Allocating Resources in Cancer Care During Pandemic. Findings from a Qualitative Interview Study with Oncologists and Ethical Analysis

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 165-166
Author(s):  
Sabine Sommerlatte ◽  
◽  
Anna-Lena Kraeft ◽  
Celine Lugnier ◽  
Anke Reinacher-Schick ◽  
...  
Keyword(s):  
Priority Setting ◽  
Cancer Care ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Health Resources ◽  
Diagnostic Procedures ◽  
Resource Scarcity ◽  
Standards Of Care ◽  
Qualitative Interview Study

"Allocation of health resources towards the treatment of patients with COVID-19 may affect the quality of care for non-COVID-19 patients. Several medical societies representing cancer health professionals have issued statements on priority setting in cancer care in the wake of the Sars-CoV-2 outbreak (1, 2). However, there is a lack of empirical data on how resources are prioritized in cancer care and which criteria are taken into consideration by those involved in decision making. In this paper we will present findings from qualitative interviews conducted with oncologists in Germany between February and July 2021. Transcripts of interviews are analysed following principles of qualitative content analysis based on Kuckartz (3). According to preliminary analysis of the first five interviews conducted three major topics emerge: 1. Experiences with scarcity regarding selected diagnostic procedures and treatment. 2. Material and procedural criteria for priority setting and decisions on deviations of standards of care. 3. Effects of priority setting on coping and psycho-social support. We will discuss findings with regards to their possible contribution to an empirical and normative founded guidance for priority setting in cancer care in times of Sars-CoV-2 outbreak and comparable events. 1. Deutsche Gesellschaft für Hämatologie und Onkologie. Coronavirus-Infektion (COVID-19) bei Patienten mit Blut- und rebserkrankungen. https://www.onkopedia.com/de/onkopedia/guidelines/coronavirus-infektion-covid-19-bei-patient-innen-mit-blut-und-krebserkrankungen/@@guideline/html/index.html 2. Marron JM, Joffe S, Jagsi R et al. Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID19 Pandemic. J Clin Onc. April 28 2020, doi:10.1200/JCO.20.00960 3. Kuckartz, U. (2018). Qualitative Inhaltsanalyse. Methoden, Praxis, Computer¬unterstützung (4th ed.). Beltz Juventa. "

scholarly journals Vision-related quality of life in adults with severe peripheral vision loss: a qualitative interview study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ryan Lange ◽  
Abigail Kumagai ◽  
Sara Weiss ◽  
Katherine B. Zaffke ◽  
Sherry Day ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Contrast Sensitivity ◽  
Qualitative Interviews ◽  
Well Being ◽  
Vision Impairment ◽  
Qualitative Interview Study ◽  
Patient Reported ◽  
Related Quality ◽  
The Impact

Abstract Background Existing patient-reported outcome (PRO) measures may not be relevant to the full range of functional and vision-related quality of life (VR-QOL) concerns of individuals with vision impairment due to severe peripheral field loss (PFL). Measurement of VR-QOL in severe PFL is important in order to determine the effectiveness of vision rehabilitation interventions for this population. The purpose of this study was to characterize the impact of severe PFL due to retinitis pigmentosa (RP) and glaucoma on VR-QOL as the initial phase in the development of a novel PRO measure. Methods Individuals with severe PFL due to RP or glaucoma were recruited from the Kellogg Eye Center and the Association for the Blind and Visually Impaired. Participants completed semi-structured qualitative interviews, the Impact of Vision Impairment (IVI) questionnaire and the RAND 36-Item Health Survey. Interviews were analyzed by two coders using thematic analysis. A matrix analysis was conducted to compare VR-QOL by cause of severe PFL. Sample size was determined by thematic saturation. Results The study included 37 participants (19 RP, 18 glaucoma). Median best-corrected visual acuity for those with RP and glaucoma was 20/40 and 20/27.5, while Pelli-Robson contrast sensitivity was 1.2 log contrast sensitivity (logCS) and 1.1 logCS, respectively. Median domain scores on the IVI (reading, mobility, well-being) ranged from a low of − 0.2 to a high of 0.7 logits in those with RP and from 0.5 to 1.2 logits in those with glaucoma. Qualitative interviews identified six VR-QOL themes relevant across participants with both RP and glaucoma, including activity limitations, driving, emotional well-being, reading, mobility, and social function. VR-QOL concerns were largely consistent among those with severe PFL due to RP and glaucoma. These overarching themes contained content relevant to specific challenges related to severe PFL. Conclusions There are commonly occurring VR-QOL concerns among individuals with severe PFL due to RP and glaucoma. The outlined themes will serve as the basis for development of the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Questionnaire.

