The communication of palliative care for the elderly cancer patient

Palliative care (PC) is often recommended by physicians for their elderly patients who are terminally ill. In contrast to hospice care, which precludes the use of any curative treatment at life's end stages, PC seeks primarily to comfort patients and to keep them pain free, yet it does not necessarily preclude medical treatment. It does seek to attend to patients' physical as well as psychological, emotional, spiritual, and existential needs in an attempt to enhance overall quality of life. A review of current literature in PC for oncology patients, elderly and otherwise, reveals a curious irony: Although PC plausibly entails a holistic, patient-centered approach to health care, much of the research on PC and, apparently, many of the practices in PC focus almost exclusively on the biomedical approach to patient care, particularly in regard to pain and symptom management. Furthermore, few methods in PC research incorporate patients' narratives and lived experiences in the final stages of their lives. We argue that a holistic, patient-centered approach must guide research in PC, including the treatment of elderly patients as "active interpreters, managers, and creators of the meaning of their health and illness" (Vanderford, Jenks, & Sharf, 1997, p.14) and of the meaning of their lives.     

Men at Risk: Considering Masculinity During Hospital-Based Social Work Intervention

The needs of hospitalized male patients are often unrecognized and unmet. Men occupy greater than half of all inpatient hospital beds and incur a broad array of illnesses and injuries at higher rates than women—yet often receive health care that pays surprisingly little attention to the concept of patient masculinity, or to masculinity's influence on the male patient's perspectives, behaviors, goals, interests, needs, and challenges. Little emphasis is placed on considering hospitalized male patients as men, understanding their need for patient-centered care within this context, and intervening in ways that regularly allow strengths to be adequately recognized and utilized. In this article, we explore how hospital social workers can reconsider masculinity as a vibrant and formative component of male patients' lives and actively view its characteristics as comprising more than just potential challenges to medical treatment—but also as untapped sources of resilience and strength.     

Patients' desires and satisfaction in general medicine clinics.

Most patients have explicit desires or requests when they visit their physicians. Identification of patients'' requests and needs is the starting point of a patient-centered approach to care. The frequency with which physicians met their patients'' desires for services and that frequency''s association with patient satisfaction were examined for 243 patients with chronic disease in general medicine clinics of a Department of Veterans Affairs hospital. Patients desired a mean of 11.9 services, of which an average of 67 percent were met. However, many patients'' desires for information and most of their desires for help with emotional and family problems were not met. Patients with the most unmet desires for services, especially services related to information, were significantly less satisfied with their physicians than were those with fewer unmet desires. Factor analysis was used to develop a short, 16-item Requests for Services Questionnaire that appeared to cover the range of services that patients with chronic conditions desire. Enhancing physicians'' ability to recognize and respond to patients'' desires for services by using short patient request questionnaires may have the potential to improve patient satisfaction and other health care outcomes.     

Experiences of Mistreatment Among Women with Cerebral Palsy

Abuse and mistreatment of women with disabilities is a complex problem that affects their health and well-being. Previous studies have focused on heterogeneous groups of women with disabilities, with only small numbers of women with cerebral palsy included, but different disabilities may play specific roles in relation to abuse. Exploring mistreatment of women with cerebral palsy is important in determining the relationship between mistreatment and a specific disability. The aim of this article was to describe experiences and meanings of mistreatment among women with cerebral palsy. The feminist biographical method was used to provide an in-depth exploration of women's storied lives, uncover the meaning of women's lives from their own perspective, and provide understanding of women whose stories are seldom told. A sample of eight participants participated in two in-depth, audio-recorded interviews. Two major themes and five subthemes emerged. The meaning of mistreatment included participants' definition of mistreatment and their explanation for mistreatment. Outcomes of mistreatment were divided into emotional, social, and physical outcomes. Health care providers need to understand the meaning and outcomes of mistreatment in their patients' lives to begin to address mistreatment, listen to patients, advocate when needed, and provide appropriate health care.     

“Open Your Heart First of All”: Perspectives of Holistic Providers in Costa Rica About Communication in the Provision of Health Care

Research documents how the care the holistic providers offer represents the quality communication that patients often do not receive from their biomedical providers. However, research investigating the perspectives of holistic providers concerning the role they see themselves playing in the provision of health is limited. This research explores the perceptions of holistic providers in Costa Rica about their communication with their patients. The results reveal two practices of communication—authenticating and integrating as central to providers' communication with patients in the provision of holistic health care. Providers describe their communication as an exploration of an anatomy of pain/suffering, including investigating the location, timing, length, intensity, and overall rhythm of the patient's condition and sense making that leads them to seek the care of a holistic provider. Most holistic providers see their role as being careful or full of care and suggest that they have an obligation to open their heart first of all.     

