scholarly journals The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical aproach

2020 ◽  
Author(s):  
Kerstin Kremeike ◽  
Gerrit Frerich ◽  
Vanessa Romotzky ◽  
Kathleen Bostroem ◽  
Thomas Dojan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Qualitative Content Analysis ◽  
Death And Dying ◽  
Clinical Approach ◽  
Research Database ◽  
Services Research ◽  
Sequential Mixed Methods ◽  
Desire To Die ◽  
Registration Date

Abstract Background: Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical interview approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. Results: 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was “proactively addressing desire to die”. Conclusions: We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically – based on evidence, patients’ views and consensus among professional experts. Trial registration: The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

scholarly journals The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical aproach

2020 ◽  
Author(s):  
Kerstin Kremeike ◽  
Gerrit Frerich ◽  
Vanessa Romotzky ◽  
Kathleen Bostroem ◽  
Thomas Dojan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Qualitative Content Analysis ◽  
Death And Dying ◽  
Clinical Approach ◽  
Research Database ◽  
Services Research ◽  
Sequential Mixed Methods ◽  
Desire To Die ◽  
Registration Date

Abstract Background: Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical interview approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. Results : 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was “proactively addressing desire to die”. Conclusions : We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically – based on evidence, patients’ views and consensus among professional experts. Trial registration: The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

scholarly journals The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical aproach

2020 ◽  
Author(s):  
Kerstin Kremeike ◽  
Gerrit Frerich ◽  
Vanessa Romotzky ◽  
Kathleen Bostroem ◽  
Thomas Dojan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Qualitative Content Analysis ◽  
Death And Dying ◽  
Clinical Approach ◽  
Research Database ◽  
Services Research ◽  
Sequential Mixed Methods ◽  
Desire To Die ◽  
Registration Date

Abstract Background: Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical interview approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. Results : 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was “proactively addressing desire to die”. Conclusions : We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically – based on evidence, patients’ views and consensus among professional experts. Trial registration: The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

scholarly journals The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical guideline

2020 ◽  
Author(s):  
Kerstin Kremeike ◽  
Gerrit Frerich ◽  
Vanessa Romotzky ◽  
Kathleen Bostroem ◽  
Thomas Dojan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Clinical Guideline ◽  
Qualitative Content Analysis ◽  
Death And Dying ◽  
Structured Interviews ◽  
Self Reflection ◽  
Sequential Mixed Methods ◽  
The One ◽  
Desire To Die

Abstract Objective: Although desire to die (DD) of varying intensity and permanence is frequent in patients with advanced cancer and those receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential DD, a training program and a semi-structured clinical interview guideline was developed. This study aimed for a revision of and consensus building on the clinical guideline to support proactively addressing DD and routine exploration of death and dying distress. Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. Results : 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on DD they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the clinical guideline. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was “proactively addressing DD”. Conclusions : We have provided the first semi-structured clinical guideline to identify and address DD and to respond therapeutically – based on evidence, patients’ views and consensus among (inter-)national professional experts. Trial registration: German Clinical Trials Register (No. DRKS00012988).

scholarly journals The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Kerstin Kremeike ◽  
Gerrit Frerich ◽  
Vanessa Romotzky ◽  
Kathleen Boström ◽  
Thomas Dojan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Clinical Approach ◽  
Sequential Mixed Methods ◽  
Desire To Die

Supporting in an existential crisis: A mixed-methods evaluation of a training model in palliative care

2017 ◽  
Vol 16 (4) ◽  
pp. 470-478
Author(s):  
Lisa Sand ◽  
Mariann Olsson ◽  
Peter Strang
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Focus Group ◽  
Mixed Methods Research ◽  
Qualitative Content Analysis ◽  
Training Model ◽  
Care Staff ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Existential Crisis

AbstractBackground:Palliative care staff often report that they lack the skills and confidence to provide support during an existential crisis. Consequently, there is a definite need for a training program in this area.Objective:Our aim was to investigate whether a training model could give palliative care staff increased knowledge, awareness, and preparedness—all useful tools for providing support.Methods:A mixed-methods research design was used. Data were collected in four hospital-based palliative homecare teams in the Stockholm area. In total, 34 staff participated, representing different palliative care team professions. Before and after the intervention, a questionnaire with a 9-point Likert-type scale was completed (n = 34). Qualitative focus group discussions were conducted a month after the intervention (25 participants). These were recorded, transcribed, and analyzed using qualitative content analysis with a manifest focus.Results:In the quantitative part of our study, the participants showed significantly increased perceived knowledge, awareness, and preparedness in every aspect (p < 0.001 for all items). The focus group discussions revealed a process that made it possible to apply new knowledge and insight. The process began with theoretical knowledge and, through care-related reflection and self-reflection, the knowledge base gradually developed and provided useful skills and increased job satisfaction.Significance of results:The team-based “TrainingModel Sand/TER” can be performed without excessive effort and contribute to improved competence in providing support during an existential crisis. It is particularly useful for staff working in clinical palliative care.

