Pub Date : 2022-06-01DOI: 10.1017/S1478951522000645
W. Breitbart
{"title":"Who are you, Who do you want to be, Who do you want to help along the way?","authors":"W. Breitbart","doi":"10.1017/S1478951522000645","DOIUrl":"https://doi.org/10.1017/S1478951522000645","url":null,"abstract":"","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"20 1","pages":"305 - 306"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91109490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1017/S1478951521001127
Maxxine Rattner
Objective: Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering - both physical and nonphysical - little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap.
Method: Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR "end of life" OR "end-of-life" OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria.
Results: Losses, worries, and fears comprise patients' primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients' experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering.
Significance of results: This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.
{"title":"Increasing our understanding of nonphysical suffering within palliative care: A scoping review.","authors":"Maxxine Rattner","doi":"10.1017/S1478951521001127","DOIUrl":"10.1017/S1478951521001127","url":null,"abstract":"<p><strong>Objective: </strong>Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering - both physical and nonphysical - little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap.</p><p><strong>Method: </strong>Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR \"end of life\" OR \"end-of-life\" OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria.</p><p><strong>Results: </strong>Losses, worries, and fears comprise patients' primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients' experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering.</p><p><strong>Significance of results: </strong>This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.</p>","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"44 1","pages":"417-432"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85836024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1017/S1478951521001243
Elizabeth M Miller, Joanne E Porter, Michael S Barbagallo
Objective: Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting.
Methods: A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms ("truth disclosure") AND ("palliative care or end-of-life care or terminal care or dying") were used. The search was repeated using ("bad news") AND ("palliative care or end-of-life care or terminal care or dying") terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers.
Results: Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: "Enablers in breaking bad news" and "Truth avoidance/disclosure." Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis.
Significance of results: The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.
{"title":"The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis.","authors":"Elizabeth M Miller, Joanne E Porter, Michael S Barbagallo","doi":"10.1017/S1478951521001243","DOIUrl":"10.1017/S1478951521001243","url":null,"abstract":"<p><strong>Objective: </strong>Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting.</p><p><strong>Methods: </strong>A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms (\"truth disclosure\") AND (\"palliative care or end-of-life care or terminal care or dying\") were used. The search was repeated using (\"bad news\") AND (\"palliative care or end-of-life care or terminal care or dying\") terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers.</p><p><strong>Results: </strong>Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: \"Enablers in breaking bad news\" and \"Truth avoidance/disclosure.\" Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis.</p><p><strong>Significance of results: </strong>The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.</p>","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"106 1","pages":"433-444"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75645974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-27DOI: 10.1017/S1478951522000463
D. H. Oh, M. Salzler, Rachel L Bernstein, Christopher W Racine
Abstract Objectives To understand (1) the association of Major Depressive Disorder (MDD) and do-not-resuscitate (DNR) status among hospitalized patients and (2) the association of MDD and hospitalization outcomes among DNR patients. Methods This was a cross-sectional analysis of United States Healthcare Cost and Utilization Project, Nationwide Inpatient Sample data from 2009 to 2013 for patients >18 years. To address the first objective, we used multivariable logistic regression among all hospitalized patients to compute the adjusted odds ratio (aOR) of having DNR status if patients have active MDD of varying severities after controlling for age, sex, race, suicidal ideation, and Elixhauser Comorbidity Index. To address the second objective, we used multivariable regression among patients with DNR status to compute aOR of having hospitalization outcomes such as increased length of stay, higher total charges, leaving against medical advice, and mortality if patients have MDD. Results Among all hospitalizations, 2.3% had DNR status. There was an inverse association between severity of MDD and having DNR status. Relative to those without MDD, patients with moderate recurrent MDD episode (aOR 0.74 (95% confidence interval (CI): 0.65–0.85) and severe recurrent MDD episode (aOR of 0.42 (95% CI: 0.37–0.48)) were significantly less likely to have DNR status. Among DNR patients, those with all severities of MDD except mild single episode MDD were >40% less likely to die during hospitalization. Among DNR patients, patients with MDD had 0.7 day longer length of stay, and >$4,500 higher total charges. Significance of results Patients are less likely to have DNR status if they have active MDD. Among patients with DNR status, those with MDD are less likely to die during hospitalization than those without MDD. With current practice, depression is not associated with increased likelihood of death due to foregoing resuscitation prematurely, though the exact mechanisms of these findings need further investigation.
