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1.
Med J Aust ; 215(3): 125-129, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34109641

RESUMO

OBJECTIVES: To investigate the perspectives of doctors involved with voluntary assisted dying in Victoria regarding the Voluntary Assisted Dying Act 2017 (Vic) and its operation. DESIGN, SETTING, PARTICIPANTS: Qualitative study; semi-structured interviews with 32 doctors who had participated in the voluntary assisted dying system during its first year of operation (commenced 19 June 2019). Doctors were interviewed during April-July 2020. RESULTS: Three major themes related to problems during the first year of operation of the Act were identified: the statutory prohibition of health professionals initiating discussions with their patients about voluntary assisted dying; the Department of Health and Human Services guidance requirement that all doctor-patient, doctor-pharmacist, and pharmacist-patient interactions be face-to-face; and aspects of implementation, including problems with the voluntary assisted dying online portal, obtaining documentary evidence to establish eligibility, and inadequate resourcing of the Statewide Pharmacy Service. CONCLUSIONS: Doctors reported only limited concerns about the Victorian voluntary assisted dying legislation, but have had some problems with its operation, including implications for the accessibility of voluntary assisted dying to eligible patients. While legislative change may resolve some of these concerns, most can be ameliorated by improving the processes and systems.


Assuntos
Definição da Elegibilidade/legislação & jurisprudência , Pessoal de Saúde/ética , Relações Médico-Paciente/ética , Médicos/psicologia , Suicídio Assistido/legislação & jurisprudência , Adulto , Idoso , Atitude do Pessoal de Saúde , Definição da Elegibilidade/ética , Feminino , Recursos em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/economia , Farmacêuticos/ética , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Vitória/epidemiologia
2.
J Cancer Surviv ; 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33763806

RESUMO

PURPOSE: To identify published literature regarding cancer survivorship education programs for primary care providers (PCPs) and assess their outcomes. METHODS: PubMed, Embase, and CINAHL databases were searched between January 2005 and September 2020. The Quality of Cancer Survivorship Care Framework and Kirkpatrick's 4-level evaluation model were used to summarize program content and outcomes, respectively. Data extraction and critical appraisal were conducted by two authors. RESULTS: Twenty-one studies were included, describing self-directed online courses (n=4), presentations (n=2), workshops and training sessions (n=6), placement programs (n=3), a live webinar, a fellowship program, a referral program, a survivorship conference, a dual in-person workshop and webinar, and an in-person seminar and online webinar series. Eight studies described the use of a learner framework or theory to guide program development. All 21 programs were generally beneficial to PCP learners (e.g., increased confidence, knowledge, behavior change); however, methodological bias suggests caution in accepting claims. Three studies reported positive outcomes at the patient level (i.e., satisfaction with care) and organizational level (i.e., increased screening referrals, changes to institution practice standards). CONCLUSIONS: A range of cancer survivorship PCP education programs exist. Evidence for clinical effectiveness was rarely reported. Future educational programs should be tailored to PCPs, utilize an evidence-based survivorship framework, and evaluate patient- and system-level outcomes. IMPLICATIONS FOR CANCER SURVIVORS: PCPs have an important role in addressing the diverse health care needs of cancer survivors. Improving the content, approach, and evaluation of PCP-focused cancer survivorship education programs could have a positive impact on health outcomes among cancer survivors.

3.
Support Care Cancer ; 28(1): 229-238, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31020437

RESUMO

PURPOSE: A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice. METHODS: Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach. RESULTS: A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others. CONCLUSIONS: A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective.


Assuntos
Emoções , Neoplasias/diagnóstico , Neoplasias/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Austrália/epidemiologia , Comunicação , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto/métodos , Masculino , Oncologia , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Relações Médico-Paciente , Pesquisa Qualitativa , Sobrevivência
6.
BMJ Support Palliat Care ; 8(4): 411-420, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29353252

RESUMO

BACKGROUND: End of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice's role and performance of at the end of life is understood in order to maximise the skills of the entire workforce. OBJECTIVE: To provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control. METHOD: Systematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS: From 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea. CONCLUSIONS: It is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.


