Patients experience major changes in life and significant others struggle with caregiving during the course of incurable cancer: a systematic review and meta-synthesis

2018 ◽  
Vol 6 (1) ◽  
pp. 88 ◽  
Author(s):  
Rikke Madsen ◽  
Regner Birkelund ◽  
Lisbeth Uhrenfeldt
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Effect Size ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Significant Others ◽  
Evidence Based ◽  
Incurable Cancer ◽  
Cancer Experience ◽  
Patients Experience

Aim: The aim of this review was to explore experiences of patients and significant others concerning  existential, psychosocial and organisational transitions during the course of incurable cancer.Methods: The search was based on 5 databases (PubMed, CINAHL, Scopus, PsycInfo and Embase) and 50 studies were finally included and critically appraised. The review was inspired by the methods of Joanna Briggs Institute, Kvale and Brinkmann and illustrated with effect size, inspired by Sandelowski and Barroso.Results: Based on experiences from 496 patients and 320 significant others, 3 main themes with  3 subthemes each were identified and, from these, a meta-synthesis was developed. Patients experience major changes in life and significant others struggle with caregiving during the course of incurable cancer. Main themes: 1. Patients living with incurable cancer experience major changes in life; 2. Patients’ experiences of both living and dying; 3. Significant others living and loosing. Relating findings to the theory of Irvin D. Yalom revealed that patients and significant others experience transitioning into living most of life in an ontological mode of existence.Conclusion: This review underlines the complexity within planning individualised palliative care and contributes with evidence-based knowledge relevant to healthcare professionals in palliative cancer care.

scholarly journals Tools to help healthcare professionals recognize palliative care needs in patients with advanced heart failure: A systematic review

2020 ◽  
pp. 026921632096394 ◽  
Author(s):  
Stephanie MC Ament ◽  
Inge ME Couwenberg ◽  
Josiane JJ Boyne ◽  
Jos Kleijnen ◽  
Henri EJH Stoffers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Palliative Care ◽  
Chronic Heart Failure ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Care Process ◽  
Care Needs ◽  
Process Guidance ◽  
Palliative Care Needs

Background: The delivery of palliative care interventions is not widely integrated in chronic heart failure care as the recognition of palliative care needs is perceived as difficult. Tools may facilitate healthcare professionals to identify patients with palliative care needs in advanced chronic heart failure. Aim: To identify tools to help healthcare professionals recognize palliative care needs in patients with advanced chronic heart failure. Design: This systematic review was registered in the PROSPERO database (CRD42019131896). Evidence of tools’ development, evaluation, feasibility, and implementation was sought and described. Data sources: Electronic searches to identify references of tools published until June 2019 were conducted in MEDLINE, CINAHL, and EMBASE. Hand-searching of references and citations was undertaken. Based on the identified tools, a second electronic search until September 2019 was performed to check whether all evidence about these tools in the context of chronic heart failure was included. Results: Nineteen studies described a total of seven tools. The tools varied in purpose, intended user and properties. The tools have been validated to a limited extent in the context of chronic heart failure and palliative care. Different health care professionals applied the tools in various settings at different moments of the care process. Guidance and instruction about how to apply the tool revealed to be relevant but may be not enough for uptake. Spiritual care needs were perceived as difficult to assess. Conclusion: Seven tools were identified which showed different and limited levels of validity in the context of palliative care and chronic heart failure.

scholarly journals Adjuvant chemotherapy for early female breast cancer: A systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline

2014 ◽  
Vol 22 ◽  
pp. 82 ◽  
Author(s):  
S. Gandhi ◽  
G.G. Fletcher ◽  
A. Eisen ◽  
M. Mates ◽  
O.C. Freedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Systemic Therapy ◽  
Cancer Care ◽  
Cytotoxic Chemotherapy ◽  
Evidence Based ◽  
Inclusion Criteria ◽  
Meta Analyses