{"title":"Do-not-resuscitate (DNR) status and major depressive disorder (MDD): Clinical association and hospitalization outcomes","authors":"D. H. Oh, M. Salzler, Rachel L Bernstein, Christopher W Racine","doi":"10.1017/S1478951522000463","DOIUrl":"https://doi.org/10.1017/S1478951522000463","url":null,"abstract":"Abstract Objectives To understand (1) the association of Major Depressive Disorder (MDD) and do-not-resuscitate (DNR) status among hospitalized patients and (2) the association of MDD and hospitalization outcomes among DNR patients. Methods This was a cross-sectional analysis of United States Healthcare Cost and Utilization Project, Nationwide Inpatient Sample data from 2009 to 2013 for patients >18 years. To address the first objective, we used multivariable logistic regression among all hospitalized patients to compute the adjusted odds ratio (aOR) of having DNR status if patients have active MDD of varying severities after controlling for age, sex, race, suicidal ideation, and Elixhauser Comorbidity Index. To address the second objective, we used multivariable regression among patients with DNR status to compute aOR of having hospitalization outcomes such as increased length of stay, higher total charges, leaving against medical advice, and mortality if patients have MDD. Results Among all hospitalizations, 2.3% had DNR status. There was an inverse association between severity of MDD and having DNR status. Relative to those without MDD, patients with moderate recurrent MDD episode (aOR 0.74 (95% confidence interval (CI): 0.65–0.85) and severe recurrent MDD episode (aOR of 0.42 (95% CI: 0.37–0.48)) were significantly less likely to have DNR status. Among DNR patients, those with all severities of MDD except mild single episode MDD were >40% less likely to die during hospitalization. Among DNR patients, patients with MDD had 0.7 day longer length of stay, and >$4,500 higher total charges. Significance of results Patients are less likely to have DNR status if they have active MDD. Among patients with DNR status, those with MDD are less likely to die during hospitalization than those without MDD. With current practice, depression is not associated with increased likelihood of death due to foregoing resuscitation prematurely, though the exact mechanisms of these findings need further investigation.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"212 1","pages":"542 - 548"},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79712265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objectives To investigate the spiritual care needs and associated influencing factors among elderly inpatients with stroke, and to examine the correlations among spiritual care needs, spiritual well-being, self-perceived burden, self-transcendence, and social support. Methods A cross-sectional quantitative design was implemented, and the STROBE Checklist was used as the foundation of the study. A convenience sample of 458 elderly inpatients with stroke was selected from three hospitals in China. The sociodemographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being, the Self-Perceived Burden Scale, the Chinese Self-Transcendence Scale, and the Perceived Social Support Scale were used. Descriptive statistics, correlation, Student's t-test, ANOVA, non-parametric, and multiple linear regression analyses were used to analyze the data. Results The total score of spiritual care needs was 29.82 ± 7.65. Spiritual care needs were positively correlated with spiritual well-being (r = 0.709, p < 0.01), self-transcendence (r = 0.710, p < 0.01), and social support (r = 0.691, p < 0.01), whereas being negatively correlated with self-perceived burden (r = −0.587, p < 0.01). Religious beliefs, educational level, residence place, disease course, spiritual well-being, self-perceived burden, self-transcendence, and social support were found to be the main influencing factors. Significance of results The spiritual care needs were prevalent and moderate. It is suggested that nurses should enhance spiritual care knowledge and competence, take targeted spiritual care measures according to inpatients’ individual personality traits or characteristics and differences of patients, reduce their self-perceived burden and improve their spiritual well-being, self-transcendence and social support in multiple ways and levels, so as to meet their spiritual care needs to the greatest extent and enhance their spiritual comfort.
摘要目的了解老年住院脑卒中患者的精神护理需求及其相关影响因素，并探讨精神护理需求与精神幸福感、自我感知负担、自我超越和社会支持之间的相关性。方法采用横断面定量设计，采用STROBE检查表作为研究基础。从国内三家医院选取458例老年卒中住院患者作为方便样本。采用社会人口学特征问卷、护士精神治疗量表、慢性疾病治疗-精神健康功能评估量表、自我感知负担量表、中国人自我超越量表和感知社会支持量表。采用描述性统计、相关分析、学生t检验、方差分析、非参数分析和多元线性回归分析对数据进行分析。结果精神护理需求总分为29.82±7.65分。精神护理需求与精神幸福感(r = 0.709, p < 0.01)、自我超越(r = 0.710, p < 0.01)、社会支持(r = 0.691, p < 0.01)呈正相关，与自我感知负担(r = - 0.587, p < 0.01)呈负相关。宗教信仰、文化程度、居住地、病程、精神幸福感、自我感知负担、自我超越和社会支持是影响心理健康的主要因素。结果的意义精神关怀需求普遍且适度。建议护士提高精神护理知识和能力，根据住院患者的个体人格特征或特点及患者差异，采取有针对性的精神护理措施，从多个途径和层面减轻其自我感知负担，提高其精神幸福感、自我超越和社会支持，最大程度地满足其精神护理需求，增强其精神舒适度。
