Sustaining hope when communicating with terminally ill patients and their families: a systematic review

Clayton, Josephine M.; Hancock, Karen; Parker, Sharon; Butow, Phyllis; Walder, Sharon; Carrick, Sue; Currow, David C.; Ghersi, Davina; Glare, Paul; Hagerty, Rebecca; Olver, Ian; Tattersall, Martin H. N.

doi:10.1002/pon.1288

Cited by 280 publications

(284 citation statements)

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“…This indicates to the person that their involvement in the discussion is voluntary and this may foster hope by encouraging the person to take the lead on the direction of the discussion (Parry et al 2014). By allowing a person to express their concerns, nurses may be able to identify which awareness context a person is in and avoid wrong assumptions being made or unwanted advice being forced (Clayton et al 2008).…”

Section: The Use Of the Sage And Thyme Modelmentioning

confidence: 99%

“…In relation to receiving significant news, hope may be defined as the ability to accept difficult information without being controlled by despair or relying on denial of the reality of the situation (Clayton et al 2008;Borneman et al 2014). This indicates that there may be a relationship between hope and the way information is communicated, highlighting the benefit of professionals understanding a patient's level of knowledge and understanding (Clayton et al 2008).…”

Section: The Awareness Context Theorymentioning

confidence: 99%

“…This indicates that there may be a relationship between hope and the way information is communicated, highlighting the benefit of professionals understanding a patient's level of knowledge and understanding (Clayton et al 2008). The awareness context theory created by Glaser and Strauss (1965) and subsequently adapted to the current healthcare system by modern authors provides a framework to explore this relationship (Borneman et al 2014).…”

Section: The Awareness Context Theorymentioning

confidence: 99%

“…Hope has significance as it is a form of strength for a person and supports them in living the remainder of their life to the full and can protect against depression (Broadhurst and Harrington 2016). Both the significance and individuality of hope highlight the need for a professional to have an awareness of spirituality when communicating with people who are living with a terminal prognosis (Clayton et al 2008). …”

Section: Hopementioning

confidence: 99%

“…A key component of person-centred care is joint decision making, whereby patients who have capacity are fully informed of their condition along with the options available and the decision they make is respected (Coulter and Collins 2011;HM Government 2005). Handled effectively this leads to positive outcomes such as increased autonomy, however if too much information is given at the wrong time or in the wrong way hopelessness may result, reducing a person's spiritual wellbeing and quality of life (Clayton et al 2008). The impact of communication between a patient and a nurse may be even more significant for those living with a terminal prognosis as during illness a person may have to deal with significant news, make important decisions and redefine what their own spirituality means (Baldacchino 2006).…”

Section: Introductionmentioning

confidence: 99%

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How a Model of Communication Can Assist Nurses to Foster Hope When Communicating with Patients Living with a Terminal Prognosis

Petley

2017

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Nurses play a central role in joint decision-making and person-centred care, whereby care is focused on the needs of an individual patient. A key part of person-centred care is the way nurses engage with patients because good communication can impact on a person's spiritual wellbeing, particularly in relation to their ability to have hope. The way nurses communicate can be even more pertinent for people living with a terminal prognosis as the issues discussed can in themselves significantly influence a person's spiritual wellbeing. This paper combines contemporary research on how health professionals can foster hope in patients living with a terminal prognosis with The Awareness Context Theory described by Glaser and Strauss in 1965. A model of communication is then used to demonstrate how the research on hope and The Awareness Context Theory can be applied to practice.

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Section: The Use Of the Sage And Thyme Modelmentioning

confidence: 99%

Section: The Awareness Context Theorymentioning

confidence: 99%

Section: The Awareness Context Theorymentioning

confidence: 99%

Section: Hopementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How a Model of Communication Can Assist Nurses to Foster Hope When Communicating with Patients Living with a Terminal Prognosis

Petley

2017

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Communication About Serious Illness Care Goals

