Connecting Through Conversation: A Novel Video-Feedback Intervention to Enhance Long-Term Care Aides' Person-Centred Dementia Communication.

Objective: To pilot test a novel communication intervention incorporating a video-feedback component on the person-centred dementia communication skills of long-term care aides. Methods: Effectiveness was assessed using a single group pre-test/post-test design. 11 care aide-resident dyads participated in the study. Objective outcomes included provider statements demonstrating linguistic (i.e., reciprocity, clarity/coherence, and continuity categories) and relational elements of person-centred dementia communication, measured via video-recorded observations of usual care interactions. Subjective outcomes of care aide communication confidence/competence, satisfaction with the resident relationship, relationship closeness, and self-reflection at work were measured using self-report questionnaires. Results: In respect to observed person-centred dementia communication skills, there was an increase in the use of linguistic statements in the reciprocity and continuity categories, as well as total linguistic statements overall. Relational statements and overall person-centred dementia communication (i.e., linguistic plus relational strategies) increased. Care aide-reported communication confidence and competence, relationship closeness with the resident, and self-reflection at work also increased after the communication intervention. Discussion: The communication intervention showed promise as an effective approach to enhance person-centred dementia communication behaviours in care aides. These results support undertaking a larger trial to examine the intervention's effectiveness more fulsomely.

Expanding the conversation: A Person-centred Communication Enhancement Model.

The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers' use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes. Thus, several person-centred care and communication theoretical perspectives have been employed to ground study in this field. However, a comprehensive theoretical position to underpin person-centred communication in dementia and older adult research does not exist to our knowledge. To offer expansion to the theoretical work in this emerging field, a Person-Centred Communication Enhancement Model for long-term care and dementia care is proposed, as well as rationale for its development. This discussion will also provide an overview and critique of the extant philosophies, theories, frameworks and models that have been utilized in the study of person-centred communication within the context of long-term care and dementia care.

Writing activities and the hidden curriculum in nursing education.

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper-focus on "figuring out" the teacher with minimal focus on the act of writing. Students used a form of behavioral "code-switching" to maximize their grade while considering how their "valuing" of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment.

Perceptions of an evidence-based empathy mobile app in post-secondary education.

Cognitive empathy (also known as perspective-taking) is an important, teachable, skill. As part of a knowledge translation project, we identified a) interest in an evidence-based cognitive empathy mobile app and b) which faculties believe that cognitive empathy is important for their profession. Students (n = 638) and instructors/professors (n = 38) completed a university-wide survey. Participants in Education, Social Work, and the Health Sciences were among those most interested in the app. The majority of participants said that they would prefer for the app to be free or less than $3 for students. Most participants preferred a one-time payment option. Across 17 faculties, all but one had 60% or more of its sampled members say that cognitive empathy is important for their profession. Results illuminate perceptions of cognitive empathy instruction and technology. Results also provide insight into issues to consider when developing and implementing an educational communication app.

Mindfulness-based arts interventions for cancer care: A systematic review of the effects on wellbeing and fatigue.

OBJECTIVE: Upon receiving a cancer diagnosis, life irrevocably changes and complex experiences of emotional distress often occur. There is a growing interest in mindfulness-based arts interventions (MBAIs) to ameliorate the distress many patients experience. Our review objective was to synthesize the evidence on the effectiveness of MBAIs on psychological wellbeing and fatigue. METHOD: Relevant quantitative articles were identified through a systematic search of the grey literature and online databases including MEDLINE, CINAHL, Cochrane CENTRAL, Art Full Text, ART bibliographies Modern, PsycINFO, Scopus, and EMBASE. Two independent reviewers screened titles/abstracts against predetermined inclusion criteria, read full-text articles for eligibility, conducted quality appraisals of included articles, and extracted pertinent data with a standardized data extraction form. The heterogeneity of the included studies precluded a meta-analysis and a narrative synthesis of study outcomes was conducted. RESULTS: Our systematic search retrieved 4241 titles/abstracts, and 13 studies met our inclusion criteria (eight randomized controlled trials and five quasi-experiments). Most of the studies focused on patients with cancer (92.3%). There is a growing interest in MBAIs over time and significant heterogeneity in the types of interventions. A significant effect was found on several outcomes that are important in psychosocial oncology: quality of life, psychological state, spiritual wellbeing, and mindfulness. The effect on fatigue was equivocal. CONCLUSIONS: This novel intervention demonstrates promise for the psychosocial care of patients with cancer. These findings are an essential antecedent to the continued implementation, development, and evaluation of MBAIs in oncology.

