Adherence to treatment in patients with chronic diseases : From alertness to persistence

Background: Adherence to treatment is a process that begins with alertness about the disease and has to end with staying in treatment. It is a concern to all health care disciplines. The aim of this study was to explore the experience of adherence to treatment patients with chronic diseases. Methods: This qualitative study was conducted during a period of 6 months in Golestan province in Iran in 2017. In-depth semi-structured interviews were done with a purposive sample of 15 patients with chronic disease (i.e. Chronic renal failure (CRF), Hypertension (HTN), Multiple sclerosis (MS) and Diabetes). Data were analyzed using qualitative content analysis in MAXQDA Software. Results: The analysis of the data in this study led to the development of ten subthemes and four themes emerged as follows: motivation, cohesion, commitment and empowerment which are necessary components for adherence to treatment in patients. “Moving from alertness to persistence” emerged as the main theme. Conclusion: The findings of the study offer helpful insights into the concept of adherence to treatment and its components for health care providers, which can be used to develop the best possible care plan and may help health care providers to support the patients to have an active role for following treatment rather than just doing it.

Case study of persons with cancer participating in a community-based exercise program : An exploration of meaning and change

Increasingly, research supports the importance of incorporating exercise into the cancer care paradigm. While quantitative studies have substantiated the significant effects of exercise on physical functioning, the individual’s perspective of participating in an exercise program has rarely been considered. The purpose of this study was to explain the impact of a community based exercise program on the lives of persons with cancer and their caregivers. Based on Bandura’s Social Cognitive Theory, a single explanatory case study with multiple embedded units of analyses was conducted. Interviews were conducted with 10 individuals representing participants with cancer, their caregivers, and health care providers. Data were analyzed using Yin’s case study method. Four themes emerged (Sense of Community, Building Relationships, Bridging the Gap, and Living Life Abundantly), which identified the unique characteristics of this community based exercise program. Incorporation of these characteristics into program planning may benefit other communities that aspire to offer a similar program to improve patient outcomes and enhance quality of life. © 2016: Barbara K. Haas, Melinda Hermanns, Christina Melin-Johansson, and Nova Southeastern University

A third of dying patients do not have end-of-life discussions with a physician : A nationwide registry study.

OBJECTIVE: The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors. METHOD: A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regarding their last days of life, and were voluntary. Descriptive statistics illustrated the proportion of patients/next-of-kin who had EOL discussions and logistic regressions were used to examine associated factors. RESULTS: About half of the patients (46%) did have an EOL discussion, but a third (32%) did not. Associated factors of those who did not have an EOL discussion were dementia (48.5%) or stroke (47.5%), older age (38.4%), being female (33.6%), being cared for in a nursing home (41.3%), or hospital (40.3%), having lost decision-making ability months before death (58.9%), and not having a documented decision to shift to EOL care (82.7%). Younger patients diagnosed with cancer and cared for at a palliative unit were more likely to have EOL discussions. The regression analysis showed similar results for next-of-kin. SIGNIFICANCE OF RESULTS: The result shows that not all patients with palliative care needs have equal access to EOL discussions, despite efforts at a national level and the recognized benefits of timely communication about the EOL care. Further efforts must be made to achieve EOL discussions for all patients

Oral-parenteral conversion factor for morphine in palliative cancer care : a prospective randomized crossover pilot study

Objective. This pilot study clinically tests whether a conversion factor of 2 to 1 is appropriate when changing from oral to parenteral morphine administration in the treatment of cancer-related nociceptive pain and calculates the size of an adequately powered future study. Methods. Eleven outpatients with incurable cancer and well-controlled nociceptive pain were randomly assigned to either intravenous or subcutaneous morphine using half the previous oral 24-hour dose. Each group crossed over after the first three-day period. Serum concentrations of morphine and its metabolites were monitored as well as intensity of pain. Results. Oral to subcutaneous and oral to intravenous quotas of morphine concentrations were approximately 0.9. Subcutaneous to intravenous morphine quotas were 1. Conclusions. The conversion factor of 2 to 1 seems to be a reasonable average but with an obvious need for individual adjustments. Concurrent medications and substantially higher doses of morphine could potentially affect the appropriate conversion factor. An adequately powered study to validate these findings would need at least 121 patients

Supportive interventions and their impact on pediatric health care professionals’ emotional well-being: A systematic literature review

The aim of this systematic literature review was to describe interventions supporting pediatric health care professionals to manage emotional strain when caring for children at the end-of-life. The review included five quantitative studies. Two categories were identified within the results: 1) Supportive interventions with the subcategories of educational interventions, peer support for grief, intensive training course, peer supported storytelling, and debriefing sessions; and 2) Effects of interventions, with the subcategories of increased understanding, increased confidence, creating meaning, grief management, and sense of well-being. Interventions that combine education and dialogue seem supportive, but debriefing might have the most impact on health care professionals’ emotional well-being. Future research should focus on deepening the understanding of the meaning of education and dialogue for health care professionals, further investigate the effects of debriefing, and focus on educational training around existential issues