scholarly journals Barriers to End-of-Life Communication in the Family Context - Systematic Review of the Perspectives of Persons at the End of Life and their Closed Ones

2019 ◽  
Author(s):  
Katharina Nagelschmidt
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Family Context ◽  
The Family ◽  
End Of Life Communication

Systematic mixed-method review of barriers to end-of-life communication in the family context

2020 ◽  
pp. bmjspcare-2020-002219
Author(s):  
Katharina Nagelschmidt ◽  
Nico Leppin ◽  
Carola Seifart ◽  
Winfried Rief ◽  
Pia von Blanckenburg
Keyword(s):  
End Of Life ◽  
Family Caregivers ◽  
Mixed Method ◽  
Assessment Tools ◽  
Family Context ◽  
Positive Thinking ◽  
The Family ◽  
Life Issues ◽  
End Of Life Issues ◽  
End Of Life Communication

BackgroundCommunication about the end of life is especially important in the family context, as patients and their families are considered as the care unit in palliative care. Open end-of-life communication can positively affect medical, psychological and relational outcomes during the dying process for patient and family. Regardless of the benefits of end-of-life conversations, many patients and their family caregivers speak little about relevant end-of-life issues.AimTo identify barriers that hinder or influence the discussion of end-of-life issues in the family context.DesignA systematic mixed-method review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Data sourcesA systematic search of PsycInfo, CINAHL, PubMed and Web of Science was conducted and extended with a hand search. Peer-reviewed primary studies reporting on the barriers to or difficulties in end-of-life conversations experienced by terminally ill patients and/or family caregivers were included in this review.Results18 qualitative and two quantitative studies met the inclusion criteria. The experiences of n=205 patients and n=738 family caregivers were analysed qualitatively; n=293 patients and n=236 caregivers were surveyed in the questionnaire studies. Five overarching categories emerged from the extracted data: emotional, cognitive, communicative, relational and external processes can hinder end-of-life communication within the family. The most frequently reported barriers are emotional and cognitive processes such as protective buffering or belief in positive thinking.ConclusionsResearch on end-of-life communication barriers in the family context is scarce. Further research should enhance the development of appropriate assessment tools and interventions to support families with the challenges experienced regarding end-of-life conversations.

The contributory role of the family context in early childhood sleep health: A systematic review

Sleep Health ◽  
2021 ◽  
Author(s):  
Lauren B. Covington ◽  
Freda Patterson ◽  
Lauren E. Hale ◽  
Douglas M. Teti ◽  
Angeni Cordova ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Childhood ◽  
Family Context ◽  
Sleep Health ◽  
The Family

scholarly journals Managing uncertainty and references to time in prognostic conversations with family members at the end of life: A conversation analytic study

2020 ◽  
Vol 34 (7) ◽  
pp. 896-905 ◽  
Author(s):  
Rebecca J Anderson ◽  
Patrick C Stone ◽  
Joseph T S Low ◽  
Steven Bloch
Keyword(s):  
End Of Life ◽  
Conversation Analysis ◽  
Communication Training ◽  
Analytic Method ◽  
Prognostic Information ◽  
Reference Time ◽  
The Family ◽  
End Of Life Communication ◽  
Precise Time ◽  
Prognostic Uncertainty

Background: When patients are likely to die in the coming hours or days, families often want prognostic information. Prognostic uncertainty and a lack of end-of-life communication training make these conversations challenging. Aim: The objective of this study is to understand how clinicians and the relatives/friends of patients at the very end of life manage uncertainty and reference time in prognostic conversations. Design: Conversation analysis of audio-recorded conversations between clinicians and the relatives/friends of hospice inpatients. Setting/participants: Experienced palliative care clinicians and relatives/friends of imminently dying hospice inpatients. Twenty-three recorded conversations involved prognostic talk and were included in the analysis. Results: Requests for prognostic information were initiated by families in the majority of conversations. Clinicians responded using categorical time references such as ‘days’, allowing the provision of prognostic estimates without giving a precise time. Explicit terms such as ‘dying’ were rare during prognostic discussions. Instead, references to time were understood as relating to prognosis. Relatives displayed their awareness of prognostic uncertainty when requesting prognostic information, providing clinicians with ‘permission’ to be uncertain. In response, clinicians often stated their uncertainty explicitly, but presented evidence for their prognostic estimates, based on changes to the patient’s function previously discussed with the family. Conclusion: Prognostic uncertainty was managed collaboratively by clinicians and families. Clinicians were able to provide prognostic estimates while being honest about the related uncertainty, in part because relatives displayed their awareness of uncertainty within their requests. The conversation analytic method identified contributions of both clinicians and families, and identified strategies based on real interactions, which could inform communication training.

