Physician Communication with Family Caregivers of Long-Term Care Residents at the End of Life (original) (raw)
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Experiences and Needs of Families Regarding Prognostic Communication in an Intensive Care Unit
Critical Care Nursing Quarterly, 2012
This article reports the results of a study designed to explore the experiences and needs of family members for prognostic communication at end of life in an intensive care unit (ICU). Subjects in this qualitative study included 20 family members of patients at high risk for death in 1 adult medical/surgical ICU. All subjects were interviewed once utilizing a semistructured interview format, with approximately half interviewed multiple times during the ICU stay. Families described 5 themes of information-related "work": (1) hearing and recalling, (2) accessing, (3) interpreting, (4) retaining, and (5) utilizing information for decision making. Barriers, including accessing physicians and cognitive issues from high levels of stress, made this work difficult. Families described a need for prognostic information, especially if the prognosis was poor. Because hearing this news was difficult, they needed it communicated with respect, sensitivity, and compassion. Suggestions for clinical practice to support families in their information-related work are presented. Overall, the importance of providers approaching communication from a holistic perspective, extending beyond simply passing on information, is emphasized. Viewing communication as a therapeutic modality, and communicating with compassion, sensitivity, and a genuine sense of caring, can help provide both the information and the emotional support and comfort families desperately need.
European Journal of Ageing
The Family Perceptions of Physician-Family Caregiver Communication scale (FPPFC) was developed to assess quality of physician-family end-of-life communication in nursing homes. However, its validity has been tested only in the USA and the Netherlands. The aim of this paper is to evaluate the FPPFC construct validity and its reliability, as well as the psychometric characteristics of the items comprising the scale. Data were collected in cross-sectional study in Belgium, Finland, Italy, the Netherlands and Poland. The factorial structure was tested in confirmatory factor analysis. Item parameters were obtained using an item response theory model. Participants were 737 relatives of nursing home residents who died up to 3 months prior to the study. In general, the FPPFC scale proved to be a unidimensional and reliable measure of the perceived quality of physician-family communication in nursing home settings in all five countries. Nevertheless, we found unsatisfactory fit to the data w...
Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care
Journal of the American Medical Directors Association, 2020
Objectives: We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs). Design: In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs. Setting and Participants: There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings. Results: Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub-themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models. Conclusions and Implications: Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported. Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine. One of the most challenging times for family caregivers (FCGs) is the transition to long-term care (LTC). 1,2 We define family caregiver broadly as any person who takes on a generally unpaid caring role providing emotional, physical, or practical support in response to an illness, disability, or age-related needs. Although the notion is that placement relieves the FCG of care tasks and reduces stress, many FCGs continue to spend similar amounts of time visiting, monitoring Funded by Northern Alberta Academic Family Medicine Fund. The authors declare no conflicts of interest.
Nursing Open
Different types of end-of-life communication between healthcare providers (HCPs) and residents or their family carers occur in nursing homes (NHs), ranging from (a) "discussing" life-sustaining treatments, care goals, advance directives, prognosis, the possibility of withdrawing treatments or palliative care options, (b) "speaking" symptom management and future care, (c) "talking" about how a patient is doing and (d) "receiving information" on a resident's health problems or what to expect (Gonella, Basso, Dimonte, et al., 2019). Difficulties in end-of-life communication have been reported
Nurse-Physician Communication Around Identifying Palliative Care Needs in Nursing Home Residents
Journal of the American Medical Directors Association, 2021
Timely identifying changing physical, psychological, social, and spiritual care needs is crucial. Physicians are responsible for treatment decision making, but in nursing homes, nurses see residents more frequently and may be best positioned to identify changes. 1 Ineffective nurse-physician communication is associated with patient safety and outcomes. 2e4 Our qualitative interview study aimed to assess experiences of specialized medical practitioners who are on the staff of nursing homes regarding communication with nursing staff about identifying emerging and changing (palliative) care needs of nursing home residents. With maximum variation sampling, we selected 15 physicians and 2 nurse practitioners employed by 8 care organizations in the western urbanized region of the Netherlands who participated in individual semistructured interviews in 2018. The topic list was informed by literature and a qualitative data set about facilitators to palliative care in dementia reported by elderly care physicians. 5 The interviews were recorded, transcribed verbatim, and analyzed with Atlas.ti version 7.5.18 (2012). We used both deductive and inductive coding adding refined codes related to communication. Using the "framework method," 6 we identified important themes regarding nursephysician communication. The Medical Ethical Committee of the Leiden University Medical Center declared the study exempt from the Medical Research Involving Human Subjects Act (P17.256, May 25, 2018). A more detailed report of the study is available elsewhere. 7 Eleven female and 6 male practitioners participated (mean age 49 years, range 27-67) and most also practiced on dementia units. The interviews lasted 36-62 minutes. Initially asked in an open manner, the interviewees were quite appreciative about the communication with nursing staff concerning identifying residents' care needs. However, with specific probes, they raised a number of communication difficulties. Two main themes covering positive and negative experiences emerged from the data: (1) teamwork and (2) continuity of information. Jenny T. van der Steen and Esmée A. Jongen share equal first authorship.
Palliative Medicine, 2014
Background: There is a growing recognition that a palliative care approach should be initiated early and not just in the terminal phase for patients with life-limiting diseases. Family physicians then play a central role in identifying and managing palliative care needs, but appear to not identify them accurately or in a timely manner. Aim: To explore the barriers to and facilitators of the early identification by family physicians of the palliative care needs. Design, setting, and participants: Six focus groups (four with family physicians, n = 20, and two with community nurses, n = 12) and 18 interviews with patients with cancer, chronic obstructive pulmonary disease, heart failure, and dementia were held. Thematic analysis was used to derive themes that covered barriers and facilitators. Results: Key barriers and facilitators found relate to communication styles, the perceived role of a family physician, and continuity of care. Family physicians do not systematically assess non-acute care needs, and patients do not mention them or try to mask them from the family physician. This is embedded within a predominant perception among patients, nurses, and family physicians of the family physician as the person to appeal to in acute and standard follow-up situations rather than for palliative care needs. Family physicians also seemed to pay more often attention to palliative care needs of patients in a terminal phase. Conclusion: The current practice of palliative care in Belgium is far from the presently considered ideal palliative care approaches. Facilitators such as proactive communication and communication tools could contribute to the development of guidelines for family physicians and policymakers in primary care.