scholarly journals End-of-Life Cancer Care Redesign: Patient and Caregiver Experiences in a Lay Health Worker–Led Intervention

2019 ◽  
Vol 36 (12) ◽  
pp. 1081-1088 ◽  
Author(s):  
Manali I. Patel ◽  
David Moore ◽  
Tumaini R. Coker
Keyword(s):  
End Of Life ◽  
Health Worker ◽  
Cancer Care ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Qualitative Interview ◽  
Lay Health Worker ◽  
Advance Care ◽  
Caregiver Experiences ◽  
Survey Responses

Importance: The Engagement of Patients with Advanced Cancer (EPAC), comprised of a lay health worker (LHW) who assists patients with advance care planning, is an effective intervention for improving patient experiences and reducing acute care use and total health-care costs. The objective of this study was to assess patients’ and caregivers’ experiences with the intervention. Methods: We invited all patients enrolled in EPAC and their caregivers to complete an 8-item survey at the end of the intervention and a random 35% sample to participate in a qualitative interview to assess their experiences. At 15-month follow-up, we invited all caregivers of patients who died during the study to participate in a qualitative interview. We analyzed survey responses using bivariate methods and recorded, transcribed, and analyzed interviews using qualitative content analysis. Results: Sixty-nine patients were alive at completion of the intervention and all 30 identified caregivers completed the survey. All viewed the intervention as a critical part of cancer care and recommended the intervention for other patients. In qualitative interviews, among 30 patients, all reported improved comfort in discussing their end-of-life care preferences. In qualitative interviews with 24 bereaved caregivers, all viewed the intervention as critical in ensuring that their loved ones’ wishes were adhered to at the end of life. Conclusions and Relevance: Incorporating an LHW into end-of-life cancer care is an approach supported and viewed as highly effective in improving care by patients and caregivers. The LHW-led EPAC intervention is one solution that can significantly impact patient and caregiver experiences.

scholarly journals Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors

2016 ◽  
Vol 2016 ◽  
pp. 1-16 ◽  
Author(s):  
Gunver S. Kienle ◽  
Milena Mussler ◽  
Dieter Fuchs ◽  
Helmut Kiene
Keyword(s):  
Cancer Care ◽  
Qualitative Content Analysis ◽  
Mental Condition ◽  
Anthroposophic Medicine ◽  
Patient Centered ◽  
Cancer Treatments ◽  
Qualitative Interview Study ◽  
Patient Assessments ◽  
Lymphangitis Carcinomatosa

Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT.Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented.Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients’ general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients’ emotional and mental condition was reported to have improved.Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.

scholarly journals The impact of COVID-19 on the provision of respectful maternity care: findings from a global survey of health workers

2021 ◽  
Author(s):  
Anteneh Asefa ◽  
Aline Semaan ◽  
Therese Delvaux ◽  
Elise Huysmans ◽  
Anna Galle ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Maternity Care ◽  
Qualitative Data ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Standards Of Care ◽  
Respectful Maternity Care ◽  
The Impact ◽  
Maternal And Newborn

Background Significant adjustments to the provision of maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic affected frontline health workers' ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected quantitative and qualitative data between July and December 2020 and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n=1,127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers' fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic disrupted the quality of care provided to women during labour and childbirth generally, and respectful maternity care specifically. Keywords Maternal health; Quality of care; Labour; Childbirth; Newborn health; Intrapartum care, Antenatal care, Postnatal care

scholarly journals Implementation of patient-centred care: which organisational determinants matter from decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027591 ◽  
Author(s):  
Kira Isabel Hower ◽  
Vera Vennedey ◽  
Hendrik Ansgar Hillen ◽  
Ludwig Kuntz ◽  
Stephanie Stock ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Social Care ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Sampling Strategy ◽  
Well Being ◽  
Decision Makers ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Health And Social Care

