Usability and acceptance of novel personal health technology to support early palliative care for patients with cancer and caregivers.

73 Background: Little research has assessed whether and how technology can support early palliative care. Our team developed a HIPAA-compliant, cloud-based Personal Health Network (PHN) with a secure, online network of family, caregivers, clinicians and service providers designated by the patient; symptom reporting/management resources; and support for communication among network members via audio/video conferencing, messaging, and document sharing. This study examines PHN usability and acceptance, and identifies additional functions for early palliative care. Methods: Patients undergoing chemotherapy in a Comprehensive Cancer Center (n = 19) and their caregivers (n = 17) watched video demonstrations of the technology, participated in semi-structured interviews, and completed surveys measuring computer self-efficacy, PHN usability and acceptance. Results: Most participants were male with college education; mean age was 58 years. Most had a tablet or desktop computer (75%), a mobile phone (94%) and believed that technology improves the security of medication information (66%). At the same time, only 44% used email to contact healthcare providers and 30% used the internet to connect with others for support and information. Most reported the PHN was easy to learn and use and was an efficient and useful tool for patient-driven social networking, team communication, care coordination and symptom management. Participants suggested adapting the PHN to support spiritual and emotional needs and advance care planning. Common concerns included skepticism about receipt of timely responses from providers to symptom reports and the need for ongoing support for older adults with limited technology experience. Conclusions: These preliminary findings support adaption of the PHN to support palliative care components identified as important to patients and caregivers and further PHN usability and acceptance testing in larger, more diverse samples. The results also underscore the need for systems to support technology users, to clarify expectations of response time with patients and caregivers, and to assure these expectations can be met by healthcare providers.

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Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.98 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 98-98

Author(s):

Shan Darrel Mohammed ◽

Pamela Savage ◽

Camilla Zimmermann

Keyword(s):

Palliative Care ◽

Grounded Theory ◽

Nurse Practitioners ◽

Comfort Level ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Structured Interviews ◽

Early Palliative Care ◽

Practice Nurses ◽

Roles And Responsibilities

98 Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.

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“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care

Palliative Medicine ◽

10.1177/0269216319883980 ◽

2019 ◽

Vol 34 (2) ◽

pp. 209-218 ◽

Cited By ~ 1

Author(s):

Shan Mohammed ◽

Pamela Savage ◽

Nanor Kevork ◽

Nadia Swami ◽

Gary Rodin ◽

...

Keyword(s):

Palliative Care ◽

Nurse Practitioners ◽

Oncology Nurses ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Structured Interviews ◽

Early Palliative Care ◽

Practice Nurses ◽

Starting Point ◽

Psychosocial Processes

Background: Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. Aim: To conceptualize the psychosocial processes involved in the introduction and provision of palliative care by oncology nurses. Design: A constructivist qualitative grounded theory study was conducted. Setting/participants: A total of 20 nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) completed semi-structured interviews. Participants were from multiple ambulatory care oncology clinics (i.e. breast, pancreatic, hematology) in a comprehensive cancer center. Results: The core category, brokering palliative care, represented the overarching concept of the study that linked other subcategories. The other subcategories were as follows: opening the door—creating the possibility of discussing early palliative care at a time when patients show signs of being receptive to this discussion; building trust—establishing relationships with patients as a starting point for open discussions about palliative care; tackling misconceptions—addressing patients’ assumptions about palliative care as signifying death; and advocating with oncologists—seeding the process of referral by bringing patients’ concerns forward. Conclusion: Oncology nurses play a central role in “brokering” the introduction of early palliative care; this process is supported by their relational proximity to patients and their location “in between” the patient and the oncologist. Training all nurses in palliative care and empowering them to have proactive discussions in a collaborative practice context would allow greater access to early palliative care.

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Screening for Palliative Care: Implementation of the NCCN Guideline at a Comprehensive Cancer Center (418-A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2011.12.123 ◽

2012 ◽

Vol 43 (2) ◽

pp. 387-388 ◽

Cited By ~ 1

Author(s):

Paul Glare ◽

Kathy Plakovic ◽

Barbara Egan ◽

David Kelsen

Keyword(s):

Palliative Care ◽

Comprehensive Cancer Center ◽

Cancer Center

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Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: A retrospective descriptive study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2003.10.011 ◽

2004 ◽

Vol 27 (6) ◽

pp. 481-491 ◽

Cited By ~ 106

Author(s):

Florian Strasser ◽

Catherine Sweeney ◽

Jie Willey ◽

Susanne Benisch-Tolley ◽

J.Lynn Palmer ◽

...

Keyword(s):

Palliative Care ◽

Patient Satisfaction ◽

Outpatient Clinic ◽

Symptom Control ◽

Descriptive Study ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Symptom Intensity

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Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Cancer ◽

10.1002/cncr.24942 ◽

2010 ◽

Vol 116 (8) ◽

pp. 2036-2043 ◽

Cited By ~ 34

Author(s):

David Hui ◽

Ahmed Elsayem ◽

Zhijun Li ◽

Maxine De La Cruz ◽

J. Lynn Palmer ◽

...

Keyword(s):

Palliative Care ◽

Antineoplastic Therapy ◽

Advanced Cancer ◽

Palliative Care Unit ◽

Comprehensive Cancer Center ◽

Cancer Center

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Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia

Journal of Health Specialties ◽

10.4103/1658-600x.156107 ◽

2015 ◽

Vol 3 (2) ◽

pp. 61 ◽

Cited By ~ 3

Author(s):

SamiAyed Alshammary ◽

Abdullah Alsuhail ◽

BalajiP Duraisamy ◽

Savithiri Ratnapalan ◽

SaadHamad Alabdullateef

Keyword(s):

Palliative Care ◽

Saudi Arabia ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Palliative Care Consultation ◽

Care Consultation

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South African paramedic perspectives on prehospital palliative care

BMC Palliative Care ◽

10.1186/s12904-020-00663-5 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Caleb Hanson Gage ◽

Heike Geduld ◽

Willem Stassen

Keyword(s):

Higher Education ◽

Palliative Care ◽

South African ◽

Medical Service ◽

Life Support ◽

Healthcare Providers ◽

Advanced Life Support ◽

Early Palliative Care ◽

Audio Recordings ◽

Valuable Role

Abstract Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

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