BackgroundThe Program in Evidence-Based Care (PEBC) of Cancer Care Ontario (CCO) has recently created an evidence-based consensus guideline on the systemic treatment of early breast cancer.  The evidence for this guideline was compiled using a systematic review to answer the question:  “What is the optimal systemic therapy for patients with early-stage, operable breast cancer, when patient and disease factors are considered?”  This question was addressed in three parts: cytotoxic chemotherapy, endocrine treatment, and human epidermal growth factor receptor 2 (HER2) directed therapy.MethodsA systematic review was performed using the MEDLINE and EMBASE databases for the period January 2008 to May 2014.  The SAGE Directory of Cancer Guidelines and websites of major oncology guideline organizations were also searched.  The basic search terms were “breast cancer” and “systemic therapy” (chemotherapy, endocrine therapy, targeted agents, ovarian suppression), and was limited to randomized controlled trials (RCTs), guidelines, systematic reviews, and meta-analyses. ResultsSeveral hundred documents were retrieved that met the inclusion criteria; the Early Breast Cancer Trialists Collaborative Group (EBCTCG) meta-analyses encompassed many of the RCTs found. Several additional studies which met the inclusion criteria were included, as well as other guidelines and systematic reviews.  Chemotherapy was largely reviewed as three classes of agents: anti-metabolite based regimens (e.g., CMF), anthracyclines, and taxane-based regimens. Single-agent chemotherapy in general is not recommended for the adjuvant treatment of breast cancer in any patient population.  Anthracycline and taxane-based polychemotherapy regimens are overall considered superior to earlier generation regimens, with the most significant impact on patient survival outcomes. Various regimens with disparate anthracycline and taxane doses and schedules are options; in general, paclitaxel given every 3 weeks is inferior. Evidence does not support the use of bevacizumab in the adjuvant setting; other systemic therapy agents such as metformin and vaccines remain under investigation. Adjuvant bisphosphonates for menopausal women will be discussed in later work.  ConclusionThe results of this systematic review represent a comprehensive compilation of high-level evidence which was the basis for the 2014 PEBC CCO guideline on systemic therapy for early breast cancer. The use of cytotoxic chemotherapy is presented here; the results addressing endocrine therapy and HER-2 targeted treatment, as well as the final clinical practice recommendations, are published separately in this issue.

scholarly journals Translating Patient Experiences into Clinical Practice: An Example of ‘Patient involvement’ from Psychosocial Cancer Rehabilitation in Denmark

2016 ◽  
Vol 2 (2) ◽  
pp. 137
Author(s):  
Loni Ledderer ◽  
Nina Nissen
Keyword(s):  
Clinical Practice ◽  
Cancer Care ◽  
Patient Involvement ◽  
Healthcare Professionals ◽  
Patient Experiences ◽  
Cancer Rehabilitation ◽  
Translation Process ◽  
Local Contexts ◽  
Patients Experience ◽  
Active Patients

In this article we examine meanings and uses of the concept of patient involvement, using a psychosocial cancer rehabilitation intervention in Denmark as an example. Drawing on Scandinavian sociological institutional- ism, we analyse the translation process of the concept and how it is understood, shaped and practised in four interrelated contexts: patients’ experience of cancer care; a call for research bids to improve cancer care; a research project of psychosocial cancer rehabilitation; and the implementation of the project’s intervention in clinical practice. Our analysis reveals distinct understandings and practices of patient involvement informed by the various actors’ perspectives and the structures of the healthcare system. The meaning of patient involvement changed from patients seeking to engage in healthcare on their terms, to patients being expected by researchers and healthcare professionals to be ‘active patients’ in particular ways. Our analysis highlights the importance of critically examining the phenomenon of patient involvement in local contexts. 

Support by peers in the clinical team in oncology: Perception of the contribution of patient advisors to improve the patient experience.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 57-57
Author(s):  
Marie-Pascale Pomey ◽  
Israël Fortin ◽  
Marie-Andrée Côté ◽  
Mado Desforges ◽  
Karine Bouchard ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Genetic Test ◽  
Healthcare Team ◽  
Clinical Team ◽  
Educational Support ◽  
Cancer Experience ◽  
Patients Experience ◽  
Support Methods ◽  
The Impact

