Do patients with lung cancer recall physician-initiated discussions about planning for end-of-life care following disclosure of a terminal prognosis?

Horne, Gillian; Payne, Sheila; Seymour, Jane

doi:10.1136/bmjspcare-2015-001015

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Furthermore, patients and relatives in our study described insufficient communication following the disclosure of diagnosis even leading to a feeling of abandonment. The same finding in lung cancer patients was published recently (Horne, Payne, & Seymour, 2016) emphasising our lack of knowledge about terminally ill patients' perceptions of communication and advance care planning and concluding the need of considering how to address these important issues. In addition, we found in our study coping deficits both in patients and relatives throughout the whole trajectory of disease underlining the need of longitudinally structured support.…”

Section: Development Of a Best Practice Guidesupporting

confidence: 58%

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

et al. 2017

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Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.

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Section: Development Of a Best Practice Guidesupporting

confidence: 58%

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

et al. 2017

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“…In turn, we can then perform targeted education as needed to improve end-of-life and advanced-care planning discussions, an identified area of poor performance among physicians. 26 …”

Section: Introductionmentioning

confidence: 99%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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Purpose: The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. Methods: We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Results: Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Conclusion: Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

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“…Finally, unlike prior research focused primarily on physician providers, in which feelings of abandonment were prevalent during the EOL period, 4,9,37 spontaneous themes of abandonment were not identified in our research. Differences in nurse-patient versus physician-patient relationships and communication may have implications for varying perceptions about abandonment near EOL.…”

Section: Discussionmentioning

confidence: 73%

“…3 Disruption of these attachments can lead to negative consequences, such as perceptions of abandonment, 4 which has implications for quality EOL cancer care, including serving as a deterrent to enrollment in palliative care programs, potentially affecting advanced care planning discussions, and causing shock and distress from lack of closure of this valued relationship. [4][5][6][7][8][9][10] Relationships between the patient and HCP may be affected not only by the termination of the relationship but also by negative changes in the relationship near EOL, including rushed visits and poor communication or miscommunication. [10][11][12][13] Stanley 11(p936) has characterized these negative changes as "emotional abandonment."…”

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confidence: 99%

A Qualitative Descriptive Study of Nurse-Patient Relationships Near End of Life

et al. 2023

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Background The end of life (EOL) period represents a challenging time for patients with cancer as they face disruptions in their relationships with their oncology healthcare providers (HCPs) when moving toward hospice care. Poor communication and severed or altered relationships in physician-patient relationships have been shown to occur near EOL, leading to perceptions of abandonment and other negative consequences for quality EOL care. Little is known, however, about nurse-patient relationships near EOL in the cancer setting. Objective The purpose of this qualitative descriptive study was to describe the relationships between patients with cancer and their cancer nurses near EOL. Methods A qualitative descriptive methodology was used via semistructured interviews. A total of 9 participants with advanced cancer were enrolled in and completed the study. Data analysis occurred through qualitative content analysis. Results The overarching theme woven throughout the narratives was “Good Communication Fosters Nurse-Patient Relationships.” Three additional themes emerged from this main theme: 1) “Valuing Professionalism in the Relationship,” 2) “Embracing Personhood in the Relationship,” and 3) “An Unimaginable Termination.” Conclusion Patients with cancer continued to perceive good communication and strong relationships with their cancer nurses even as EOL approached. Themes consistent with negative alterations in these relationships or perceptions of abandonment were not identified. Implication for Practice Cancer nurses can foster nurse-patient relationships through patient-centered communication techniques. Spending adequate time engaging with patients as individuals is also recommended. Perhaps most importantly, nurse-patient relationships should continue to be supported as EOL approaches.

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Do patients with lung cancer recall physician-initiated discussions about planning for end-of-life care following disclosure of a terminal prognosis?

Abstract: 06/Q2307/22.

Cited by 7 publications

References 17 publications

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

A Qualitative Descriptive Study of Nurse-Patient Relationships Near End of Life

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