Assuntos
Medicina Geral/métodos , Assistência Terminal/métodos , Clínicos Gerais/educação , Clínicos Gerais/psicologia , Humanos , Papel do Médico , Avaliação de Sintomas
7.
Health (London) ; 19(3): 263-79, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25121725

RESUMO

Specialist palliative care is a prominent and expanding site of health service delivery, providing highly specialised care to people at the end of life. Its focus on the delivery of specialised life-enhancing care stands in contrast to biomedicine's general tendency towards life-prolonging intervention. This philosophical departure from curative or life-prolonging care means that transitioning patients can be problematic, with recent work suggesting a wide range of potential emotional, communication and relational difficulties for patients, families and health professionals. Yet, we know little about terminally ill patients' lived experiences of this complex transition. Here, through interviews with 40 inpatients in the last few weeks of life, we explore their embodied and relational experiences of the transition to inpatient care, including their accounts of an ethic of resilience in pre-palliative care and an ethic of acceptance as they move towards specialist palliative care. Exploring the relationship between resilience and acceptance reveals the opportunities, as well as the limitations, embedded in the normative constructs that inflect individual experience of this transition. This highlights a contradictory dynamic whereby participants' experiences were characterised by talk of initiating change, while also acquiescing to the terminal progression of their illness.


Assuntos
Comportamento , Cuidados Paliativos/psicologia , Resiliência Psicológica , Assistência Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Comunicação , Medo , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Pesquisa Qualitativa , Serviço Social , Fatores Socioeconômicos
8.
J Pain Symptom Manage ; 44(1): 10-22, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22672916

RESUMO

CONTEXT: Symptom clusters, important for symptom management strategies, have been determined empirically by various analytical methods. Guidance to select methods from the options available in standard statistical packages is limited. OBJECTIVES: To compare alternative common factor analysis (FA) extraction methods appropriate to the data, to assess whether or not they determine similar symptom clusters, and to propose analytical approaches that are useful in this clinical context. METHODS: Within one month of commencing chemotherapy, outpatients from oncology and hematology clinics (n = 202) reported their symptom experience on a modified Rotterdam Symptom Checklist. Symptom distress levels in the past week were rated on a scale of one (not at all) to four (very much). In a secondary data analysis of 42 symptoms, the associations between symptoms and factors were determined using alternative common FA methods: principal axis factoring, unweighted least squares, image factor analysis, and alpha factor analysis (AFA). Symptom inclusion in a cluster was based on the interpretation of pattern and structure coefficients, and importantly, clinical relevance of the grouping. RESULTS: Five symptom clusters were commonly identified across methods: musculoskeletal discomforts/lethargy, oral discomforts, upper gastrointestinal discomforts, vasomotor symptoms, and gastrointestinal toxicities. In AFA, three additional clusters were lethargy, somatic symptoms, and treatment-related symptom clusters. CONCLUSION: The most parsimonious solution resulted from principal axis factoring, but for large numbers of symptoms, AFA may be superior by identifying symptom clusters more useful for symptom management. Interpreting complex symptom relationships may lead to the investigation of pathophysiological mechanisms and intervention opportunities. Future studies should include psychological and cognitive symptoms.


Assuntos
Análise Fatorial , Gastroenteropatias/complicações , Letargia/complicações , Dor Musculoesquelética/complicações , Neoplasias/complicações , Gastroenteropatias/fisiopatologia , Humanos , Letargia/fisiopatologia , Dor Musculoesquelética/fisiopatologia , Neoplasias/fisiopatologia , Qualidade de Vida , Índice de Gravidade de Doença , Síndrome
9.
Support Care Cancer ; 20(1): 95-105, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21293884

RESUMO

GOALS OF WORK: The aim of this secondary data analysis was to investigate symptom clusters over time for symptom management of a patient group after commencing adjuvant chemotherapy. MATERIALS AND METHODS: A prospective longitudinal study of 219 cancer outpatients conducted within 1 month of commencing chemotherapy (T1), 6 months (T2), and 12 months (T3) later. Patients' distress levels were assessed for 42 physical symptoms on a clinician-modified Rotterdam Symptom Checklist. Symptom clusters were identified in exploratory factor analyses at each time. Symptom inclusion in clusters was determined from structure coefficients. Symptoms could be associated with multiple clusters. Stability over time was determined from symptom cluster composition and the proportion of symptoms in the initial symptom clusters replicated at later times. MAIN RESULTS: Fatigue and daytime sleepiness were the most prevalent distressing symptoms over time. The median number of concurrent distressing symptoms approximated 7, over time. Five consistent clusters were identified at T1, T2, and T3. An additional two clusters were identified at 12 months, possibly due to less variation in distress levels. Weakness and fatigue were each associated with two, four, and five symptom clusters at T1, T2, and T3, respectively, potentially suggesting different causal mechanisms. CONCLUSION: Stability is a necessary attribute of symptom clusters, but definitional clarification is required. We propose that a core set of concurrent symptoms identifies each symptom cluster, signifying a common cause. Additional related symptoms may be included over time. Further longitudinal investigation is required to identify symptom clusters and the underlying causes.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias/fisiopatologia , Pacientes Ambulatoriais , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante/métodos , Análise por Conglomerados , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/etiologia , Análise Fatorial , Fadiga/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
10.
Med J Aust ; 190(S7): S99-104, 2009 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-19351303

