Abstract
Merckaert I, Delevallez F, Gibon AS, et al.: Transfer of communication skills to the workplace: Impact of a 38-hour communication skills training program designed for radiotherapy teams. J Clin Oncol 2015. (E-pub ahead of print.)
This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and four months later for the waiting list group. Assessments included an audiorecording of a radiotherapy planning session to assess team members' communication skills and expressions of concern with breast cancer patients (analyzed with content analysis software) and an adapted European Organization for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Results demonstrated that 237 radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P=0.003) and more supportive skills (P=0.050) and provided more setting information (P=0.010). Over time, patients interacting with members of the trained teams asked more open questions (P=0.022), expressed more emotional words (P=0.025), and exhibited a higher satisfaction level regarding nurses' interventions (P=0.028). The authors conclude that the 38-hour training program facilitated transfer of team members' learned communication skills to the clinical practice and improved patients' satisfaction with care.
Bristowe K, Horsley HL, Shepherd K, et al.: Thinking ahead: The need for early Advance Care Planning for people on haemodialysis: A qualitative interview study. Palliat Med 2015. (E-pub ahead of print.)
Clearly, there is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to an increasingly elderly, frail, and comorbid end-stage kidney disease population. Timely, sensitive, and individualized advance care planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. The aim of this semistructured qualitative study was to explore the experiences of people with end-stage kidney disease regarding starting hemodialysis, its impact on quality of life, and their preferences for future care; and to explore the advance care planning needs of this population and the timing of this support. A total of 20 patients at two U.K. National Health Service hospitals were purposively sampled by age, time on hemodialysis, and symptom burden. Results demonstrated that themes emerged around “Looking Back,” emotions of commencing hemodialysis; “Current Experiences,” illness and treatment burdens; and “Looking Ahead,” facing the realities. Challenges throughout the trajectory included getting information, communicating with staff, and the ‘conveyor belt’ culture of hemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. The authors conclude that renal patients have considerable unmet advance care planning needs. There is a need to normalize discussions about preferences and priorities in renal and hemodialysis units earlier in the disease trajectory. However, an individualized approach is essential—one size does not fit all.
Al-Qadheeb NS, Hoffmeister J, Roberts, R, et al.: Perceptions of nurses and physicians of their communication at night about intensive care patients' pain, agitation, and delirium. Am J Crit Care 2015. (E-pub ahead of print.)
Ineffective daytime nurse-physician communication in intensive care adversely affects patients' outcomes. However, nurses' and physicians' communications and perceptions of this communication at night are unknown. The object of this study was to determine perceptions of nurses and physicians of their communication with each other at night in the intensive care unit about patients' pain, agitation, and delirium, and to develop a qualitative survey instrument to investigate this topic. A validated survey was distributed to nighttime nurses and physicians in two medical intensive care units. Results demonstrated that most nurses (30/45; 67%) and physicians (56/75; 75%) responded. Nurses (35%) and physicians (31%) thought that a similar proportion of communications was related to pain, agitation, and delirium. Most nurses (70%) and physicians (80%) agreed that nurses used good judgment when paging physicians at night because of patients' pain, agitation, and delirium; but physicians (72%) were more likely than nurses (48%) to think that these pages did not portray the situation accurately (P=0.004). For many text pages, physicians attributed a heightened level of urgency more often than did the nurses who sent the texts. Nurses often thought that physicians did not appreciate the urgency (33%) or complexity (33%) of the situations the nurses communicated via pages. More physicians (41%) than nurses (14%) agreed that nurses exceeded medication orders for pain, agitation, and delirium before contacting a physician (P=0.008). The authors conclude that perceptual differences between physicians and nurses about nurse-physician communications at night regarding pain, agitation, and delirium were numerous and should be studied further.
Noh H: Values important to terminally ill African American older adults in receiving hospice care. J Social Work End of Life Care 2014;10:338–355.
While racial disparity in the use of hospice care by older African Americans is widely acknowledged, little is known about the values they consider important in receiving health care services or about their direct experiences with having these values respected by hospice care providers. Using individual, face-to-face interviews, data were collected directly from 28 African American hospice patients about their experiences in hospice care. Content analysis was used to identify and categorize themes from multiple readings of the qualitative data. Resulting themes included dying at home, open communications, independent decision making, autonomy in daily life, unwillingness to be a burden, and relationships. The author concludes that through the initial assessment, value preferences can be explored and then shared with hospice team members to ensure that services are provided in a way that patient values and preferences are respected.
Tran E, Spiceland C, Sandhu NP, Jatoi A: Malignant bowel obstruction in patients with recurrent ovarian cancer. Am J Hospice Palliat Med 2015. (E-pub ahead of print.)
In this study the authors attempted to report the incidence, risk factors, and survival related to bowel obstruction in 311 ovarian cancer patients with recurrent disease. A total of 68 (22%) patients had a documented bowel obstruction during their cancer course, and 49 (16%) developed it after cancer recurrence. Surprisingly, 142 (45%) fit into an “unknown” category (more than three months of data lacking from last contact/death). No risk factors were identified; management included surgery (n=21), conservative measures (n=21), and other (n=7). Documented bowel obstruction was not associated with a statistically significant reduction in survival after cancer recurrence. The authors conclude that although bowel obstruction occurs in only a subgroup of patients with ovarian cancer and does not appear to detract from survival after cancer recurrence, limited end-of-life information may be resulting in an underestimation of incidence.
Leppin AL, Humeniuk KM, Fernandez C, et al.: Was a decision made? An assessment of patient–clinician discordance in medical oncology encounters. Health Expectations 2015. (E-pub ahead of print.)
Shared decision making is promoted to improve cancer care quality. However, patients and clinicians may have different ideas about what constitutes a cancer care decision, which may limit the validity of self-reported measures of shared decision making. The authors of this study sought to estimate the extent to which patients and clinicians agree on whether a cancer care decision was made during an outpatient encounter. They surveyed patients and clinicians immediately after an oncology encounter at a large, tertiary medical center and calculated agreement in response to the single-item question, “Was a specific decision about cancer care made during the appointment today?” Answer options were ‘yes’ and ‘no.’ Participants were 315 oncology patients, with any solid tumor malignancy and at any stage of management, and their clinicians (22 staff oncologists, 9 senior fellows, and 5 nurse practitioners). Results demonstrated that patients and clinicians reported having made a cancer care decision in 184 (58%) and 174 (55%) encounters, respectively. They agreed on whether a cancer care decision was made in 213 (68%) encounters (chance-adjusted agreement was 0.34). In 56 of the 102 discordant encounters, the patient reported making a decision while the clinician did not. The authors found no significant correlates with discordance. The authors conclude that patients and clinicians do not always agree on whether a cancer care decision was made. As such, measures that ask patients and/or clinicians to evaluate a decision making process or outcome may be methodologically insufficient when they do not explicitly orient respondents towards the thing they are being asked to assess.