Cultural health capital and the interactional dynamics of patient-centered care

As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions. In this paper, we report the findings of a qualitative study conducted from 2010 to 2011 in the Western United States. We investigated the various elements of cultural health capital, how patients and providers used cultural health capital to engage with each other, and how this process shaped the patient-centeredness of interactions. We find that the accomplishment of patient-centered care is highly dependent upon habitus and the cultural health capital that both patients and providers bring to health care interactions. Not only are some cultural resources more highly valued than others, their differential mobilization can facilitate or impede engagement and communication between patients and their providers. The focus of cultural health capital on the ways fundamental social inequalities are manifest in clinical interactions enables providers, patients, and health care organizations to consider how such inequalities can confound patient-centered care.     

Comparison of Consensus on Life-sustaining Treatment of the Elderly in Care Facilities and Family Member Dyad

Objectives

The purpose of this study is to compare the agreement in opinion between the elderly in care facilities and their family members regarding the life-sustaining treatment at the deathbed and to find out if the intentions of the elderly are being properly reflected in their deathbed treatment.

Methods

Data were collected from 85 elderly individuals at five care facilities in Chunkcheongnam-do and 85 family members. The data were collected with a self-administered questionnaire from July 22, 2013 to August 15, 2014. A total of 170 cases were analyzed using SPSS version 21.

Results

First, the family members'' preference for life-sustaining treatment was higher than the patients'' preference. The preference between the elderly and their family members regarding life-sustaining treatment was statistically significant with regards to oral nutrition, pain control through oral and anal administration, pain control through intravenous administration, transfusion, and admission to an intensive care unit. Second, looking at the agreement between elderly and guardians regarding life-sustaining treatment, there was significant concordance about general testing, oral nutrition, intravenous hydration, intravenous nutrition, antibiotic treatment for severe infection with low resiliency, admission to an intensive care unit, blood pressure increase medication use, cardiopulmonary resuscitation, and tracheotomy.

Conclusion

It is essential for the medical staff to confirm agreement between the elderly and their family members regarding life-sustaining treatment, and if such a prior agreement is not feasible, the patient''s intention should be considered more actionable than their family members.     

Perceptions of recovery and rehabilitation in people with brain injury in Spain. A qualitative study

IntroductionAcquired brain injury (ABI) is a condition that severely impairs the personal, family, social and professional lives of the individuals who experience it. The aim of this study was to gain insight into ABI patients'' perceptions of their condition and rehabilitation process so that physiotherapists can approach their treatment in a more comprehensive, satisfactory manner.MethodsA qualitative study was carried out with individual interviews, and focus group sessions (semi‐structured interviews) were held with 33 individuals from various associations.ResultsFour themes emerged in this study: physiotherapy treatment, changes in lifestyle, patients'' feelings about their condition and aspirations for the future. The participants reported that their condition had led to multiple changes in their personal and family lives that were not always positive.ConclusionsThese findings may be useful for identifying ways to increase acceptance of their condition and design a comprehensive rehabilitation programme for these patients and their families. The psychosocial needs of ABI patients could be optimized by providing good physical care through effective communication within the rehabilitation environment where communication between professionals and patients prevails, to meet their real needs and expectations.Patient or Public ContributionThis study was conducted based on interviews with adult ABI patients regarding their experiences concerning their rehabilitation process and daily life.     

Sex Differences in Health Care Provider Communication During Genital Herpes Care and Patients' Health Outcomes

Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.     