Video feedback: A novel application to enhance person-centred dementia communication.

AIM: A discussion of the use of video feedback as an effective and feasible method to promote person-centred communication approaches within dementia care and long-term care. BACKGROUND: Effective strategies to integrate person-centred approaches into health care settings have attracted global attention and research in the past two decades. Video feedback has emerged as technique to enhance reflective learning and person-centred practice change in some care settings; however, it has not been tested in the context of person-centred dementia communication in long-term care. DESIGN: Discussion paper. DATA SOURCES: Articles dating from 1995 to 2018 retrieved via searches of the SCOPUS, CINAHL, MEDLINE and Cochrane Systematic Review databases. IMPLICATIONS FOR NURSING: Inclusion of video feedback in a person-centred dementia communication intervention for nurses and other health care providers may effectively fill a gap evident in the literature. This intervention can offer feedback of enhanced quality and enduring impact on behaviour change relative to traditional training. CONCLUSION: A critical review of empirical and theoretical evidence supports video feedback as a potential means to enhance person-centred communication within the context of dementia and long-term care. The promising benefits of video feedback present a novel research opportunity to pilot its use to enhance person-centred communication between nurses/health care providers and persons with dementia in long-term care.

Are perspective-taking outcomes always positive? Challenges and mitigation strategies.

BACKGROUND: Engaging in perspective-taking often has positive outcomes for both healthcare providers and patients. Perspective-taking by healthcare providers has been linked to increased patient satisfaction and compliance, patients' positive perceptions of healthcare providers' interpersonal skills, and a reduction in judgmental attitudes toward individuals who engage in health-risk behaviors. The positive outcomes that are associated with perspective-taking are often highlighted in the literature. However, less discussed are the negative outcomes. AIM: This paper discusses the positive and negative outcomes associated with perspective-taking and presents potential methods for mitigating negative outcomes. CONCLUSION: When designing and implementing perspective-taking interventions, educators and researchers should consider potential negative intervention outcomes and strategies to attenuate these outcomes.

Effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to synthesize evidence on the effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness.

Shared Attributes of Responsibility and Emotion in Patients With Lung Cancer and Family Caregivers
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OBJECTIVES: To compare the attributions and emotions held by patients with lung cancer (affected individuals) and family caregivers in their management of the disease. 
. SAMPLE & SETTING: A secondary data analysis of 304 affected individuals and 304 family caregivers. Participants were selected from five oncology outpatient settings.
. METHODS & VARIABLES: Comparative analysis and regression modeling. Variables include responsibility, anger, and pride in managing lung cancer.
. RESULTS: Affected individuals reported higher self-oriented blame, fault, and anger than did family caregivers. Family caregivers reported more blame, fault, and anger toward the affected individual than toward themselves. Current smoking behavior of either the affected individual or family caregiver was associated with increased reports of self-oriented blame, fault, and anger. Additional research is needed to understand the attributional and emotional responses affected by the type of lung cancer, gender differences, and characteristics of the caregiving dyad.
. IMPLICATIONS FOR NURSING: Nurses should be aware of the potential for affected individuals to experience internal (self) and external (family caregiver) sources of blame, fault, and anger. Knowledge of the reasons for current smoking behavior is important for understanding emotional responses and determining interventions.

A qualitative analysis of individual and family caregiver responses to the impact of urinary incontinence on quality of life.