“All of a sudden, a lot less still makes it worthwhile to be alive:” Palliative care patients’ views on life

2018 ◽  
Vol 17 (2) ◽  
pp. 214-220 ◽  
Author(s):  
Vanessa Romotzky ◽  
Julia Strupp ◽  
Alexander Hayn ◽  
Jens Ulrich Rüffer ◽  
Judith Grümmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Qualitative Content Analysis ◽  
Death And Dying ◽  
Human Beings ◽  
Type Result ◽  
Video Recordings ◽  
The Moment ◽  
And Coping ◽  
Age Range

AbstractObjectiveWe aimed to elucidate the views on life as narrated by patients in palliative care (PC) to find out what patients deem to be essential in their life, whether something has changed concerning their view of life in light of the disease, and whether interviewees would like to give others something to take with them.MethodData were collected from narrative audio and video interviews with 18 inpatients in a specialized PC unit. Interviews were recorded and transcribed verbatim and analyzed using qualitative content analysis applying MAXQDA software. CDs and DVDs with recorded interviews were provided to patients.ResultEighteen interviews were analyzed: 11 audio and 7 video recordings. The age range was 41–80 years. Patients reported on changes in their views on life. Despite it being a complex and painful process, patients still gave examples of benefits experienced during their illness trajectory. Patients identified resources and coping strategies such as meaningful contacts with close others and mindfulness. Shifts have occurred in terms of taking more time for themselves, enjoying the moment, being more calm, and spending more time with family and friends. What patients wanted to pass on to others was to pay attention to the needs of both the self and the others, shape your life individually, confront yourself early with issues of death and dying, and care for your fellow human beings. Patients and relatives valued the opportunity to keep their interview as a CD/DVD.Significance of resultsResults support the idea that many people facing terminal illness continue to focus on living and remain within their biographies and the contexts of their lives, even if their functional status declines. Patients and relatives appreciated that interviews were provided as kind of a legacy. Yet, more robust research is needed to decide whether such interviews yield any therapeutic effect.

The Development of an Online Tobacco Tracker Tool to Crowdsource Campus Environmental Reports for Smoke and Tobacco Free College Policies: A Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Sabrina F. Loureiro ◽  
Kim M. Pulvers ◽  
Melissa M. Gosdin ◽  
Keavagh R. Clift ◽  
Myra J. Rice ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Positive Reinforcement ◽  
The United States ◽  
College Campuses ◽  
Policy Enforcement ◽  
Sequential Mixed Methods ◽  
Effective Policy ◽  
Online Tracking ◽  
One Year

BACKGROUND College campuses in the United States have begun implementing Smoke and Tobacco-Free policies to discourage the use of tobacco. Smoke and Tobacco-Free policies, however, are contingent upon effective policy enforcement. OBJECTIVE To develop an empirically-derived online tracking tool (Tracker) for crowdsourcing campus environmental reports of tobacco use and waste to support smoke and tobacco-free college policies. METHODS An exploratory sequential mixed methods approach was utilized to inform the development and evaluation of the Tracker. In October 2018, three focus groups across two California universities were conducted and themes were analyzed, guiding Tracker development. After one year of implementation, users were asked in April 2020 to complete a survey about their experience. RESULTS In the focus groups, two major themes emerged: barriers and facilitators to tool utilization. Further Tracker development was guided by focus group input to address these barriers (e.g. information, policing, and logistical concerns) and facilitators (e.g. environmental motivators, positive reinforcement). Amongst 1,163 Tracker reports, those who completed the user survey (n=316) reported the top motivations to using the tool were having a cleaner environment (79%) and health concerns (69%). CONCLUSIONS Environmental concerns, a motivator which emerged in focus groups, shaped the Tracker’s development and was cited by the majority of users surveyed as a top motivator for utilization.

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