ObjectivesHealth and social care systems, organisations and providers are under pressure to organise care around patients’ needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers’ perspectives across diverse HSCOs.DesignQualitative study of n=24 participants in n=20 semistructured face-to-face interviews conducted from August 2017 to May 2018.Setting and participantsDecision makers were recruited from multiple HSCOs in the region of the city of Cologne, Germany, based on a maximum variation sampling strategy varying by HSCOs types.OutcomesThe qualitative interviews were analysed using an inductive and deductive approach according to qualitative content analysis. The Consolidated Framework for Implementation Research was used to conceptualise determinants of PCC.ResultsDecision makers identified similar determinants facilitating or obstructing the implementation of PCC in their organisational contexts. Several determinants at the HSCO’s inner setting and the individual level (eg, communication among staff and well-being of employees) were identified as crucial to overcome constrained financial, human and material resources in order to deliver PCC.ConclusionsThe results can help to foster the implementation of PCC in various HSCOs contexts. We identified possible starting points for initiating the tailoring of interventions and implementation strategies and the redesign of HSCOs towards more patient-centredness.

Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study

Dementia ◽  
2015 ◽  
Vol 16 (4) ◽  
pp. 513-522 ◽  
Author(s):  
Isabelle Moebs ◽  
Susan Gee ◽  
Motohide Miyahara ◽  
Helen Paton ◽  
Matthew Croucher
Keyword(s):  
Cognitive Impairment ◽  
Emotional Support ◽  
Cognitive Rehabilitation ◽  
Qualitative Interviews ◽  
Group Leaders ◽  
Intervention Programme ◽  
Memory Problems ◽  
Qualitative Interview Study ◽  
The Voice

Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.

Moral distress in nurses caring for patients with Covid-19

2021 ◽  
pp. 096973302110032
Author(s):  
Henry J Silverman ◽  
Raya Elfadel Kheirbek ◽  
Gyasi Moscou-Jackson ◽  
Jenni Day
Keyword(s):  
New York ◽  
Ethical Climate ◽  
Moral Distress ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Resource Scarcity ◽  
Standards Of Care ◽  
Medical Systems ◽  
Institutional Review ◽  
Good Patient Care

Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences.

scholarly journals Clinicians’ knowledge and attitudes towards patient reported outcomes in colorectal cancer care – insights from qualitative interviews

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nora Tabea Sibert ◽  
Christoph Kowalski ◽  
Holger Pfaff ◽  
Simone Wesselmann ◽  
Clara Breidenbach
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Implementation Strategies ◽  
Clinical Staff ◽  
Successful Implementation ◽  
Patient Reported ◽  
Clinical Benefits

Abstract Introduction Patient-reported outcomes (PROs) can be used in cancer care to monitor patients’ disease-related symptoms and functional status. However, successful implementation of such instruments is only possible if clinical staff are convinced of the clinical benefits. It is therefore crucial to investigate the attitudes of clinical staff to PROs in routine cancer care. Methods Semi-structured, guideline-based interviews were held with 12 clinicians working in certified colorectal cancer centers in Germany who are taking part in an observational study on PROs (five surgeons, two oncologists, one psycho-oncologist, two oncological care nurses, one stoma therapist, and one physician assistant) in order to investigate firstly, how clinicians describe PRO instruments (“wording”); and secondly, the clinicians’ general attitude toward PROs. A qualitative content analysis according to Kuckartz was performed. Results The wording used to describe PROs was not consistent. Statements on attitudes toward PROs were very heterogeneous and were therefore categorized into “(rather) positive” and “(rather) negative.” The principal advantages of PROs mentioned by participants included broader, structured knowledge about patients and treatment, as well as relevance for patients. Subcategories for (rather) negative attitudes included statements expressing doubts about the questionnaires and “no need for PROs.” Discussion The clinicians participating mainly expressed fairly positive attitudes toward PROs. However, they had little knowledge about PROs in general and the interviews therefore mainly reflect their expectations and assumptions about them. These initial impressions may be regarded as providing a basis for future implementation strategies and for training of clinicians on how to use PROs in routine cancer care.