PURPOSE: The purpose of the original mixed-design study was to compare affected individual and family caregiver perceptions of urinary incontinence quality of life in relation to their empathic responses toward one another and to explore their qualitative responses of factors that hinder or facilitate these responses. The aim of this secondary analysis is to report responses shared by affected individuals and family caregivers on how their lives have been impacted by urinary incontinence. DESIGN: Qualitative study with content analysis. SUBJECTS AND SETTING: The sample comprised 13 persons with urinary incontinence and 13 family caregivers. Their mean age was 78 years and the mean age for caregivers was 67 years. Caregivers were mainly the spouses or daughters of affected respondents. Interviews were conducted in participants' homes in Winnipeg, Manitoba, Canada. METHODS: Data were collected via 26 audio-recorded interviews. Content analysis was used to capture major themes arising from the data. RESULTS: Five major themes with respective subthemes highlight how urinary incontinence influenced the quality of life of affected individuals and their family caregivers, including (1) life changes, (2) psychological responses and coping, (3) painful responses of others, (4) reticence to seek medical attention, and (5) advice to health care professionals. CONCLUSIONS: Health care professionals should recognize that dealing with urinary incontinence in the home is a "team effort" between affected individuals and family caregivers. Educational efforts need to counter attitudes in care providers who avoid talking about urinary continence and enhance sensitivities toward affected individuals' and family caregivers' ongoing need for control in continence care based on their unique needs and preferences.

A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home.

BACKGROUND: Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients' and caregivers' roles and perspectives managing pain is, therefore, fundamental to addressing cancer pain in this setting. Consequently, we sought to explore and describe their perspectives and roles. METHODS: A qualitative descriptive approach was used. Semi-structured interviews were conducted with a purposeful sample of patient- family caregiver dyads. Participants included 18 patients aged 65 years and over, with advanced cancer, receiving palliative care at home, and 15 family caregivers. The interview data were analysed using thematic analyses. Strategies were used to establish rigour. RESULTS: Two main themes were identified. The first theme, "Communicating the pain", represented pain assessment and incorporated four subthemes in which participants described: their roles in pain assessment, the identification and expression of pain, and the communication of pain between patients and caregivers. The second theme, "Finding a solution", comprised of four subthemes that reflected participants' roles and approaches in controlling pain; as well as their beliefs about cancer pain control, experience with side effects, and perspectives on the goals of treatment. CONCLUSIONS: The findings support other studies in identifying knowledge and attitudinal barriers to pain control; while adding to the literature by highlighting practical and relational barriers faced by older patients and their family caregivers. Health care professionals can do much to address the barriers identified by: correcting misconceptions regarding cancer pain, facilitating the communication of pain within dyads, and ensuring that patients and family caregivers have the knowledge, skills, and ability to assess and implement pain treatment strategies. This support needs to be individually tailored to meet the ongoing needs of both members of the dyad so that the shared goals of pain management are accomplished.

Cancer-related pain in older adults receiving palliative care: patient and family caregiver perspectives on the experience of pain.

BACKGROUND: Despite an emphasis on pain management in palliative care, pain continues to be a common problem for individuals with advanced cancer. Many of those affected are older due to the disproportionate incidence of cancer in this age group. There remains little understanding of how older patients and their family caregivers perceive patients' cancer-related pain, despite its significance for pain management in the home setting. OBJECTIVES: To explore and describe the cancer pain perceptions and experiences of older adults with advanced cancer and their family caregivers. METHODS: A qualitative descriptive approach was used to describe and interpret data collected from semistructured interviews with 18 patients (≥65 years of age) with advanced cancer receiving palliative care at home and their family caregivers. RESULTS: The main category 'Experiencing cancer pain' incorporated three themes. The theme 'Feeling cancer pain' included the sensory aspects of the pain, its origin and meanings attributed to the pain. A second theme, 'Reacting to cancer pain', included patients' and family caregivers' behavioural, cognitive (ie, attitudes, beliefs and control) and emotional responses to the pain. A third theme, 'Living with cancer pain' incorporated individual and social-relational changes that resulted from living with cancer pain. CONCLUSIONS: The findings provide an awareness of cancer pain experienced by older patients and their family caregivers within the wider context of ongoing relationships, increased patient morbidity and other losses common in the aged.

