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BMC Palliative Care Apr 2020Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with... (Meta-Analysis)
Meta-Analysis
Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families.
BACKGROUND
Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families.
METHODS
A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis.
RESULTS
Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients' openness to their own needs).
CONCLUSIONS
To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals' communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.
Topics: Family; Health Personnel; Humans; Neoplasms; Palliative Care; Patient Acceptance of Health Care; Patients; Qualitative Research
PubMed: 32284064
DOI: 10.1186/s12904-020-00556-7 -
International Journal of Nursing Studies May 2021Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of... (Review)
Review
CONTEXT
Malnutrition in institutionalized patients is associated with adverse outcomes and increased costs. Nurses have a crucial role in the recognition and treatment of malnutrition and empowering patients in nutritional care.
OBJECTIVE
This systematic review provides an overview of the effectiveness of nursing nutritional interventions to counteract malnutrition.
DATA SOURCES
Data were obtained through a systematic search in MEDLINE/PubMed, Cochrane, CINAHL, EMBASE and ISI Web of Science databases from inception to February 15 2018.
DATA EXTRACTION
Studies were eligible for inclusion when published in English, Spanish or German. Primary outcome parameters were nutritional status and dietary intake.
DATA ANALYSIS
The Evidence analysis checklist from the American Dietetic Association and GRADE were used to evaluate the methodological quality of the studies.
RESULTS
Out of 8162 studies, fifteen studies were included in the study, representing nine hospitals and six long-term care facilities. Two main categories of nursing nutrition interventions were identified; the implementation of 1) a nursing nutrition plan focusing on nursing actions in nutritional care or 2) nursing assistance in feeding support, mostly during mealtimes. Studies were heterogeneous and of most of them of low quality. This hampered drawing conclusions on effectiveness of nursing nutrition interventions on malnutrition related outcomes in clinical care. Nevertheless, six out of 15 studies reported a slightly improved nutritional status and/or clinical outcomes as a result of the interventions.
CONCLUSION
This review identified two categories of nursing nutrition interventions to counteract malnutrition. Their effectiveness needs to be further evaluated in future studies. Tweetable abstract: Systematic review of effective Nursing Nutrition Interventions in the management of malnutrition in hospital and nursing home care.
Topics: Hospitals; Humans; Inpatients; Malnutrition; Nursing Homes; Nutritional Status
PubMed: 33647842
DOI: 10.1016/j.ijnurstu.2021.103888 -
General Hospital Psychiatry 2019Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although...
OBJECTIVE
Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings.
METHOD
A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines.
RESULTS
Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia.
CONCLUSIONS
Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.
Topics: Hospitalization; Humans; Inpatients; Sleep Initiation and Maintenance Disorders
PubMed: 31170567
DOI: 10.1016/j.genhosppsych.2019.05.006 -
Critical Care (London, England) Dec 2019Memory gaps in intensive care unit (ICU) survivors are associated with psychiatric disorders. The ICU diaries improve the patient's factual memory of the ICU, but it is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Memory gaps in intensive care unit (ICU) survivors are associated with psychiatric disorders. The ICU diaries improve the patient's factual memory of the ICU, but it is not clear if they reduce the incidence of psychiatric disorders in patients and relatives after hospital discharge. The aim of this study is to evaluate the literature on the effect of ICU diaries for patients admitted in ICU and their relatives.
METHODS
Two authors independently searched the online databases PubMed, OVID, Embase, EBSCO host, and PsycINFO from inception to July 2019. Studies were included if the intervention group (ICU diary) was compared with a group with no diaries and the sample was comprised patients ≥ 18 years old admitted in the ICU for more than 24 h and their relatives. Randomized clinical trials, observational studies, letter with original data, and abstracts were included, irrespective of the language. The search was not limited by any specific outcome. Review articles, commentaries, editorials, and studies without a control group were excluded. Structured tools were used to assess the methodological quality ("Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)" for cohort studies and the "Cochrane Risk of Bias tool" for included RCTs and before/after studies). A random-effects model was employed considering the anticipated variability between the studies.
RESULTS
Seven hundred eighty-five titles were identified for screening. Two additional studies were selected after a reference search, and after a full-text review, a total of 12 studies were included. When pooling the results, ICU diary was associated with lower risk of depression (RR 0.41, 95% CI 0.23-0.75) and better quality of life (10.3 points higher in SF-36 general health score, 95% CI 0.79-19.8), without a decrease in anxiety or post-traumatic stress disorder (PTSD). For the relatives receiving an ICU diary, there was no difference in the incidence of PTSD, anxiety, or depression.
CONCLUSION AND RELEVANCE
This systematic review and meta-analysis supports the use of ICU diaries to reduce the risk of depression and preserve the quality of life of patients after ICU admission. ICU diaries do not seem to have any beneficial effect on the relatives of the patients.
TRIAL REGISTRATION
PROSPERO, CRD42019136639.
Topics: Critical Illness; Diaries as Topic; Family; Humans; Intensive Care Units; Memory Disorders; Outcome Assessment, Health Care; Patients; Stress Disorders, Post-Traumatic; Survivors
PubMed: 31842929
DOI: 10.1186/s13054-019-2678-0 -
Journal of Advanced Nursing Feb 2023To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. (Review)
Review
AIMS
To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes.
DESIGN
Systematic review.
DATA SOURCES
Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted.
REVIEW METHODS
Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool.
RESULTS
Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concerns appeared more successful than other types of interventions.
CONCLUSIONS
There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter.
IMPACT
To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions.