scholarly journals Discrepant Perceptions About End-of-Life Communication: A Systematic Review

2007 ◽  
Vol 34 (2) ◽  
pp. 190-200 ◽  
Author(s):  
Karen Hancock ◽  
Josephine M. Clayton ◽  
Sharon M. Parker ◽  
Sharon Walder ◽  
Phyllis N. Butow ◽  
...  
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
End Of Life Communication

scholarly journals The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review

2015 ◽  
Vol 14 (4) ◽  
pp. 433-444 ◽  
Author(s):  
Laura Lord ◽  
David Clark-Carter ◽  
Amy Grove
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Communication Skills ◽  
Self Efficacy ◽  
Skills Training ◽  
Communication Skills Training ◽  
Training Interventions ◽  
Staff Behavior ◽  
The Impact ◽  
End Of Life Communication

AbstractObjective:A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff.Method:Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills.Results:Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills.Significance of results:Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.

scholarly journals The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review

2018 ◽  
Vol 35 (8) ◽  
pp. 1140-1154 ◽  
Author(s):  
Madison B. Smith ◽  
Tamara G. R. Macieira ◽  
Michael D. Bumbach ◽  
Susan J. Garbutt ◽  
Sandra W. Citty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Nursing Students ◽  
End Of Life ◽  
Communication Skills ◽  
End Of Life Care ◽  
Learning Experiences ◽  
Life Care ◽  
Simulation Based ◽  
End Of Life Communication

Objectives: To present the findings of a systematic review on the use of simulation-based learning experiences (SBLEs) to teach communication skills to nursing students and clinicians who provide palliative and end-of-life care to patients and their families. Background: Palliative care communication skills are fundamental to providing holistic patient care. Since nurses have the greatest amount of direct exposure to patients, building such communication competencies is essential. However, exposure to patients and families receiving palliative and end-of-life care is often limited, resulting in few opportunities to learn these skills in the clinical setting. Simulation-based learning experiences can be used to supplement didactic teaching and clinical experiences to build the requisite communication skills. Methods: Searches of CINAHL, MEDLINE, PsychINFO, ERIC, and Web of Science electronic databases and Grey Literature returned 442 unique records. Thirty articles met the established criteria, including the SBLE must contain a nursing role. Results: Simulation-based learning experience are being used to teach palliative and end-of-life communication skills to nursing students and clinicians. Lack of standardization, poor evaluation methods, and limited exposure to the entire interprofessional team makes it difficult to identify and disseminate validated best practices. Conclusion: While the need for further research is acknowledged, we recommend this evidence be augmented by training programs that utilize SBLEs through (1) applying standards, (2) clearly specifying goals and objectives, (3) integrating externally validated scenarios, and (4) employing rigorous evaluation methods and measures that link the SBLE to the training objectives and desired clinician practice behaviors and patient outcomes.

Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings

2019 ◽  
Vol 33 (6) ◽  
pp. 589-606 ◽  
Author(s):  
Silvia Gonella ◽  
Ines Basso ◽  
Maria Grazia De Marinis ◽  
Sara Campagna ◽  
Paola Di Giulio
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Common Ground ◽  
Life Care ◽  
Family Carers ◽  
Basic Care ◽  
The Family

Background: Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase. Aim: To identify the elements that nursing home residents’ family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective. Design: Systematic review (PROSPERO no. 95581) with meta-aggregation method. Data Sources: Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied. Results: In all, 18 studies met inclusion criteria. A ‘life crisis’ often resulted in a changed need of care, and the transition towards palliative care was sustained by a ‘patient-centered environment’. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident’s end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care. Conclusion: The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.

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