Fecal occult blood testing instructions and impact on patient adherence.

INTRODUCTION: Although the physician's role with patients is crucial in encouraging FOBT screening, the nature and content of physician-patient discussions about FOBT screening is unclear. As part of a larger study, this paper reports on our analyses of physician beliefs about fecal occult blood testing (FOBT) and strategies they employed to enhance patient adherence. The second aim of this paper is to report on the perceptions of individuals at average risk for colorectal cancer (CRC) in regard to their awareness of the FOBT and their responses to physician recommendations about FOBT screening. METHODS: The larger study was conducted in urban and rural Manitoba, Canada between 2008 and 2010. We used a qualitative design and conducted semi-structured, audio-recorded interviews with 15 physicians and 27 individuals at average risk for CRC. We included data from 11 family members or friends on their perspectives of FOBT instructions as individuals who were also at average risk for CRC and had their own experiences with CRC screening recommendations. RESULTS: Despite widespread knowledge of The Canadian Task Force on Preventive Health Care CRC screening guidelines, physician attitudes, behaviors, and instructions were not uniform in promoting patient adherence to FOBT screening. Individuals at average-risk for CRC identified that FOBT instructions were confusing and burdensome, which in turn served as a barrier in their adherence to FOBT screening. CONCLUSIONS: Variation in FOBT instruction counseling in relation to the recommended age of individuals at average risk for CRC, as well as adequate patient preparation affected patient adherence. We recommend uniform or standardized instructions and counseling by health care providers who administer the FOBT kit to patients to promote adherence to recommended CRC screening.

Impact of patient smoking behavior on empathic helping by family caregivers in lung cancer.

PURPOSE/OBJECTIVES: To test the impact of patient smoking behavior on family caregiver judgments of responsibility, emotions, empathic responses, and helping behavior. DESIGN: Structural equation modeling. SETTING: Five oncology outpatient settings in Canada. SAMPLE: 304 dyads consisting of patients with lung cancer and their primary caregivers. METHODS: Self-report questionnaires, abstracted medical record data, confirmatory factor analysis, and structural equation modeling. MAIN RESEARCH VARIABLES: Smoking history, judgments of responsibility for controlling the disease, anger, pride, empathic responses, and helping behaviors. FINDINGS: The impact of patient smoking behavior on caregiver help was mediated by caregiver judgments of responsibility, affective reactions of anger and pride, and empathic responses by caregivers. CONCLUSIONS: When patients continued to engage in smoking behavior, despite a diagnosis of lung cancer, caregivers tended to ascribe more responsibility and feel more anger and less pride in the patients' efforts to manage the disease, therefore placing caregivers at risk for less empathy and helping behavior. IMPLICATIONS FOR NURSING: Caregiver blame and anger must be assessed, particularly when the patient with lung cancer continues to smoke. If caregiver judgments of blame and anger are evident, then an attribution approach is indicated involving a dialogue between the caregiver and the patient, with the aim of enhancing the caregiver's understanding of how negative attributions and linked emotions impact his or her ability to engage in empathic helping behaviors.

What is the role of family in promoting faecal occult blood test screening? Exploring physician, average-risk individual, and family perceptions.

