A qualitative evidence synthesis of healthcare professionals’ experiences and views of palliative care for patients with a haematological malignancy

Dowling, Maura; Fahy, Paul; Houghton, Catherine; Smalle, Mike

doi:10.1111/ecc.13316

Cited by 11 publications

(4 citation statements)

References 69 publications

(220 reference statements)

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“…According to this, an additional mechanism that might be beneficial in terms of integration is the training of hematological professionals in palliative care and in understanding deeply the palliative care approach, while training palliative care practitioners as well to the specificities of the hematological patient, as suggested by many authors ( 26 , 28 – 30 , 45 ).…”

Section: Discussionmentioning

confidence: 99%

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

Tanzi

Martucci

2023

Front. Oncol.

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BackgroundResearch in PC (Palliative Care) is frequently challenging for patient’s frailty, study design, professional misconceptions, and so on. Little is known about specificity in PC research on Hematologic cancer patients, who have distinct characteristics that might influence the enrollment process.AimsWhat works, how and for whom, in increasing enrollment in studies in PC on patients with hematologic malignancies?MethodsRealist review: a qualitative review whose goal is to identify and explain the interaction between Contexts, Mechanisms, and Outcomes (CMOs). The theory was informed by a narrative, theory-based literature research, including an initialsystematic research, and the addition of papers suggested by experts of the field. We also used 7 interviews with experts in PC about patients with hematologic malignancies research and our own experience from a PC pilot study on patients with hematologic malignancies to refine the initial theory.ResultsIn our initial theory we hypothesize that: - Access to palliative care could be beneficial to hematologic patients, even in early stages - Hematologists tend to under-use palliative care services in general, due to unpredictable disease trajectories and cultural barriers. - These factors may negatively impact the patients’ enrollment in PC researchWe included secondary literature as narrative reviews, if they presented interesting propositions useful for our theoretical construction. 23 papers met our inclusion criteria.We also searched for relevant CMOs impacting referral in palliative care, and we selected a list of CMOs that could be relevant also in hematology. We accordingly theorized a group of interventions that could increase the enrollment in PC research and presented them using “social exchange theory” (SET) as a theoretical framework.Prominent researchers in PC in hematologic malignancies were interviewed on their opinion on our results, and additional CMOs.ConclusionsBefore conducting research in PC on patients with hematologic malignancies, it’s probably advisable to assess: - The perception of the different actors (physicians, nurses, other professionals involved), in particular the hematologists, in terms of pros and cons of referral to PC and enrollment in PC trials - The existing relationship between PC and the Hematology departmentAccordingly, it’s possible to tailor different interventions on the various actors and choose a model of trial to increase the perception of benefits from PC and, consequently, enrollment.

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Section: Discussionmentioning

confidence: 99%

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

Tanzi

Martucci

2023

Front. Oncol.

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“…It is important to specify that the identi ed barriers that arise are the same in each studies despite the cultural contexts presented being very different [1,2,4,[9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

A multicenter survey on the perception of palliative care among the health professionals working in hematology

Lorenzo,

Mozzi,

Salmaso

et al. 2023

Preprint

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Introduction Patients with hematological malignancies have less access to Palliative Care and have more delayed referrals than patients with solid tumors. Why does this occur? This survey aims to analyze the perceptions of Palliative Care of health professionals who treat hematological patients and to identify the barriers and facilitators when patients are referred to Palliative Care services. Method This is a multicenter, exploratory, descriptive web-based survey. A questionnaire was submitted to the medical and nursing staff at five Italian Hematological units and San Marino’s hospital. The survey covered accessibility, knowledge, education, perceived barriers and facilitators, and personal experiences concerning Palliative Care. Quantitative and qualitative analyses were performed. Results The number of completed questionnaires was 142/320: 96 by nurses and 46 by physicians. It emerged that 96.5% of participants supported integration of hematology and Palliative Care. It was found that 50.7% of participants had a Palliative Care team at their hospital, though only 16.2% had attended a specific course within their hospital, and 70.4% of them were familiar with the role of a palliativist. Nearly half of professionals (49.2%) agreed to refer patients to Palliative Care at the beginning of the care pathway, 52.8% when the prognosis is less than three months or with incoercible symptoms. The percentages of physicians and nurses agreeing to transfusions even in the final stages of the disease were 60.9% and 55.3%, respectively. Concerning facilitators, 65.5% of physicians and 47.2% of nurses considered an in-hospital Palliative Care team and a case manager to be fundamental; 82.4% of participants highlighted the importance of Palliative Care training. Conclusion The results show that professionals have a positive attitude towards achieving multidisciplinary integration. The small number of referrals may be due to clinical, cultural, educational, organizational, and resource issues.

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“…It has been outlined that hematologists may overtreat patients due to intense doctor-patient relationships in the setting of a treatments’ unpredictable nature. Furthermore, the therapeutic possibilities allow hematologists to think, “Maybe we can pull another ‘rabbit out of the hat’” given the options offered by different therapeutic lines [ 16 ]. Honest communication and transparent treatment proposals to share with patients and their caregivers are strongly intertwined variables [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Behavioral Patterns in Breaking Bad News Communication: An Ethnographic Study with Hematologists

Artioli

Ghirotto

Alquati

et al. 2022

IJERPH

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Hematologists adequately disclosing bad news is a critical point precluding patient-centered communication. Specific courses on communication for hematologists seem to be rare, as well as research exploring their communicative skills and patterns. We aim at describing the hematologists’ behavior during difficult conversations to account for behavioral patterns in communication and provide new insights regarding teaching skills to communicate bad news. We employed a focused visual ethnography to answer the following research: “what are hematologists’ behavioral patterns in communicating bad news to patients and families?” The collected data included (1) video recordings, (2) observational field notes, (3) interviews with hematologists. The analysis highlighted four patterns: (1) a technical-defensive pattern, (2) an authoritative pattern, (3) a relational-recursive pattern, and (4) a compassionate sharing pattern. Hematologists seem to have difficulty expressing compassionate caring and empathetic comprehension. Communication skills remain a challenge for hematologists. The study of behavioral patterns can lead to increasingly targeted training interventions for this specific learner population.

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A qualitative evidence synthesis of healthcare professionals’ experiences and views of palliative care for patients with a haematological malignancy

Cited by 11 publications

References 69 publications

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

A multicenter survey on the perception of palliative care among the health professionals working in hematology

Behavioral Patterns in Breaking Bad News Communication: An Ethnographic Study with Hematologists

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