Barriers to patient information provision in primary care: patients' and general practitioners' experiences and expectations of information for low back pain

Background As patient involvement in health‐care increases, the role of information is crucial, especially in conditions where self‐management is considered an integral part of care. However, the suitability and applicability of much patient information has not been appraised in terms of how far it meets patients' information needs. Aims To ascertain patients' and clinicians' experiences and expectations of information in low back pain in order to suggest a suitable ‘patient‐centred’ content for a patient information pack to be used in a primary care setting. Methods A qualitative study using semi‐structured interviews with General Practitioners (GPs) (n = 15) and focus groups comprising patients with low back pain (n = 37). Results Barriers to information‐giving for low back pain in primary care exist. Patients are dissatisfied with the information they receive from their GPs, especially regarding diagnosis and treatment. Patients tend to access information from a variety of other sources, which is often contradictory, conflicts with research evidence and leads to unreasonable expectations. GPs have varying views regarding the value of patient information and are equivocal about their roles as information providers. Although The Back Book is generally acceptable as a patient information leaflet for low back pain, attention to the tone of the text is required. Conclusions Barriers exist to patient information provision, both generally and for low back pain, which need to be addressed in order to close the gap between strategy and implementation. Improving clinician communication skills and involving patients in developing information materials which meet their needs are crucial to this process.     

Who Cares for the Caregivers? Why Medical Social Workers Belong on End-of-Life Care Teams

Changes within the health care industry have resulted in a shift that, to a large extent, places patients in the position of managing their own health care. While self-determination is desirable, it can also lead to new challenges, as when patients who are critically ill and/or dying must rely on family members to function as primary caregivers and managers of their treatment plans. Typically, patients and their families lack the guidance and oversight of a medical professional to coordinate a multifaceted health care regimen instituted by the variety of specialists involved in patients' diagnoses and treatments. As the patients' health declines and treatment plans become more complex, so too does the level of involvement of family caregivers, who often must manage treatment plans in addition to providing bedside care. This article cites the example of a woman who was exhausted by her role as sole caregiver for her dying husband and describes her feelings of powerlessness within the hospital setting as she struggled to coordinate assistance from her husband's medical specialists during end-of-life decision making. This case illustrates the importance of the following: (a) in cases involving hospitalized patients who require complex care from multiple specialists, it should become standard practice to enlist medical social workers to provide an overall assessment of the patients' status, prognoses, and home care plans, (b) in cases involving prolonged home care culminating in end-of-life decisions, the needs of nonprofessional caregivers must be recognized, evaluated, and addressed.     

Long-Term Psychosocial Support for Families of Children Who Have Undergone Allogeneic Stem Cell Transplant

ABSTRACT

Stem cell transplant (SCT) in children has a continuing impact in the lives of the SCT recipients and their families. This realization has led to extended psychosocial support to these families. The aim of this study was to evaluate the extended psychosocial support. How many families accepted the proffered contact with the social worker and what kind of support did the families ask for? The data were collected from the patients' medical charts by the health care social worker. Content analysis was used as the research method. The study reveals a need for continued psychosocial support lasting many years after treatment. The need for support does not lessen with the passage of time, but the nature of the support changes.     

Factors related to patients' satisfaction with their medical care

Patient satisfaction has become a frequently researched outcome measure of the quality of health-care delivery. This article reviews research of patient satisfaction after recent, identifiable medical care visits. Results of the reviewed studies are grouped into 13 factors of the medical care setting and of the physicians' competence and relationships to their patients which may be related to patient satisfaction. The factors with the clearest relationship to satisfaction include the accessibility of medical care, the organizational structure of clinics, treatment length, perceived competence of physicians, clarity and retention of physicians' communication to patients, physicians' affiliative behavior, physicians' control, and patients' expectations. Other factors with more complicated or no apparent relationship to satisfaction were mode of payment, clarity of patients' communication to physicians, physicians' personality, patients' sociodemographic characteristics, and patients' health status. The additive and potential interactive effects of these factors are discussed. Additional studies of the interactive aspects of the physician-patient raltionship are encouraged, and implications for further research are presented, with emphasis on sampling, measurement, and design issues.     

Patient–professional partnerships and chronic back pain self‐management: a qualitative systematic review and synthesis

Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self‐manage chronic back pain; patients being actively involved for self‐managing chronic back pain; and the influence of patient–professional partnerships on self‐management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient–professional partnerships influence self‐management. Review findings suggest that a partnership between patients and professionals supports patients' self‐management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self‐referral or telephone consultation to patients with chronic conditions.     

The Use of Humor in Promoting Positive Provider-Patient Interactions in a Hospital Rehabilitation Unit

Humor within the health care setting apparently can serve to facilitate positive patient-provider interactions and to create a patient-centered environment. This article provides an ethnographic account of patient-provider interactions held during therapeutic activity sessions within a hospital unit (MIRTH) designed to promote therapeutic humor. This study's findings suggest that humor in these activity sessions was mainly a by-product of more predominant effects, such as patients' positive attitude and happiness. Whereas MIRTH used contrived humor to portray its identity as a humor unit, staff and patients also took advantage of spontaneous humor that emerged out of interactions. Humor appeared secondary to the primary outcome of promoting patients' happiness and well being.     