BACKGROUND: Although the number of Canadians being screened for colon cancer is rising, only 40% of Canadians aged 50 years or older reported they had engaged in faecal occult blood test (FOBT) screening as recommended. The notion of 'partnerships' that is inclusive of physicians, individuals at average-risk for colorectal cancer, and influential family members is receiving more attention in primary health care literature and policy on promoting health maintenance behaviours. To the best of our knowledge there are no studies that have taken a tripartite approach in describing perspectives of these three key stakeholders on the role of family in promoting adherence to FOBT. The aim of this study was to address the gap in understanding the perspectives of primary care physicians, individuals at average-risk for colorectal cancer, and family on family role in promoting adherence to FOBT screening. METHOD: We employed a qualitative design and conducted semi-structured interviews with 15 physicians, 27 patients at average-risk for colorectal cancer, and 19 family members or friends from urban and rural Manitoba, Canada between October 2008 and March 2010. Interviews were audio-recorded, transcribed verbatim, and analysed using content analysis and constant comparative techniques. RESULTS: While physicians described a clear role for family in managing chronic disease or dealing with acute or serious illness, they identified barriers in working with family to promote FOBT screening: lack of time, privacy and confidentiality concerns, and family dynamics. Conversely, patients and family described instrumental, emotional, informational, and appraisal roles that family play in promoting FOBT outside medical encounters. CONCLUSION: Adherence to colorectal cancer screening is based on supportive 'patient-physician' dialogue that is separate from assistive 'patient-family member' relations. Further research is required to explore social support mechanisms involving family members outside medical encounters that hold promise in boosting self-efficacy, overcoming barriers, and gaining positive reinforcement for individuals at average-risk when making the decision to engage in FOBT.

A comparison of patient and family caregiver prospective control over lung cancer.

AIM: This paper is a report of our secondary analysis of patient and family caregiver prospective control in lung cancer. BACKGROUND: Control beliefs underlie self-care in sickness and health. Self-care often involves 'shared' activities between the afflicted individual and caregiving family and friends. However, depending on how control is perceived, conflicts can occur in decision-making thus jeopardizing optimal self-care. We need to comprehend how control beliefs compare between patients and caregivers and how their control beliefs are linked with dealing with serious illness. METHODS: Based on questionnaire data collected in our larger study between September 2005 and February 2009, we conducted exploratory comparative analyses of 304 patients' and caregivers' control beliefs in managing lung cancer. Eight 5-point response items captured prospective control. Exploratory factor analysis with promax rotation was conducted to compare dyadic perceptions on the dimensionality of prospective control. We also conducted exploratory correlations between control beliefs and smoking cessation, attributional reactions, caregiver helping and symptom reports. RESULTS: Principal component analysis identified the same factors for patients and caregivers: factor 1, Fate control and factor 2, Team control. Patient and caregiver 'Fate' and 'Team' control sub-scales were respectively associated with hope, caregiver helping and patient smoking cessation. CONCLUSION: Clinicians need to support, adapt or develop a philosophy of cancer care that is inclusive of partnerships, drawing on beliefs of patients and caregivers that controlling lung cancer is a team effort which in turn is tentatively linked to patient smoking cessation, positive emotions and caregiver helping.

A dyadic affair: who is to blame for causing and controlling the patient's lung cancer?

Couples facing lung cancer may be at an increased risk of relationship distress in relation to unresolved blame and anger. Using a comparative design, we conducted preliminary analyses of illness attributions as reported by 100 patients and their primary support persons. Patients and support persons responded to a series of 5-point Likert-type questions to capture locus of causality and controllability as well as attribution-related cognitions and emotions. Most patients and support persons had a smoking history. Both patients and support persons ascribed the locus of causality and controllability for lung cancer as the patient. Between-group analyses revealed that patients and support persons ascribed more negative attributions toward oneself and more positive attributions toward their partner. However, within-group analysis revealed that support persons tended to ascribe more responsibility, fault, and blame toward the patient. We speculated that patients may be responding to negative signals received from their support persons that perpetuated their self-blame. The care of patients, particularly those who used tobacco, might be approached from a "shared line of attack," wherein both patients and support persons are encouraged to examine and understand their attributions to "soften" the blame and anger toward oneself or their partner.

Linkages among empathic behaviors, physical symptoms, and psychological distress in patients with ovarian cancer: a pilot study.