{"title":"Needs for nurses to provide spiritual care and their associated influencing factors among elderly inpatients with stroke in China: A cross-sectional quantitative study","authors":"Zhangyi Wang, Haomei Zhao, Yue Zhu, Si-feng Zhang, Luwei Xiao, Haiqin Bao, Zhao Wang, Yue Wang, Xuechun Li, Yajun Zhang, Xiaoli Pang","doi":"10.1017/S1478951522000426","DOIUrl":"https://doi.org/10.1017/S1478951522000426","url":null,"abstract":"Abstract Objectives To investigate the spiritual care needs and associated influencing factors among elderly inpatients with stroke, and to examine the correlations among spiritual care needs, spiritual well-being, self-perceived burden, self-transcendence, and social support. Methods A cross-sectional quantitative design was implemented, and the STROBE Checklist was used as the foundation of the study. A convenience sample of 458 elderly inpatients with stroke was selected from three hospitals in China. The sociodemographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being, the Self-Perceived Burden Scale, the Chinese Self-Transcendence Scale, and the Perceived Social Support Scale were used. Descriptive statistics, correlation, Student's t-test, ANOVA, non-parametric, and multiple linear regression analyses were used to analyze the data. Results The total score of spiritual care needs was 29.82 ± 7.65. Spiritual care needs were positively correlated with spiritual well-being (r = 0.709, p < 0.01), self-transcendence (r = 0.710, p < 0.01), and social support (r = 0.691, p < 0.01), whereas being negatively correlated with self-perceived burden (r = −0.587, p < 0.01). Religious beliefs, educational level, residence place, disease course, spiritual well-being, self-perceived burden, self-transcendence, and social support were found to be the main influencing factors. Significance of results The spiritual care needs were prevalent and moderate. It is suggested that nurses should enhance spiritual care knowledge and competence, take targeted spiritual care measures according to inpatients’ individual personality traits or characteristics and differences of patients, reduce their self-perceived burden and improve their spiritual well-being, self-transcendence and social support in multiple ways and levels, so as to meet their spiritual care needs to the greatest extent and enhance their spiritual comfort.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"15 1","pages":"407 - 416"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86212995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1017/s1478951522000529
Daniel, J., Ouyang, Susan, C., Vaughan
ed and indexed in the following: CINAHL database; Cumulative Index to Nursing and Allied Health Liteature; MEDLINE Change of address: Allow six weeks for all changes to become effective. All communication should include both old and new addresses (with postal codes) and should be accompanied by a mailing label from a recent issue. Editorial Office: William Breitbart, Editor-in-Chief, Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, New York, NY 10022, USA. Telephone: (646) 888-0020. Fax: (212) 888-2356. E-mail: breitbaw@mskcc.org. Office of Publication: Cambridge University Press, One Liberty Plaza, New York, NY 10006, USA: Telephone: (212) 337-5000. Fax: (212) 337-5959. Printed in the United States of America on acid-free paper. Emeritus Lea Baider, Sharett Institute of Oncology, Israel Susan Block, Dana-Farber Cancer Institute, USA Irene Higginson, King’s College London, UK Paul Jacobsen, Ph.D., National Cancer Institute, USA Professor Uwe Koch, University Hospital at Hamburg-Eppendorf, Germany Neil MacDonald, McGill University, Canada Volume 20 April 2022 Number 2
{"title":"PAX volume 20 issue 2 Cover and Front matter","authors":"Daniel, J., Ouyang, Susan, C., Vaughan","doi":"10.1017/s1478951522000529","DOIUrl":"https://doi.org/10.1017/s1478951522000529","url":null,"abstract":"ed and indexed in the following: CINAHL database; Cumulative Index to Nursing and Allied Health Liteature; MEDLINE Change of address: Allow six weeks for all changes to become effective. All communication should include both old and new addresses (with postal codes) and should be accompanied by a mailing label from a recent issue. Editorial Office: William Breitbart, Editor-in-Chief, Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, New York, NY 10022, USA. Telephone: (646) 888-0020. Fax: (212) 888-2356. E-mail: breitbaw@mskcc.org. Office of Publication: Cambridge University Press, One Liberty Plaza, New York, NY 10006, USA: Telephone: (212) 337-5000. Fax: (212) 337-5959. Printed in the United States of America on acid-free paper. Emeritus Lea Baider, Sharett Institute of Oncology, Israel Susan Block, Dana-Farber Cancer Institute, USA Irene Higginson, King’s College London, UK Paul Jacobsen, Ph.D., National Cancer Institute, USA Professor Uwe Koch, University Hospital at Hamburg-Eppendorf, Germany Neil MacDonald, McGill University, Canada Volume 20 April 2022 Number 2","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"124 1","pages":"f1 - f4"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77021926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-17DOI: 10.1017/s1478951522000347
D. H. Xiang
{"title":"When I grow up I want to be back here","authors":"D. H. Xiang","doi":"10.1017/s1478951522000347","DOIUrl":"https://doi.org/10.1017/s1478951522000347","url":null,"abstract":"","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"6 1","pages":"775 - 775"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72804487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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