RESUMO

OBJECTIVES: To assess the prevalence, severity and distress from physical symptoms and the prevalence of anxiety and depression in patients about to undergo chemotherapy for potentially curable cancers; and to explore the presence of symptom clusters and investigate their relationships with anxiety and depression. DESIGN, PARTICIPANTS AND SETTING: Cross-sectional survey of 192 patients with breast or gastrointestinal cancers or lymphoma before first ever chemotherapy treatment with curative intent. MAIN OUTCOME MEASURES: Hospital Anxiety and Depression Scale to assess anxiety and depression and the Chemotherapy Symptom Assessment Scale to measure physical symptom prevalence, severity and distress ("bother"). RESULTS: Prevalence of anxiety was 45% and depression 25%. The most prevalent physical symptoms were pain (48%), feeling unusually tired (45%) and difficulty sleeping (45%). Physical symptoms rated as most severe were pain (28%), difficulty sleeping (26%) and feeling unusually tired (19%). Physical symptoms causing the most distress were pain (39%), constipation (18%) and nausea (16%). Factor analysis of symptom distress scores indicated that five factors explained 36.7% of the variance and included: gastrointestinal (nausea, vomiting, pain), general malaise (tiredness, feeling weak, headaches), emotional (feeling depressed, feeling anxious), nutritional (changes to appetite, weight loss or gain) and general physical (mouth/throat problems, shortness of breath). Regression analysis indicated that symptom distress for the malaise (beta = 1.46; P < 0.001), nutritional (beta = 0.70; P < 0.05) and gastrointestinal (beta = 0.73; P < 0.05) factors were independent predictors of depression. CONCLUSIONS: Before commencing chemotherapy, patients are already experiencing distressing symptoms and have high scores for anxiety and depression, partially explained by physical symptom distress. Patients should be routinely screened for both emotional and physical needs and appropriate interventions should be developed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN012606000178549.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Neoplasias/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Estudos de Coortes , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Dor/complicações , Prevalência , Transtornos do Sono-Vigília/complicações , Vitória/epidemiologia , Adulto Jovem
11.
Res Nurs Health ; 32(3): 345-60, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19274688

RESUMO

Multivariate methods are required to assess the interrelationships among multiple, concurrent symptoms. We examined the conceptual and contextual appropriateness of commonly used multivariate methods for cancer symptom cluster identification. From 178 publications identified in an online database search of Medline, CINAHL, and PsycINFO, limited to articles published in English, 10 years prior to March 2007, 13 cross-sectional studies met the inclusion criteria. Conceptually, common factor analysis (FA) and hierarchical cluster analysis (HCA) are appropriate for symptom cluster identification, not principal component analysis. As a basis for new directions in symptom management, FA methods are more appropriate than HCA. Principal axis factoring or maximum likelihood factoring, the scree plot, oblique rotation, and clinical interpretation are recommended approaches to symptom cluster identification.


Assuntos
Análise por Conglomerados , Estudos Transversais , Interpretação Estatística de Dados , Análise Multivariada , Neoplasias/complicações , Pesquisa em Enfermagem/métodos , Técnicas de Apoio para a Decisão , Análise Fatorial , Guias como Assunto , Humanos , Funções Verossimilhança , Neoplasias/enfermagem , Avaliação em Enfermagem , Análise de Componente Principal , Análise de Regressão , Reprodutibilidade dos Testes , Projetos de Pesquisa
12.
J Adv Nurs ; 60(4): 447-52, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17822427

RESUMO

AIM: The paper is a report of a study to demonstrate how the use of schematics can provide procedural clarity and promote rigour in the conduct of case study research. BACKGROUND: Case study research is a methodologically flexible approach to research design that focuses on a particular case - whether an individual, a collective or a phenomenon of interest. It is known as the 'study of the particular' for its thorough investigation of particular, real-life situations and is gaining increased attention in nursing and social research. However, the methodological flexibility it offers can leave the novice researcher uncertain of suitable procedural steps required to ensure methodological rigour. METHOD: This article provides a real example of a case study research design that utilizes schematic representation drawn from a doctoral study of the integration of health promotion principles and practices into a palliative care organization. DISCUSSION: The issues discussed are: (1) the definition and application of case study research design; (2) the application of schematics in research; (3) the procedural steps and their contribution to the maintenance of rigour; and (4) the benefits and risks of schematics in case study research. CONCLUSION: The inclusion of visual representations of design with accompanying explanatory text is recommended in reporting case study research methods.