57 Background: Since 2018, three establishments in Quebec have introduced patient advisors (PA) in their healthcare team in order to improve cancer patients’ experience. These PA, who have had a cancer experience, meet patients undergoing radiotherapy treatments or in oncogenetics for breast cancer on the healthcare site. They conduct consultations to complete the offer of services by bringing emotional, informational, and educational support. Methods: A longitudinal study of multiple cases was completed from January to June 2020. After each accompaniment, the PA filled out a logbook to document the main themes covered and the accompanied patient fill out a survey to evaluate their experience one week after the intervention. A qualitative analysis of the logbook content and descriptive statistics were conducted. The REDCAP platform was used for monitoring the process of data collection and to administer the surveys online. Results: In total, 67 patients were accompanied by 4 PA. 71 logbooks were completed by the PA. The logbooks show that 70.3% of accompaniments took place right before radiotherapy and 63.6% following the results of the genetic test in oncogenetics. 50% of meetings took place in person in the establishment (in a space dedicated to the PA or not) and 45.8% were by phone. The meetings lasted approximately 37 minutes (min: 15 minutes and max: 90 minutes). The majority only met once (93.1 %). The most common themes discussed are: the role of the PA (94.1%), returning to day life (57.6%) and dealing with stress and anxiety (52.2%). 96% of PA felt that they did not encounter any difficulties during the accompaniment. For the accompanied women, the partnership was most beneficial for their experience with the illness (sharing experiences of side-effects, on the impact of the illness on every day life, with their social circle). 79% of patients found that the accompaniment met their needs. 90% of patients estimate that these meetings are complimentary to the healthcare professionals’ interventions. Finally, 89.5% of accompanied patients think that it would be very important to develop these types of meetings on a larger scale. Concerning the adaptation of spaces for the meetings, 26.3% are very satisfied and 26.3% are rather satisfied (probably an area for improvement). Conclusions: Overall, the partnerships seem to answer the needs of the accompanied patients and the PA can share their experience inside the clinical team.

Healthcare professionals’ experiences and perspectives on using telehealth for home-based palliative care: a scoping review protocol (Preprint)

2021 ◽  
Author(s):  
Elias David Lundereng ◽  
Andrea Aparecida Goncalves Nes ◽  
Heidi Holmen ◽  
Anette Winger ◽  
Hilde Thygesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Scoping Review ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Hand Search ◽  
Home Based ◽  
Review Protocol ◽  
Analysis Protocol

BACKGROUND Telehealth seems feasible for use in home-based palliative care. However, acceptance among healthcare professionals is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of healthcare professionals on the use of telehealth for home-based palliative care. OBJECTIVE To systematically map published studies on healthcare professionals’ experiences and perspectives on the use of telehealth in home-based palliative care. METHODS The proposed scoping review will employ the methodology of Arksey and O’Malley. This protocol is guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P). A systematic search was performed in Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine (AMED) and Web of Science (WoS) for studies published between January 2000 to July 5, 2021. We will also hand search the reference lists of included papers to identify additional studies of relevance. The search will be updated in 2022. Pairs of authors will independently assess eligibility of studies and extract data. The two first stages of thematic synthesis will be used to thematically organize the data material. Since the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. RESULTS The database searches were performed on July 5, 2021 and the eligibility criteria were tested in July-August 2021. After removal of 2364 duplicates, the search yielded 2420 citations.We will screen titles, abstracts and full-text papers by fall 2021. Results are anticipated by September 2022. CONCLUSIONS A mapping of studies could identify research gaps regarding healthcare professionals’ experiences and perspectives on the use of telehealth in home-based palliative care and may determine the value and feasibility of conducting a full systematic review.

Palliative Care

2006 ◽  
Vol 4 (8) ◽  
pp. 776 ◽  
Author(s):  
_ _
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Care ◽  
Incurable Cancer ◽  
Disease Modifying Therapy ◽  
Hospice Movement ◽  
Life Issues ◽  
Care Guidelines ◽  
Recent Version

Over the past 20 years, increasing attention has been paid to quality-of-life issues in oncology. As the hospice movement has grown in this country, palliative care has developed into an integral part (rather than the antithesis) of comprehensive cancer care. Palliative care must be integrated earlier into the continuum of cancer care, and palliative, symptom-modifying therapy should be provided simultaneously with disease-modifying therapy from diagnosis. The goal of the NCCN palliative care guidelines is to help assure that each patient with cancer experiences the best possible quality of life throughout the illness trajectory. These guidelines are intended to help oncology teams provide the best care possible for their patients with incurable cancer. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Palliative care education in Latin America: A systematic review of training programs for healthcare professionals

2017 ◽  
Vol 16 (1) ◽  
pp. 107-117 ◽  
Author(s):  
Cecilia Vindrola-Padros ◽  
Rosa Mertnoff ◽  
Cristina Lasmarias ◽  
Xavier Gómez-Batiste
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Latin America ◽  
Latin American ◽  
Healthcare Professionals ◽  
Training Programs ◽  
International Association ◽  
Grey Literature ◽  
Interdisciplinary Teams ◽  
Teaching Staff

ABSTRACTObjective:The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation.Method:We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings.Results:We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff.Significance of results:Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.

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