Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication

2015 ◽  
Vol 14 (3) ◽  
pp. 212-224 ◽  
Author(s):  
J. Öhlén ◽  
G. Carlsson ◽  
A. Jepsen ◽  
I. Lindberg ◽  
F. Friberg
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Cancer Care ◽  
Information Provision ◽  
Sense Making ◽  
Health Providers ◽  
Participatory Action ◽  
Professional Health ◽  
Over Time

ABSTRACTObjectives:In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication.Method:A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model.Results:The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated.Significance of results:The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient’s way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.

scholarly journals Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action Research: Examining Implementation through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory Action Research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance (innovation), the inner setting, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting and individual characteristics featured less commonly. The guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, a trend toward reduced staff de-motivation among those who did attend was noted post-implementation. Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR, identified challenges to address in future projects such as staff cover on the ward and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07). Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Palliative care integration for patients with advanced chronic obstructive pulmonary disease (COPD): Identifying essential components using participatory action research

2021 ◽  
pp. 026921632110289
Author(s):  
Tanja Fusi-Schmidhauser ◽  
Katherine Froggatt ◽  
Nancy Preston
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Care Model ◽  
Participatory Action ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in standard care remains underdeveloped. The unpredictability of the disease progression and misconceptions about palliative care being equivalent to end-of-life care often prevent a timely integrated approach in advanced COPD. Aim: To identify practices designed to increase integration of palliative care in the management of patients with advanced COPD in a respiratory service in Southern Switzerland. Design: A participatory action research approach was chosen and key stakeholders were involved to develop new knowledge and practices, supported by a Theory of Change framework. Data from each cycle and retrospective analysis at the end of the whole research were analysed using thematic analysis. Setting/participants: Five action research cycles with seven healthcare professionals working in palliative or respiratory care settings were conducted. Results: Three elements of integrated palliative care in advanced COPD were identified: multidimensional assessment, healthcare professionals’ education and interdisciplinary team meetings, which are the pillars of a new integrated palliative care model for patients with advanced COPD. Conclusions: The new integrated palliative care model in advanced COPD includes essential elements with a focus on patients, healthcare professionals and care delivery. Further research on testing this model in clinical practice, service development, implementation processes and possible outcomes, including evaluation of the financial impact of integrated palliative care is necessary to foster this care approach across all possible settings.

scholarly journals Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action Research: Examining Implementation Through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background: The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care.Methods: The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory Action Research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre and post-implementation while champion interviews were also conducted post-implementation. Results: Features of the guidance (innovation), the inner setting, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting and individual characteristics featured less commonly. The guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, a trend toward reduced staff de-motivation among those who did attend was noted post-implementation. Conclusions: A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR, identified challenges to address in future projects such as staff cover on the ward and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Empowerment of Women to Provide Home-based Supportive and Palliative Care for Patients with Cancer: Participatory Action Research Protocol

2021 ◽  
Vol 14 (11) ◽  
Author(s):  
Sharifeh Monemian ◽  
Mohammad Reza Sharbafchi ◽  
Fariba Taleghani
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Action Observation ◽  
Research Approach ◽  
Participatory Action ◽  
Health Team ◽  
Patients With Cancer ◽  
Action Research Approach ◽  
Home Based

Background: Determining the needs and challenges of women, who care for patients with cancer and providing appropriate strategies to empower them in the design and implementation of appropriate change programs pave the way for the promotion of these women's health and empowerment. Objectives: This study aims at identifying the needs and challenges of women and developing a program to empower women, who care for patients with cancer. Methods: The present study is based on a participatory action research approach and uses the Kemmis and McTaggart model. The participatory action research of this study will be in 4 phases of planning, action, observation, and reflection. In the planning phase, the needs and challenges of female caregivers are examined from the perspective of women and the health team and, then, women's empowerment strategies in providing home-based supportive and palliative care for patients with cancer are determined, using the results of the qualitative phase and review of the literature by using the decision matrix. In the action phase, the selected strategies are implemented with the help of process owners. In the observation phase, combining different methods, data will be collected to measure the results of change. Finally, in the reflection phase, the results of the implementation of the strategies are evaluated and this cycle continues until the intended results are achieved. Discussion: Empowerment of the women, who care for patients with cancer requires awareness, motivation, and active participation of women and the health team. As many cultural and social factors affect the health and participation of these women, participatory research can involve them in promoting their health.

Cancer care in the length of the European migrant crisis rationale and feasibility of a participatory action research

2016 ◽  
Vol 25 (9) ◽  
pp. 1116-1118 ◽  
Author(s):  
Simone Cheli ◽  
Lucia Caligiani ◽  
Marinetta Nembrini ◽  
Luisa Fioretto
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Cancer Care ◽  
Participatory Action
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