scholarly journals Lived Experience of Hereditary Chronic Pancreatitis – A Qualitative Interview Study

2021 ◽  
pp. 174239532110397
Author(s):  
Regina Müller ◽  
Ali A Aghdassi ◽  
Judith Kruse ◽  
Markus M Lerch ◽  
Christoph Rach ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Lived Experience ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Rare Condition ◽  
Theoretical Frameworks ◽  
Patient Centered ◽  
Biographical Disruption ◽  
Qualitative Interview Study ◽  
Hereditary Chronic Pancreatitis

Objectives Hereditary chronic pancreatitis is a rare condition characterized by intermittent acute episodes of pancreatitis and long-term impairment of pancreatic functions. However, the subjective perspective of individuals affected by hereditary chronic pancreatitis has been little studied. This qualitative study investigates the experience of hereditary chronic pancreatitis patients and their relatives because the awareness of the needs of those affected is an essential component of a patient-centered management of chronic conditions. Methods Semi-structured qualitative interviews were conducted with hereditary chronic pancreatitis patients and their relatives. Data were analysed using qualitative content analysis. The concepts of ‘biographical contingency,’ ‘biographical disruption’ and the ‘shifting perspectives model’ served as theoretical frameworks. Results A total of 24 participants (17 patients, 7 relatives) were interviewed individually. Four main themes were identified: (1) The unpredictable clinical course of hereditary chronic pancreatitis; (2) hereditary chronic pancreatitis as a devastating experience; (3) hereditary chronic pancreatitis as part of a normal life; and (4) being reduced to hereditary chronic pancreatitis. Discussion The ‘shifting perspectives model’ of chronic illness covers the four dimensions adequately and can serve as a theoretical model to explain hereditary chronic pancreatitis patients’ experience. A better understanding of the patients and their families’ experience and the shifting character of hereditary chronic pancreatitis can help healthcare professionals to tailor the care to meet the needs of those affected.

scholarly journals Social inclusion and violence prevention in psychiatric inpatient care. A qualitative interview study with service users, staff members and ward managers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Veikko Pelto-Piri ◽  
Lars Kjellin
Keyword(s):  
Social Justice ◽  
Inpatient Care ◽  
Social Inclusion ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Psychiatric Inpatient ◽  
Hospital Staff ◽  
Service Users ◽  
Staff Members ◽  
Qualitative Interview Study

Abstract Background Many psychiatric services include social inclusion as a policy with the aim to offer users the opportunity to participate in care and to form reciprocal relationships. The aim of this study was to explore opportunities and problems with regard to participation, reciprocity and social justice that different stakeholders experience when it comes to social inclusion for service users and minimizing violence in psychiatric inpatient care. Methods Qualitative interviews were performed with 12 service users, 15 staff members, and six ward managers in three different kinds of psychiatric wards in Sweden. The data were analyzed using the framework method and qualitative content analysis, which was based on the three following social inclusion values: participation, reciprocity, and social justice. Results Themes and subthemes were inductively constructed within the three social inclusion values. For participation, staff and ward managers reported difficulties in involving service users in their care, while service users did not feel that they participated and worried about what would happen after discharge. Staff gave more positive descriptions of their relationships with service users and the possibility for reciprocity. Service users described a lack of social justice, such as disruptive care, a lack of support from services, not having access to care, or negative experiences of coercive measures. Despite this, service users often saw the ward as being safer than outside the hospital. Staff and managers reported worries about staffing, staff competence, minimizing coercion and violence, and a lack of support from the management. Conclusions By applying the tentative model on empirical data we identified factors that can support or disrupt the process to create a safe ward where service users can feel socially included. Our results indicate that that staff and service users may have different views on the reciprocity of their relationships, and that users may experience a lack of social justice. The users may, due to harsh living conditions, be more concerned about the risk of violence in the community than as inpatients. Staff and ward managers need support from the management to foster a sense of community in the ward and to implement evidence-based prevention programs.

Sign in / Sign up

Export Citation Format

Share Document