Clinical thinking, knowledge and the referral practices of consultant physicians to specialist palliative care services : an interpretative phenomenological analysis

Aim and research questions: The aim of the study described in this thesis was to explore the personal and professional experience of consultant cardiologists, oncologists and old age psychiatrists and the consequent impact on referral practices to specialist palliative care services. The research questions attempted to develop an understanding of the relationship between their perceptions of and attitudes to palliative care and consequent decision making. Methods: The chosen methodological approach was interpretative phenomenological analysis (IPA) which supported exploration of the consultants experience together with facilitating their understanding of their idiographic experience. Ten minimally structured individual interviews were conducted with four cardiologists, four oncologists and four old age psychiatrists. Consistent with the philosophical approach of IPA their individual experiences were analysed - descriptively, conceptually and linguistically. The experiences of each consultant group were then combined to elicit their shared experience before being compared across group. The work was interpreted by detailed discussion which considered the structural context, the influence of the macro, meso and micro levels of health care and the political, historical and clinical aspects of palliative care on their experience. Deepr exploration was undertaken by considering the phenomenological concept of the life-world, 'habitus' and the philosophical and theoretical contexts of knowing and clinical thinking. The use of language and specifically metaphor supported increased understanding. Findings: The consultants' experiences (both personal and professional) reflected the primacy of their clinical expertise and their uncertainty as to whether a palliative care referral was always in the best interests of the patient group. The requirement for prognostication, identifying the transitions from active to palliative care was especially problematic for heart failure and dementia patients due to the uncertain disease trajectory. Many of the consultants identified the personal cost and clinical dilemmas of determining the end of life. Their stories, in particular identified the difficulties in establishing and communicating an end of life prognosis reflecting their unique personal and professional responsibility as medical consultants which contradicts the perceived contemporary dominance of multi professional working.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Long term nurse – parent relationships in paediatric palliative care: A narrative literature review

Background: Paediatric palliative care (PPC) is an active, total approach to the holistic care of the child and family. Close, long-lasting relationships between healthcare professionals and parents in paediatric palliative care enhance quality, provide emotional support and can influence how parents manage their role in the face of uncertainty. Aim: To present a narrative literature review of long-term relationships between children's nurses and parents in PPC settings. Methods: Six databases (CINAHL, PsycINFO, ASSIA, Scopus, Medline and BNI) were searched, identifying 35 articles. A grey literature search produced seven additional relevant items. Findings: Four themes were identified: bonds; attachments and trust; sharing the journey; going the extra mile; and boundaries and integrity. All themes revealed an element of tension between closeness and professionalism. Conclusion: Gaining a greater understanding of how closeness and professionalism are successfully managed by children's palliative care nurses could positively influence pre- and post-registration nurse education

Learning from the experiences of cancer patients and their carers

UK cancer policy aims to improve the quality of cancer services and enhance the experience of people affected by cancer. A recognised barrier to improving services is healthcare professionals’ lack of insight into patients’ and carers’ experiences; this article reports on the process of integrating these into a cancer education programme for nursing students. The cancer academic team identified patients and carers to help co-produce the programme. Students had an opportunity to listen to patients’ and carers’ stories and to learn from – rather than about – patients. Small-group work enabled patients, carers and students to explore the cancer experience in a safe and supportive setting. Working collaboratively with people affected by cancer ensured that the focus was on their experience, placing it at the core of the cancer education programme

“I Was Like an Autumn Leaf That Looks Pretty From the Outside, but Would Break Once You Touched It”: A Case Study of the Lived Experience of Breast Cancer Survival

In this hermeneutic phenomenological case study, we explored the lived experiences of one Saudi Arabian woman, Sahara, living with breast cancer and after, identifying her culture’s impact on the “meaning-making” process. We derived the data from a semi-structured interview and analyzed using interpretive phenomenological analysis (IPA). The themes were: (1) “discourse”: being a breast cancer patient; (2) “sociality”: the complex sense of living with visibility and invisibility; and (3) “selfhood”: regaining the sense of being normal. The study benefits healthcare providers, who need to understand women’s life-world, the impact of culture when designing a program of survival care, and the response to their needs

Clinical thinking, knowledge and the referral practices of consultant physicians to specialist palliative care services - an interpretative phenomenological analysis.

Aim and research questions: The aim of the study described in this thesis was to explore the personal and professional experience of consultant cardiologists, oncologists and old age psychiatrists and the consequent impact on referral practices to specialist palliative care services. The research questions attempted to develop an understanding of the relationship between their perceptions of and attitudes to palliative care and consequent decision making. Methods: The chosen methodological approach was interpretative phenomenological analysis (IPA) which supported exploration of the consultants experience together with facilitating their understanding of their idiographic experience. Ten minimally structured individual interviews were conducted with four cardiologists, four oncologists and four old age psychiatrists. Consistent with the philosophical approach of IPA their individual experiences were analysed - descriptively, conceptually and linguistically. The experiences of each consultant group were then combined to elicit their shared experience before being compared across group. The work was interpreted by detailed discussion which considered the structural context, the influence of the macro, meso and micro levels of health care and the political, historical and clinical aspects of palliative care on their experience. Deepr exploration was undertaken by considering the phenomenological concept of the life-world, 'habitus' and the philosophical and theoretical contexts of knowing and clinical thinking. The use of language and specifically metaphor supported increased understanding. Findings: The consultants' experiences (both personal and professional) reflected the primacy of their clinical expertise and their uncertainty as to whether a palliative care referral was always in the best interests of the patient group. The requirement for prognostication, identifying the transitions from active to palliative care was especially problematic for heart failure and dementia patients due to the uncertain disease trajectory. Many of the consultants identified the personal cost and clinical dilemmas of determining the end of life. Their stories, in particular identified the difficulties in establishing and communicating an end of life prognosis reflecting their unique personal and professional responsibility as medical consultants which contradicts the perceived contemporary dominance of multi professional working

What is important for student nurses to know about cancer treatment and care: a qualitative study of student nurses’ and stakeholder perspectives

Aims and Objectives To explore the views of student nurses’ and stakeholders of what is important for student nurses to know about cancer treatment and care. Background Worldwide, the number of people living with cancer is increasing because the population is aging and effective cancer treatments are prolonging survival. All nurses need knowledge, skills, confidence and competence to support people living with cancer. Education is an important tool in preparing a nursing workforce that can support people affected by cancer. Design A descriptive, explorative qualitative design. Methods Semi-structured interviews with 12 student nurses and 7 stakeholders were conducted in 2014 (a sub-group of participants in a mixed-methods study investigating an innovation in undergraduate cancer education and reported elsewhere.) The interviews were audiotaped, transcribed and analysed using content analysis. Results Two key findings emerged: the benefits of learning from people affected by cancer and knowledge deficits. Students valued the opportunity to meet people affected by cancer away from a clinical environment. It gave them the opportunity to gain skills and confidence, in providing information and psycho-educational support, in a safe and facilitated context. Students and stakeholders reported blended learning (lectures and engaging with both cancer clinicians and people affected by cancer) important for developing confidence and competence in cancer care. However, at the end of their education students identified knowledge deficits in relation to; cancer screening, common cancers, treatment side effects and supporting people who have been given “bad news”. Conclusions Collaborative working with people affected by cancer and educationalists has allowed the patient and carer experience to be placed at the centre of the undergraduate cancer education. Relevance to clinical practice This research reveals the potential importance of the co-production of undergraduate nurse cancer education, if nurses are to understand and improve the experience of people living with cancer and beyond. This article is protected by copyright. All rights reserved

Nurses' decision-making about cancer patients end of life skin care in Wales: an exploratory mixed method vignette study protocol

Introduction Patients with cancer are at high risk of developing pressure ulcers at the end of life as a result of their underlying condition or cancer treatment. There are many guidelines which set out best practice with regard to end-of-life skin care. However, the complexity of palliative cancer care often means that it is challenging for nurses to make the appropriate person-centred decisions about end-of-life skin care. This study seeks to explore the perceived importance that nurses place on different factors in their end-of-life skin care for patients with cancer. The utility, face validity and content validity of a prototype decision-making tool for end-of-life skin care will also be evaluated. Methods and analysis A mixed-method design will be used to gather data from primary and secondary care nurses working in different hospitals and local authority areas across Wales. Clinical vignettes will be used to gather qualitative and quantitative data from nurses in individual interviews. Qualitative data will be subject to thematic analysis and quantitative data will be subject to descriptive statistical analysis. Qualitative and quantitative data will then be synthesised, which will enhance the rigour of this study, and pertinently inform the further development of an end-of-life skin care decision-making tool for patients with cancer. Ethics and dissemination Ethical approval to undertake the study has been granted by Cardiff University School of Healthcare Sciences Research Governance and Ethics Screening Committee. Informed consent will be obtained in writing from all the participants in this study. The results of this study will be disseminated through journal articles, as well as presentations at national and international conferences. We will also report our findings to patient and public involvement groups with an interest in improving cancer care, palliative care as well as skin care

An innovation in curriculum content and delivery of cancer education within undergraduate nurse training in the UK. What impact does this have on the knowledge, attitudes and confidence in delivering cancer care?

Purpose: This was an evaluation of an innovation in curriculum content and delivery within undergraduate nursing education in the UK. Its purpose was to investigate the effect on knowledge, attitudes and confidence in delivering cancer care. Methods: The study design was a pre-test post-test survey design with a comparison group. Participants were two cohorts of undergraduate nursing students (nintervention ¼ 84, ncomparison ¼ 91). The intervention cohort were exposed to a new 3.5 day programme of cancer education, coproduced with patients, carers and health professionals, which focused on cancer as a life changing long-term condition. The comparison cohort had been exposed to a 2 day programme produced by a lecturer. Results: Following exposure to the new model for the delivery of undergraduate nurse cancer education, the intervention cohort demonstrated good overall knowledge of the impact of cancer, more positive attitudes towards cancer treatment and more confidence in their ability to deliver cancer care. Attitudes were more positive and confidence in ability to support cancer patients at all stages of the cancer journey were greater than in the comparison group. Insights gained into the cancer patient and carer perspectives were highly valued. Conclusions: This study has found that a new model for the delivery of cancer education focusing on survivorship and delivered in partnership with patients, carers and clinicians, may improve knowledge, attitudes and confidence in the delivery of cancer care. Further work is now needed, using a more robust experimental design, to investigate the generalisability of the results to other education programs

Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: a mixed methods systematic review

Background Cancer services need to be inclusive and accessible by everybody, including people with disabilities. However, there is evidence suggesting that people with disabilities experience poorer access to cancer services, compared to people without disabilities. Objectives To investigate the barriers and facilitators of access to cancer services for people with physical disabilities and their experiences of cancer care. Methods A mixed-method systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach. We used the Mixed Methods Appraisal Tool (MMAT -Version 11) to assess the quality of the included studies. We employed thematic synthesis to bring together data from across both qualitative and quantitative studies and we assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. Results Seven quantitative studies and 10 qualitative studies (across 18 publications) were included. The findings highlighted a dearth of research on the experiences of men with disabilities. Furthermore, only one study explored experiences of cancer treatment, with all other studies focusing on cancer screening. Five synthesised findings were identified that reflected barriers and facilitators, highlighting both what makes access to services difficult and what are the strategies that could improve it. Conclusions Knowing what works for people with disabilities can enable the delivery of appropriate services. The findings of this review suggest that the mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible, and offered in a respectful manner