (140/247). Independent predictors of less aggressive resuscitation in OHCA patients included status as a Fellow of the Hong Kong College of Emergency Medicine (ß= -0.314, P=0.028) and being an Advanced Cardiac Life Support instructor (ß= -0.217, P=0.032). There was no difference in aggressiveness of resuscitation in terms of years of clinical experience (ß=0.015, P=0.921), knowledge of TOR (ß=0.057, P=0.509), or attitudes about TOR (ß= -0.103, P=0.214). The correlation between knowledge and attitudes was low (Spearman’s coefficient=0.02, P=0.795).
Conclusion: Clinical practice and behaviour of TOR was not demonstrated to have associations with knowledge or attitude. Status as a Fellow of the Hong Kong College of Emergency Medicine or Advanced Cardiac Life Support instructor were the only two parameters identified that had significant relationships with earlier TOR in medically futile patients with OHCA.

Origine : PubMed

Preparing future doctors for palliative care - views of course organisers

WALKER, Steven ; GIBBINS, Jane ; PAES, Paul ; BARCLAY, Stephen ; ADAMS, Astrid ; CHANDRATILAKE, Madawa ; GISHEN, Faye ; LODGE, Philip ; WEE, Bee
BMJ supportive and palliative care, 09/2018, vol.8, n°3, p. 299-306

Document en ligne

Thème : Soins.

MEDECIN ; ETUDIANT ; COMMUNICATION ; PHASE TERMINALE ; ROYAUME UNI ; UNITE SOINS PALLIATIFS ; FORMATION ; PRISE EN CHARGE ; PATIENT ; UNIVERSITE ; QUESTIONNAIRE

BACKGROUND: Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown.
OBJECTIVE: To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction.
METHODS: An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools.
RESULTS: Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course 'enabled misconceptions and fears about PC, death, dying and bereavement to be addressed', 'delivered quality PC training' (23, 77%), 'fulfilled General Medical Council requirements' (19, 63%), 'prepared students well to care for patients with PC/EOLC needs' (18, 60%) and 'enabled students to visit a hospice and see the role of doctors in caring for the dying' (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%).
CONCLUSIONS: Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.

Origine : PubMed

Development and validation of the comprehensive quality of life outcome (COQOLO) inventory for patients with advanced cancer

MIYASHITA, Mitsunori ; WADA, Makoto ; MORITA, Tatsuya ; ISHIDA, Mayumi ; ONISHI, Hideki ; TSUNETO, Satoru ; SHIMA, Yasuo
BMJ supportive and palliative care, 03/2019, vol.9, n°1, p. 75-83

Document en ligne

Thème : Recherche - Evaluation - Méthodologie.

QUALITE VIE ; CANCER ; JAPON ; PHASE TERMINALE ; ECHELLE MESURE ; REPRESENTATION MORT ; QUESTIONNAIRE ; UNITE SOINS PALLIATIFS

BACKGROUND: The purpose of this study was to develop a scale capable of measuring comprehensive quality of life (QOL) outcomes based on the concept of a good death for patients with advanced cancer.
METHODS: We conducted an anonymous cross-sectional questionnaire survey on inpatients being treated at the Oncology Clinic in Saitama Medical University International Medical Center and seven palliative units throughout Japan.
RESULTS: A total of 405 patients with cancer participated in this study. Factor analysis of scores on the Comprehensive Quality of Life Outcome (CoQoLo) inventory revealed 28 items and the following 10 subscales: physical and psychological comfort; staying in a favourite place; maintaining hope and pleasure; good relationships with medical staff; not being a burden to others; good relationships with family; independence; environmental comfort; being respected as an individual; and having a fulfilling life. The total CoQoLo score was moderately correlated with satisfaction (r=0.34) and overall QOL (r=0.34), and moderately correlated with feelings of support and security regarding cancer care (r=0.44). Cronbach's α and the intraclass correlation coefficient of the total score were 0.90 and 0.79, respectively. No significant correlation was found between the total CoQoLo score and self-reported Eastern Cooperative Oncology Group performance status (r=-0.01).
CONCLUSIONS: These results suggest that the CoQoLo has sufficient reliability and validity and therefore provides an accurate measure of QOL outcomes independent of the general physical condition of the patient.

Origine : PubMed

Palliative care in medical practice - medical students' expectations

DIVER, Ruth ; QUINCE, Thelma ; BARCLAY, Stephen ; BENSON, John ; BRIMICOMBE, James ; WOOD, Diana ; THIEMANN, Pia
BMJ supportive and palliative care, 09/2018, vol.8, n°3, p. 285-288

Document en ligne

Thème : Soins.

MOTIVATION ; MEDECIN ; ETUDIANT ; FORMATION ; ROYAUME UNI ; QUESTIONNAIRE

OBJECTIVES: During their careers, all doctors will be involved in the care of the dying, and this is likely to increase with current demographic trends. Future doctors need to be well-prepared for this. Little is known about medical students' expectations about providing palliative care. Our aim was to investigate how satisfying students expect palliative care to be, and any attitudes towards palliative care associated with a negative expectation.
METHODS: Fifteen UK medical schools participated in the study, with 1898 first and final year students completing an online questionnaire which investigated how satisfying they expect providing palliative care to be and their attitudes towards palliative care.
RESULTS: At both the beginning and end of their training, a significant proportion of students expect palliative care to be less satisfying than other care (19.3% first year, 16% final year). Students expecting palliative care to be less satisfying were more likely to be men, and their attitudes suggest that while they understand the importance of providing palliative care they are concerned about the potential impact of this kind of work on them personally.
CONCLUSIONS: Medical student education needs to address why palliative care is important and how to deliver it effectively, and the strategies for dealing positively with the impact of this work on future clinicians.

Origine : PubMed

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ACCOMPAGNEMENT CANCER DEMARCHE PALLIATIVE ECHELLE MESURE ENQUETE EVALUATION FAMILLE FIN VIE FORMATION INFIRMIERE MORT PATIENT PERSONNEL SANTE QUALITE VIE QUESTIONNAIRE

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