2014

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ffective communication plays a major role in facilitating adaptation to illness realities, appropriate decision making, and quality of life 1,2 throughout the trajectory of a serious illness. As patients approach the end of life, communication about goals of care and planning is a key element in helping assure that patients receive the care they want, in alleviating anxiety, and in supporting families. [3][4][5] Effective communication supports, not only endof-life care, but quality of life throughout the illness trajectory, even if death is not an imminent outcome.In this review, we evaluate current practices in communication about serious illness, their effects on patients, and factors that may influence these practices; we conclude by identifying best practices in communication about goals of care in serious illness, primarily in the ambulatory setting. On the basis of this assessment, we propose a systematic approach, informed by evidence, to help assure that each seriously ill patient has a personalized serious illness treatment plan. The most common clinical conditions relevant to this discussion include cancer, congestive heart failure, chronic obstructive pulmonary disease, and chronic kidney disease and/or end-stage renal disease. This work was undertaken as part of the American College of Physicians (ACP) High Value Care Initiative and subsequently endorsed by the High Value Task Force of the ACP. MethodsWe conducted a narrative review of evidence about advance care planning and end-of-life communication practices to provide clinicians with practical, evidence-based advice. Both observational and intervention studies were included, as well as indirect evidence from high-quality studies of palliative care specialist interventions that address the impact of communication about serious illness care planning on outcomes. We use the term serious illness care goals to include discussions about goals of care, advance care planning, and end-of-life discussions for patients with serious illness to emphasize the targeted population and the potential impact on these discussions, not just for the very end of life but for care throughout the course of serious illness. In citing specific studies, we use the terms (eg, end-of-life care) used by the authors (see eMethods in the Supplement for a detailed description of methodology). For a summary of the ACP High Value Care Advice, see Box 1.An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of nonbeneficial medical care near death, enhanced goal-consistent care, positive family outcomes, and reduced costs. Existing evidence does not support the commonly held belief that communication about end-of-life issues increases patient distress. However, conversations about care goals are often conducted by physicians who do no...

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Deficits in Advance Care Planning for Patients With Decompensated Cirrhosis at Liver Transplant Centers

et al. 2021

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IMPORTANCEThe burden of end-of-life care for patients with cirrhosis is increasing in the US, and most of these patients, many of whom are not candidates for liver transplant, die in institutions receiving aggressive care. Advance care planning (ACP) has been associated with improved end-of-life outcomes for patients with other chronic illnesses, but it has not been well-characterized in patients with decompensated cirrhosis. OBJECTIVE To describe the experience of ACP in patients with decompensated cirrhosis at liver transplant centers. DESIGN, SETTING, AND PARTICIPANTS For this multicenter qualitative study, face-to-face semistructured interviews were conducted between July 1, 2017, and May 30, 2018, with clinicians and patients with decompensated cirrhosis at 3 high-volume transplant centers in California. Patient participants were adults and had a diagnosis of cirrhosis, at least 1 portal hypertension-related complication, and current or previous Model for End-Stage Liver Disease with sodium score of 15 or higher. Clinician participants were health care professionals who provided care during the illness trajectory. MAIN OUTCOMES AND MEASURES Experiences with ACP reported by patients and clinicians. Participants were asked about the context, behaviors, thoughts, and decisions concerning elements of ACP, such as prognosis, health care preferences, values and goals, surrogate decision-making, and documentation. RESULTS The study included 42 patients (mean [SD] age, 58.2 [11.2] years; 28 men [67%]) and 46 clinicians (13 hepatologists [28%], 11 transplant coordinators [24%], 9 hepatobiliary surgeons [20%], 6 social workers [13%], 5 hepatology nurse practitioners [11%], and 2 critical care physicians [4%]). Five themes that represent the experiences of ACP were identified:(1) most patient consideration of values, goals, and preferences occurred outside outpatient visits; (2) optimistic attitudes from transplant teams hindered the discussions about dying;(3) clinicians primarily discussed death as a strategy for encouraging behavioral change; (4) transplant teams avoided discussing nonaggressive treatment options with patients; and (5) surrogate decision makers were unprepared for end-of-life decision-making.CONCLUSIONS AND RELEVANCE This study found that, despite a guarded prognosis, patients with decompensated cirrhosis had inadequate ACP throughout the trajectory of illness until the end of life. This finding may explain excessively aggressive life-sustaining treatment that patients receive at the end of life.

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Sustaining hope when communicating with terminally ill patients and their families: a systematic review

Cited by 280 publications

References 36 publications

How a Model of Communication Can Assist Nurses to Foster Hope When Communicating with Patients Living with a Terminal Prognosis

How a Model of Communication Can Assist Nurses to Foster Hope When Communicating with Patients Living with a Terminal Prognosis

Communication About Serious Illness Care Goals

Deficits in Advance Care Planning for Patients With Decompensated Cirrhosis at Liver Transplant Centers

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