Advance Care Planning in Serious Illness: A Narrative Review.

CONTEXT: Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility. OBJECTIVE: To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness. METHODS: We conducted a narrative review merging the best available ACP empirical data, grey literature, and emergent scholarly discourse using a snowball search of PubMed, Medline, and Google Scholar (2000-2022). Findings were informed by our team's interprofessional clinical and research expertise in serious illness care. RESULTS: Early ACP practices were largely tied to mandated document completion, potentially failing to capture the holistic preferences of patients and surrogates. ACP models focused on serious illness communication rather than documentation show promising patient and clinician results. Ideally, ACP would lead to goal-concordant care even amid the unpredictability of serious illness trajectories. But ACP might also provide a false sense of security that patients' wishes will be honored and revisited at end-of-life. An iterative, 'building block' framework to integrate ACP throughout serious illness is provided alongside clinical practice, research, and policy recommendations. CONCLUSIONS: We advocate a balanced approach to ACP, recognizing empirical deficits while acknowledging potential benefits and ethical imperatives (e.g., fostering clinician-patient trust and shared decision-making). We support prioritizing patient/surrogate-centered outcomes with more robust measures to account for interpersonal clinician-patient variables that likely inform ACP efficacy and may better evaluate information gleaned during serious illness encounters.

Developing a model for embedded palliative care in a cancer clinic.

OBJECTIVES: Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic. METHODS: Retrospective chart review of patients following an initial phase and then a prospective review following the implementation of a model for embedded PC. RESULTS: In the initial phase, 18 patients were seen for a total of 53 visits; 78% were seen more than once, with a mean of three visits per patient. In the model phase, 46 patients were seen for a total of 163 visits; 74% were seen more than once, with a mean of 3.5 visits. Demographics were similar between the two groups. Content of the first PC visit in the initial and model phases was symptom management (61% and 57%), psychosocial support/relationship building (28% and 35%) and advance care planning/decision-making support (11% and 8%), respectively. CONCLUSIONS: The initial phase demonstrated acceptability and feasibility of a model for embedded PC for patients and the oncology team. Establishment of specific eligibility criteria and screening to identify eligible patients in the model phase led to an increased uptake of PC for patients with advanced kidney cancer and melanoma in a cancer clinic.

Healing and Transcendence: A Roy Adaptation Model-Guided Comparison.

Healing and transcendence are concepts of considerable interest to nurses who engage in holistic nursing practice. The two concepts are often used within the context of adaptation to describe the processes experienced by individuals who experience suffering and distress from various life events. Despite their intuitive significance to the human experience, the similarities and differences between the two concepts remains unclear. The purpose of this paper is to present the results of a Roy adaptation model-guided comparison of the two concepts that addresses their shared and distinct characteristics.

Spiritual Healing in the Aftermath of Childhood Maltreatment: Translating Men's Lived Experiences Utilizing Nursing Conceptual Models and Theory.

This article presents an explication of spiritual healing situated within 3 nursing conceptual models (Neuman's systems model, Rogers' science of unitary human beings, and Roy's adaptation model) and 1 middle-range theory (Watson's theory of human caring), all of which include a focus on spirituality. These models and the theory are the vehicle for translation of themes of spiritual healing extracted from data provided by 30 adult male survivors of childhood maltreatment into nursing practice. This discipline-specific translational scholarship advances the profession of nursing.

Dwelling in suffering: barriers to men's healing from childhood maltreatment.

Based on findings from a hermeneutic phenomenological study, this article provides a description and interpretation of barriers to healing that men encountered in the aftermath of childhood maltreatment. An analysis of interview data collected from 52 adult male survivors healing from childhood maltreatment identified a theme, Dwelling in Suffering, as representing the full range of barriers that impeded their healing. Subthemes of Dwelling in Suffering Personally, Relationally, and Social-Environmentally are discussed. This research highlights a complex understanding of the challenges men experience in healing from childhood maltreatment and the need for practice interventions and future research to ameliorate men's suffering.

How women with advanced cancer pray: a report from two focus groups.

PURPOSE/OBJECTIVES: To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping. RESEARCH APPROACH: Qualitative, descriptive design using focus groups. SETTING: Three cancer centers that are part of a university-affiliated comprehensive cancer network in the northeastern United States. PARTICIPANTS: 13 adult, female outpatients receiving active treatment for ovarian or lung cancer. METHODOLOGIC APPROACH: Two semistructured, focus group interviews were conducted. Audiotapes were transcribed verbatim. Data were coded and analyzed using standard content analysis procedures. MAIN RESEARCH VARIABLES: Prayer and coping. FINDINGS: Four themes emerged: finding one's own way, renewed appreciation for life, provision of strength and courage, and gaining a stronger spiritual connection. In addition, praying for others, conversational prayer, petitionary prayer, ritual prayer, and thanksgiving prayer were used most often by participants to cope. CONCLUSIONS: The findings support prayer as a positive coping mechanism for women with advanced ovarian or lung cancer. INTERPRETATION: The study provides knowledge about prayer as a source of spiritual and psychological support. Oncology nurses should consider the use of prayer for patients coping with advanced cancer.

Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer.

BACKGROUND: Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation. OBJECTIVES: To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer. METHODS: One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study. RESULTS: Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (beta -0.28 [p = 0.0003]) and medical system (beta -0.38 [p < 0.0001]), had higher degrees of self-efficacy (beta -0.22 [p = 0.005]), and had stronger family relationships and support (beta -0.27 [p = 0.0004]). CONCLUSIONS: The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.

Activities of daily living in women with advanced breast cancer.

PURPOSE/OBJECTIVES: To detail the daily activities of women with advanced breast cancer. DESIGN: Descriptive, qualitative. SETTING: Six clinical sites in New England. Of the six sites, three were urban, one was suburban, and two were rural, with three sites being comprehensive cancer centers. SAMPLE: 84 women with a confirmed diagnosis of stage IV breast cancer with a life expectancy of four months or more. METHODS: A secondary analysis of an expressive writing intervention study control group. As part of the control writing group, participants kept handwritten activity logs for four consecutive days. Standard content analysis procedures were used to analyze the transcribed activity logs. MAIN RESEARCH VARIABLES: Activities of daily living in women with advanced breast cancer. FINDINGS: 22 codes were identified that depicted the daily activities of participants. Subsequent analysis merged the 22 codes into six themes. CONCLUSIONS: Findings demonstrated that patients with advanced breast cancer are living very full, active lives despite numerous symptoms and cancer treatments. IMPLICATIONS FOR NURSING: The study serves as a foundation for the development of interventions to enhance daily functioning. Oncology nurses should counsel women with advanced cancer regarding pacing and self-care activities.