Patients' perspectives on high-tech home care: a qualitative inquiry into the user-friendliness of four technologies

Background

The delivery of technology-enhanced home care is growing in most industrialized countries. The objective of our study was to document, from the patient's perspective, how the level of user-friendliness of medical technology influences its integration into the private and social lives of patients. Understanding what makes a technology user-friendly should help improve the design of home care services.

Methods

Four home care interventions that are frequently used and vary in their technical and clinical features were selected: Antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. Our qualitative study relied on the triangulation of three sources of data: 1) interviews with patients (n = 16); 2) interviews with carers (n = 6); and 3) direct observation of nursing visits of a different set of patients (n = 16). Participants of varying socioeconomic status were recruited through primary care organizations and hospitals that deliver home care within 100 km of Montreal, the largest urban area in the province of Quebec, Canada.

Results

The four interventions have both a negative and positive effect on patients' lives. These technologies were rarely perceived as user-friendly, and user-acceptance was closely linked to user-competence. Compared with acute I.V. patients, who tended to be passive, chronic patients seemed keener to master technical aspects. While some of the technical and human barriers were managed well in the home setting, engaging in the social world was more problematic. Most patients found it difficult to maintain a regular job because of the high frequency of treatment, while some carers found their autonomy and social lives restricted. Patients also tended to withdraw from social activities because of social stigmatization and technical barriers.

Conclusions

While technology contributes to improving the patients' health, it also imposes significant constraints on their lives. Policies aimed at developing home care must clearly integrate principles and resources supporting the appropriate use of technology. Close monitoring of patients should be part of all technology-enhanced home care programs.     

心内科老年患者实施个性化护理干预对其睡眠质量及护理服务质量的影响

目的探讨心内科老年患者实施个性化护理干预的效果。方法回顾性分析2013年3月—2016年9月于医院心内科住院治疗的80例老年患者临床诊治及护理情况,所有患者均给予常规治疗及个性化护理干预。分别于患者入院时及出院1周后调查其服药依从性及认知情况;采用匹兹堡睡眠质量指数量表(PSQI)评价患者入院时及出院1周后睡眠状况;采用医院自制问卷调查表调查患者对此次护理服务的满意度。结果患者出院1周后规律服药和按时服药率明显高于入院时,漏服药、断续服药、自行停药及错服药物率明显低于入院时,P<0.05;患者出院1周后认知得分为(1.92±0.24)分,明显高于入院时(1.14±0.08)分,t=27.57,P=0.00。患者出院1周PSQI评分为(5.72±1.28)分,明显低于入院时(8.02±1.15)分,t=11.95,P=0.00。患者对护理服务的满意度为98.75%(79/80)。结论心内科老年患者实施个性化护理干预可有助于提高其治疗依从性及对疾病的认知,改善其睡眠质量,从而提高其对医院护理服务的满意度,如此良性循环将有助于促进我院心内科护理服务质量的不断改进,更好的满足患者对护理服务的需求。     

Beyond barriers: fundamental ‘disconnects’ underlying the treatment of breast cancer patients' sexual health

Sexual health concerns represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that service providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing patients' sexual health concerns has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on the experiences of 21 breast cancer survivors, this paper explores three ways in which fundamental cultural and structural characteristics of the cancer care system in the USA may prevent breast cancer survivors from addressing their sexual health concerns, including: (1) when patients discussed sexual health with their providers, their providers approached sexuality as primarily physical, while participants experienced complex, multidimensional sexual health concerns; (2) specialisation within cancer care services made it difficult for patients to identify the appropriate provider to address their concerns; and (3) the structure of cancer care literally disconnects patients from the healthcare system at the time when sexual side effects commonly emerged. These data suggest that addressing breast cancer survivors' sexual health concerns requires a multifaceted approach to health systems change.     

Patient education and emotional support practices in abortion care facilities in the United States

PurposeLittle is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care.MethodsWe conducted confidential telephone interviews with staff from 27 abortion facilities about their practices.Main FindingsThe majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for “patient-centered,” “supportive,” “nonjudgmental” care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion.ConclusionsAll facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion.Practice ImplicationsThis information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices.