Patient participation in shared decision-making in palliative care - an integrative review

Background Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care. Objectives To synthesise research findings on patient participation in shared decision-making in palliative care. Research design An integrative literature review. Methods The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist. Findings Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information. Conclusion Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view.Peer reviewe

Patient participation in shared decision-making in palliative care - an integrative review

Background Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care.Objectives To synthesise research findings on patient participation in shared decision-making in palliative care.Research design An integrative literature review.Methods The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist.Findings Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information.Conclusion Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view

Suomalaisten hoitosuositusten käyttöönoton tutkimusta tarvitaan lisää

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Suomalaisten hoitosuositusten käyttöönoton tutkimusta tarvitaan lisää

English summar

Spiritual well-being correlates with quality of life of both cancer and non-cancer patients in palliative care - further validation of EORTC QLQ-SWB32 in Finnish

Publisher Copyright: © 2023. The Author(s).BACKGROUND: The European Organisation for Research and Treatment of Cancer (EORTC) has developed the Spiritual Well-being Questionnaire (EORTC QLQ-SWB32), a measure of spiritual well-being validated with people receiving palliative care for cancer, although its usefulness is not restricted to that population. We aimed to translate and validate this tool in Finnish and to study the relationship between spiritual well-being (SWB) and quality of life (QOL). METHODS: A Finnish translation was produced according to the guidelines of EORTC and included forward- and back-translations. Face, content, construct and convergence/divergence validity and reliability were studied in a prospective manner. QOL was assessed with EORTC QLQ-C30 and 15D questionnaires. Sixteen individuals participated in the pilot testing. 101 cancer patients drawn from oncology units, and 89 patients with other chronic diseases drawn from religious communities in different parts of the country participated in the validation stage. Retest was obtained from 16 individuals (8 cancer and 8 non-cancer patients). Inclusion criteria included patients with either a well-defined palliative care plan, or who would benefit from palliative care, as well as the capacity to understand and communicate in Finnish. RESULTS: The translation appeared understandable and acceptable. Factorial analysis identified four scoring scales with high Cronbach alfa values: Relationship with Self (0.73), Relationship with Others (0.84), Relationship with Something Greater (0.82), Existential (0.81), and, additionally, a scale on Relationship with God (0.85). There was a significant correlation between SWB and QOL in all participants. CONCLUSIONS: The Finnish translation of EORTC QLQ-SWB32 is a valid and reliable measure both for research and clinical practice. SWB is correlated with QOL in cancer and non-cancer patients undergoing palliative care or who are eligible for it.Peer reviewe

Insulin Resistance Predicts Cognitive Decline: An 11-Year Follow-up of a Nationally Representative Adult Population Sample

OBJECTIVEThe aim of this study was to examine whether insulin resistance, assessed by HOMA of insulin resistance (HOMA-IR), is an independent predictor of cognitive decline.RESEARCH DESIGN AND METHODSThe roles of HOMA-IR, fasting insulin and glucose, HbA(1c), and hs-CRP as predictors of cognitive performance and its change were evaluated in the Finnish nationwide, population-based Health 2000 Health Examination Survey and its 11-year follow-up, the Health 2011 study (n = 3,695, mean age at baseline 49.3 years, 55.5% women). Categorical verbal fluency, word-list learning, and word-list delayed recall were used as measures of cognitive function. Multivariate linear regression analysis was performed and adjusted for previously reported risk factors for cognitive decline.RESULTSHigher baseline HOMA-IR and fasting insulin levels were independent predictors of poorer verbal fluency performance (P = 0.0002 for both) and of a greater decline in verbal fluency during the follow-up time (P = 0.004 for both). Baseline HOMA-IR and insulin did not predict word-list learning or word-list delayed recall scores. There were no interactions between HOMA-IR and apolipoprotein E epsilon 4 (APOE epsilon 4) genotype, hs-CRP, or type 2 diabetes on the cognitive tests. Fasting glucose and hs-CRP levels at baseline were not associated with cognitive functioning.CONCLUSIONSOur results show that higher serum fasting insulin and insulin resistance predict poorer verbal fluency and a steeper decline in verbal fluency during 11 years in a representative sample of an adult population. Prevention and treatment of insulin resistance might help reduce cognitive decline later in life

Kohti palliatiivisen hoidon laaturekisteriä : Palliatiivisen hoidon ja saattohoidon laatutieto -projektin loppuraportti

Palliatiivisen hoidon ja saattohoidon laatutieto -projektissa tehtiin esiselvitys palliatiivisen hoidon laaturekisterin perustamisen edellytyksistä sosiaali- ja terveydenhuollossa. Tavoitteena oli luoda alustava ehdotus kansallisesta elämän loppuvaiheen hoidon laatutiedon keräämisestä, hyödyntämisestä ja kehittämisestä. Projektissa määriteltiin alustavasti palliatiivisen laaturekisterin potilaspopulaatio, ehdotukset laadun seurantaindikaattoreiksi, minimitietosisällöt seurantaindikaattoreille sekä olemassa olevat ja puuttuvat sekä tulevaisuudessa kerättävät tietolähteet ja tiedonkeruutavat. Lisäksi kartoitettiin muualla maailmassa olevia palliatiivisen hoidon ja saattohoidon laaturekistereitä. Projektin aikana käynnistettiin kaksi pilottitutkimushanketta nykyisten kirjauskäytäntöjen ja laatutiedon saatavuuden kartoittamiseksi sekä tuotettiin uudet palliatiivisen hoidon toimenpidekoodit helpottamaan laatutiedon rakenteista tiedonkeruuta. Lisäksi laadittiin kansallinen palliatiivisen hoidon ja saattohoidon laatusuositus ja laatukäsikirja iäkkäiden palveluihin. Projektiryhmä esittää laaturekisterin perustamisen selvitystyötä jatkettavaksi esiselvityksen pohjalta niin, että tulevaisuudessa palliatiivisen hoidon rekisteri voitaisiin lisätä kansallisesti THL:n rekisterinpidollisella vastuulla toimivaksi laaturekisteriksi

Nationell kvalitetsrekommendation för palliativ vård och vård i livets slutskede

Nationell kvalitetsrekommendation för palliativ vård och vård i livets slutskede är avsedd som grund för kvalitetsuppföljning för alla social- och hälsovårdsenheter där man vårdar personer i livets slutskede. För yrkesutbildade personer och chefer inom hälso- och sjukvården är kvalitetsrekommendationen till hjälp vid bedömning av verksamhetens kvalitet samt vid fastställande av vilken vårdnivå man bör eftersträva. Den anger vilka omständigheter i verksamheten man bör fästa särskild uppmärksamhet vid och i vilken riktning man bör utveckla verksamheten. För aktörer med organiseringsansvar ger kvalitetsrekommendationen information om vilka resurser och strukturer som krävs för högklassig vård, vilken kvalitet som bör eftersträvas och förutsättas samt stöd vid bedömning av verksamhetens kvalitet. För patienten och dennes närstående är kvalitetsrekommendationen en beskrivning av den palliativa vården och dess kvalitet, såsom den kan förväntas vara. I kvalitetsrekommendationerna har man identifierat tio delområden för verksamheten, dvs. kvalitetsområden för att anordna och producera övergripande palliativ vård av god kvalitet. Kvalitetskriterier har fastställts för varje kvalitetsområde. Dessa kriterier är viktiga kännetecken som beskriver kvaliteten på vården eller tjänsten. I kvalitetsrekommendationen har man fastställt förslag på kvalitetsindikatorer för kvalitetskriterierna på allmän nivå. Med hjälp av dessa kvalitetsindikatorer kan man mäta kvalitetskriteriernas förverkligande

Palliatiivisen hoidon ja saattohoidon kansallinen laatusuositus

Palliatiivisen hoidon ja saattohoidon kansallinen laatusuositus on tarkoitettu laadun seurannan perusteeksi kaikille sosiaali- ja terveydenhuollon yksiköille, joissa hoidetaan elämän loppuvaiheessa olevia henkilöitä. Laatusuositus auttaa ammattilaisia ja esihenkilöitä arvioimaan oman toiminnan laatua sekä määrittämään minkälaista hoidon tasoa on syytä tavoitella. Suositus kertoo, mihin seikkoihin toiminnassa on syytä kiinnittää erityistä huomiota sekä mihin suuntaan sitä tulee kehittää. Järjestämisvastuussa oleville tahoille laatusuositus kertoo minkälaisia voimavaroja ja rakenteita laadukas hoito edellyttää, minkälaista laatua tulee tavoitella ja edellyttää sekä auttaa arvioimaan toiminnan laadukkuutta. Potilaalle ja hänen läheiselleen laatusuositus on puolestaan kuvaus palliatiivisesta hoidosta ja sen laadusta sellaisena kuin sitä on edellytys odottaa. Laatusuosituksessa on tunnistettu 10 toiminnan osa-aluetta kokonaisvaltaisen ja laadukkaan palliatiivisen hoidon järjestämiseksi ja tuottamiseksi. Kullekin laatualueelle on määritelty laatukriteereitä, jotka ovat tärkeitä hoidon tai palvelun laatua kuvaavia tunnusmerkkejä. Lisäksi laatukriteereille on määritelty yleisellä tasolla ehdotuksia laatuindikaattoreiksi, joiden avulla laatukriteerien toteutumista voidaan mitata