PURPOSE/OBJECTIVES: To explore linkages among empathic responding by informal caregivers with the physical symptom experiences and psychological distress of patients with ovarian cancer. DESIGN: Preliminary, descriptive, correlational, and cross-sectional. SETTING: Psychosocial oncology support group in Canada. SAMPLE: Convenience sample of 13 women with stage I-IV ovarian cancer with the majority diagnosed with disease recurrence. METHODS: Data were collected on a single telephone call using the Hospital Anxiety and Depression Scale, the Empathic Responding Scale, the Memorial Symptom Assessment Scale, and the Dyadic Perspective-Taking Scale. Analysis included a correlation of variables. MAIN RESEARCH VARIABLES: Empathic responding, physical symptom experiences, and psychological distress. FINDINGS: Preliminary findings provided partial support for linkages among the perceived empathic behaviors of informal caregivers and the psychological distress and physical symptom experiences of patients with ovarian cancer. Patients who were more depressed reported elevated symptom experiences. Patients also reported more anxiety and depression when they perceived that their informal caregivers were engaging in less empathic behaviors toward them. CONCLUSIONS: The empathic behavior of informal caregivers toward patients appeared to be related to lower levels of anxiety and depression in patients with end-stage ovarian cancer. IMPLICATIONS FOR NURSING: Clinicians need to be aware that anxiety and depression in patients with ovarian cancer appear to be related to the patients' physical symptom experiences and the degree of empathic support the patients perceive from their informal caregivers. This has implications for clinical assessment of patients' anxiety and depression, physical symptoms, and available empathic social support.

Does blaming the patient with lung cancer affect the helping behavior of primary caregivers?

PURPOSE/OBJECTIVES: To examine whether primary caregivers' helping behaviors are predicted by their illness attribution reactions as proposed in Weiner's model. DESIGN: Latent-variable structural equation modeling. SETTING: Five oncology outpatient settings in central Canada. SAMPLE: 100 dyads consisting of patients with lung cancer and their primary caregivers. METHODS: Self-report questionnaires, abstracted medical record data, confirmatory factor analysis, and structural equation modeling. MAIN RESEARCH VARIABLES: Smoking history, judgments of responsibility for controlling the disease, anger, pride, and helping behaviors. FINDINGS: An interrelation was seen between judgments of responsibility toward patients to control aspects of the disease, affective reactions of anger and pride, and helping behavior. Anger and pride had a stronger influence on helping behavior than smoking history did. CONCLUSIONS: Judgments of responsibility for controlling lung cancer and anger toward patients put caregivers at risk for dysfunctional helping behavior, particularly if patients had a history of tobacco use. IMPLICATIONS FOR NURSING: Primary caregivers' affective states directly affect their helping behavior toward patients with lung cancer. Clinicians should be aware that caregivers who perceive the patient to be largely responsible for managing the disease also may be angry toward that patient. Angry caregivers are at risk of providing suboptimal helping behavior.

Family caregivers' assessment of symptoms in patients with advanced cancer: concordance with patients and factors affecting accuracy.

The purposes of the study were to examine the concordance between patients' and family caregivers' assessments of patients' symptoms, and to identify demographic and psychosocial factors that affect levels of agreement. Sixty-six patients with advanced cancer receiving palliative care, and their primary, informal caregivers assessed patients' symptoms using the Memorial Symptom Assessment Scale (MSAS). Levels of agreement for individual symptoms ranged from poor to excellent (interclass correlation coefficient 0.07-0.75). Analysis of the group means using paired t-tests revealed significant differences for the MSAS subscales (psychological, physical, and general distress index), and for four of the 12 physical symptoms and five of the six psychological symptoms. The magnitude of the observed differences indicated a small to moderate bias for caregivers to overestimate, which was more marked for psychological than for physical symptoms. A number of factors associated with the caregiver (particularly the emotional state, the burden of providing care, and male gender) and the patient (the perception of being a burden to others) were significantly correlated with levels of disparity on some measures. The findings are consistent with the growing body of literature on the validity of proxy respondents' assessments of patients' symptoms.