Vulnerability and Resilience: Phenomenological Analysis of Cancer Patients Value Directives

Michael, Natasha; Symons, Xavier; Mendz, George L.; Kissane, David W.

doi:10.1016/j.jpainsymman.2022.07.015

Cited by 6 publications

(7 citation statements)

References 42 publications

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“…Vulnerability and resilience are not mutually exclusive. 31 An early study on protective factors in connection with the development of resilience already came to the conclusion that ‘protectiveness is not the obverse of vulnerability’. 32 In the interviews, resilience was described as a resource to improve palliative care outcome variables, such as quality of life.…”

Section: Discussionmentioning

confidence: 99%

‘Not a panacea’ – Expert perspectives on the concept of resilience and its potential for palliative care

Maus,

Peusquens,

Kriegsmann-Rabe

et al. 2024

Palliat�Care

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Background: Resilience is an increasingly used term in medicine and subject to various definitions, often not easy to grasp. There are established core concepts for patients receiving palliative care, for example, meaning in life, that have already been researched a lot. Resilience, relative to these concepts, is a new object of research in palliative care, where it has so far been used predominantly with regard to the well-being of teams. Aim: To explore how experts in palliative care define the concept of resilience and its suitability for patients, significant others, and professionals. Design: Qualitative study using summarizing content analysis according to Mayring. Setting/participants: Twenty-one health and social care professionals with expertise caring for persons with life-threatening/limiting illnesses and their relatives were interviewed in three individual interviews and four focus groups. All conversations were recorded, transcribed, coded via MAXQDA, and validated by another researcher. Results: Resilience has been described as something procedural, dynamic, individual, and flexible. In connection with well-known concepts such as posttraumatic growth or terms from the field of mindfulness, social environment or personal factors have also been linked to resilience. Resources such as spirituality can contribute to resilience, and resilience itself can function as a resource, for example, by contributing to quality of life. An active use of the term in practical work with patients or relatives is rare, but it is used in education or team measures. Limited lifespan can pose a challenge to an active use of the concept of resilience. Conclusion: Resilience as a very individual approach provides added value to other core concepts of palliative care. Within the palliative context, the normative dimension of resilience must be well reflected. A broader definition of resilience is recommended, leaving room for everyone to find their own form of resilience. The concept of resilience in palliative care includes opportunities as well as risks and should, therefore, be implemented carefully, requiring specific training.

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Section: Discussionmentioning

confidence: 99%

‘Not a panacea’ – Expert perspectives on the concept of resilience and its potential for palliative care

Maus,

Peusquens,

Kriegsmann-Rabe

et al. 2024

Palliat�Care

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“…It is, therefore, important that healthcare professionals are flexible and can adjust the conversations and the information given as appropriate [ 45 ]. Michael et al [ 46 ] also emphasize a patient’s ability to adapt and cope with illness and impaired function. Adaptation and coping can be facilitated if the patient is treated with care, goodwill and trust.…”

Section: Discussionmentioning

confidence: 99%

“…Adaptation and coping can be facilitated if the patient is treated with care, goodwill and trust. In conversations with patients, existential questions need a place where the patient’s values and life goals can be used as a starting point for optimizing care [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs: a qualitative interview study

et al. 2023

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Background In palliative care, registered nurses provide advanced nursing care to relieve patients’ symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described. Aim To gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients. Method Secondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content. Results The confidential conversation was considered an important part of palliative care and is the nurse’s responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient’s terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation. Conclusion Nurses’ confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.

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“…Interventions in this category involved the use of a question prompt list (QPL; one RCT) [12] and videos (two RCTs) [13][14][15][16]. The QPL was adapted from a booklet used in America and Australia [43], to promote discussions about prognoses and EoL issues with patients with advanced cancer and estimated life expectancies less than 1 year attending outpatient palliative care consultations [12].…”

Section: Intervention Tools For Patients and Caregiversmentioning

confidence: 99%

Interventions aiming to improve advance care planning uptake in oncology: a scoping review of recent randomized controlled trials

Libert,

Langhendries,

Choucroun

et al. 2024

Current Opinion in Oncology

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Purpose of review The evidence regarding the effectiveness of interventions aiming to improve ACP uptake appears mixed. The purpose of this scoping review is to summarize findings from recent RCTs assessing the efficacy of interventions designed to increase ACP uptake in cancer care. Recent findings The PubMed database was searched for studies published between 2021 and 2023. Ten RCTs were identified that evaluated a wide range of interventions aimed at encouraging or facilitating ACP communication among patients with advanced cancer, caregivers, and HCPs. Three RCTs developed ACP facilitation tools for patients and sometimes caregivers. Six RCTs involved integrating trained ACP facilitators into patient care, and one RCT used nudges to encourage oncologists trained in ACP discussions to initiate discussions with patients at highest risk of short-term mortality. Most of the reviewed interventions were based on previously tested intervention approaches or tools. Summary The key effects identified in this review are the facilitation of ACP discussions among patients, caregivers, and HCPs, and the documentation of patient preferences in the medical record. The direct involvement of facilitators in ACP document drafting and inclusion in patient files, as well as interventions prompting end-of-life discussions, contributed to this effect.

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Vulnerability and Resilience: Phenomenological Analysis of Cancer Patients Value Directives

Cited by 6 publications

References 42 publications

‘Not a panacea’ – Expert perspectives on the concept of resilience and its potential for palliative care

‘Not a panacea’ – Expert perspectives on the concept of resilience and its potential for palliative care

“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs: a qualitative interview study

Interventions aiming to improve advance care planning uptake in oncology: a scoping review of recent randomized controlled trials

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