Assuntos
Algoritmos , Pesquisa Metodológica em Enfermagem/métodos , Coleta de Dados/métodos , Feminino , Humanos , Masculino , Pesquisa em Educação de Enfermagem/métodos , Pesquisa Metodológica em Enfermagem/normas , Cuidados Paliativos/métodos , Projetos de Pesquisa/normas
13.
Int J Palliat Nurs ; 12(2): 60-9, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16603994

RESUMO

The aim of this project was to develop clinical practice guidelines for the use and administration of pharmacological agents for symptom control via syringe drivers within Australia. By developing evidence-based clinical practice guidelines for the use of this common device, this project aimed to improve patient outcomes, reduce practice variation, minimize errors and encourage more efficient use of resources. A literature review identified current literature regarding syringe driver management and an expert panel was assembled to assist in the development of the guidelines. The development of these practice guidelines provides an example of how palliative care practitioners can use a framework of contemporary evidence to enhance clinical practice.


Assuntos
Tratamento Farmacológico/normas , Bombas de Infusão/normas , Infusões Intravenosas/normas , Guias de Prática Clínica como Assunto/normas , Pesquisa em Enfermagem Clínica , Monitoramento de Medicamentos/enfermagem , Monitoramento de Medicamentos/normas , Tratamento Farmacológico/instrumentação , Tratamento Farmacológico/enfermagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Eficiência Organizacional , Falha de Equipamento , Segurança de Equipamentos , Medicina Baseada em Evidências , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/enfermagem , Erros de Medicação/prevenção & controle , Avaliação em Enfermagem/normas , Cuidados Paliativos , Educação de Pacientes como Assunto/normas , Gestão da Qualidade Total/organização & administração
14.
Int J Palliat Nurs ; 12(1): 20-6, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16493301

RESUMO

AIM: To identify the supportive needs of individuals with multiple sclerosis (MS) and their families. DESIGN, SAMPLE AND METHOD: In-depth interviews were carried out with people living with MS in the community, their family members and health professionals. The data were transcribed verbatim and recurring themes identified. FINDINGS: The analysis of interviews revealed four themes: disbelief and devastation; losses and forced life choices; tracking down services and information; and sadness and relief. CONCLUSION: Given the duration, range of symptoms and distress often associated with MS, the findings of this research raise the important question of the role of palliative services in supporting the person with MS and his/her family.


Assuntos
Atitude Frente a Saúde , Família/psicologia , Esclerose Múltipla/psicologia , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Cuidados Paliativos/psicologia , Apoio Social , Atividades Cotidianas , Adaptação Psicológica , Ansiedade/psicologia , Comportamento de Escolha , Efeitos Psicossociais da Doença , Depressão/psicologia , Pesar , Humanos , Assistência de Longa Duração , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/prevenção & controle , Pesquisa Metodológica em Enfermagem , Cuidados Paliativos/organização & administração , Pesquisa Qualitativa , Qualidade de Vida , Queensland , Estresse Psicológico/psicologia , Inquéritos e Questionários , Revelação da Verdade , Desemprego/psicologia , Vitória , Austrália Ocidental
15.
Med J Aust ; 179(S6): S26-8, 2003 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-12964932

RESUMO

The growing demand for palliative care means that health professionals are expected to provide palliative care as a core part of their practice. Training in the practice of palliative care is a recent addition to undergraduate and postgraduate medical and other healthcare curricula, and several initiatives are under way to promote palliative care principles and practice in healthcare training. The challenge that we all face is how to develop these skills in the face of multiple demands on our time. Strategies for improving palliative care education include a national undergraduate curriculum for palliative care, expanded training opportunities for generalist practitioners, and further recognition for the role of practitioners of specialist palliative care and associated curriculum development.


Assuntos
Pessoal de Saúde/educação , Cuidados Paliativos , Austrália , Currículo , Educação Continuada , Humanos , Medicina , Especialização
16.
J Pain Symptom Manage ; 23(5): 393-405, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12007757

RESUMO

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be "distressing, horrible or excruciating," with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients' responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and further research using concepts drawn from broader social and behavioral models.


Assuntos
Atitude Frente a Saúde , Inquéritos Epidemiológicos , Pacientes Internados , Neoplasias/complicações , Manejo da Dor , Dor/etiologia , Adulto , Idoso , Austrália , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Dor/psicologia
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