NO PATIENT OR PUBLIC CONTRIBUTION
There was no funding to remunerate a patient/member of the public for this review.
Topics: Adult; Humans; Hospitals; Health Personnel; Inpatients; Communication
PubMed: 36408930
DOI: 10.1111/jan.15500 -
The Patient Apr 2018A tracheostomy is a surgically created opening through the anterior neck tissues and the trachea, into which a tube is inserted. Despite its influence on basic human... (Review)
Review
BACKGROUND
A tracheostomy is a surgically created opening through the anterior neck tissues and the trachea, into which a tube is inserted. Despite its influence on basic human needs such as respiration, communication and nutrition, little is known about the impact of tracheostomy on patients and their caregivers or what could be done to enable better care and quality of life (QoL) for these individuals.
OBJECTIVE
The aim of this review was to better understand the current knowledge related to the experience and QoL of adults living with a tracheostomy and their caregivers so as to be able to improve these experiences.
METHOD
A systematic review of the English-language, peer-reviewed literature was conducted in PubMed, Scopus, PsychINFO, Google Scholar, and CINAHL databases. Articles were eligible if they included adult patient or lay caregiver-reported experiences of tracheostomy.
RESULTS
Overall, 1080 articles were identified and 17 eligible for inclusion. Fourteen articles reported on experiences of tracheostomy patients, while three focused on those of their caregivers. Studies were conducted in the home setting (n = 5), on a hospital ward (n = 4), in an intensive care unit (n = 3), in an outpatient clinic (n = 3), in a rehab facility (n = 1), and online (n = 1). Patients and their caregivers reported a range of mostly negative experiences related to the care, support, and management of a tracheostomy, speech and communication, wellbeing and QoL, disfigurement and body image, and stigma and social withdrawal.
CONCLUSION
Few studies have published data on the patient and caregiver experiences with tracheostomy, especially in the community setting. There is a need to better understand these experiences in order to be able to formulate strategies and provide resources to improve the quality of care and overall QoL of patients with a tracheostomy and their caregivers in-hospital and in the community.
Topics: Adaptation, Psychological; Caregivers; Communication; Home Care Services; Hospitalization; Humans; Patients; Qualitative Research; Quality of Life; Self Efficacy; Stress, Psychological; Tracheostomy
PubMed: 28914429
DOI: 10.1007/s40271-017-0277-1 -
Journal of Pediatric Surgery May 2023Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important health care quality indicators. PREMs... (Review)
Review
PURPOSE
Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important health care quality indicators. PREMs measure patients' perception of the care they have received, differing from satisfaction ratings, which measure their expectations. The use of PREMs in pediatric surgery is limited, prompting this systematic review to assess their characteristics and identify areas for improvement.
METHODS
A search was conducted in eight databases from inception until January 12, 2022, to identify PREMs used with pediatric surgical patients, with no language restrictions. We focused on studies of patient experience but also included studies that assessed satisfaction and sampled experience domains. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool.
RESULTS
Following title and abstract screening of 2633 studies, 51 were included for full-text review, of which 22 were subsequently excluded because they measured only patient satisfaction rather than experience, and 14 were excluded for a range of other reasons. Out of the 15 included studies, questionnaires used in 12 studies were proxy-reported by parents and in 3 by both parents and children; none focused only on the child. Most instruments were developed in-house for each specific study, without patients' involvement in the process, and were not validated.
CONCLUSIONS
Although PROMs are increasingly used in pediatric surgery, PREMs are not yet in use, being typically substituted by satisfaction surveys. Significant efforts are needed to develop and implement PREMs in pediatric surgical care, in order to effectively capture children's and families' voices.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Child; Patient Satisfaction; Patients; Surveys and Questionnaires; Quality Indicators, Health Care; Patient Outcome Assessment
PubMed: 36797113
DOI: 10.1016/j.jpedsurg.2023.01.015 -
HERD Jan 2017This present literature review explores current issues and research inconsistencies regarding the design of hospital circulation zones and the associated health-related... (Review)
Review
OBJECTIVE
This present literature review explores current issues and research inconsistencies regarding the design of hospital circulation zones and the associated health-related outcomes.
BACKGROUND
Large general hospitals are immense, highly sophisticated institutions. Empirical studies have indicated excessively institutional environments in large medical centers are a cause of negative effects to occupants, including stress, anxiety, wayfinding difficulties and spatial disorientation, lack of cognitional control, and stress associated with inadequate access to nature. The rise of patient-centered and evidence-based movements in healthcare planning and design has resulted in a general rise in the quality of hospital physical environments. However, as a core component of any healthcare delivery system, hospital circulation zones have tended to remain neglected within the comparatively broad palette of research conducted and reported to date.
METHOD
A systematic literature review was conducted based upon combinations of key words developed vis-à-vis a literature search in 11 major databases in the realm of the health sciences and the planning and design of built environments for healthcare.
RESULTS
Eleven peer-reviewed articles were included in the analysis. Six research themes were identified according to associated health-related outcomes, including wayfinding difficulties and spatial disorientation, communication and socialization patterns, measures and control of excessive noise, patient fall incidents, and occupants' stress and satisfaction levels.
CONCLUSIONS
Several knowledge gaps as well as commonalities in the pertinent research literature were identified. Perhaps the overriding finding is that occupants' meaningful exposure to views of nature from within hospital circulation zones can potentially enhance wayfinding and spatial navigation. Future research priories on this subject are discussed.
Topics: Accidental Falls; Communication; Environment Design; Health Facility Environment; Hospital Design and Construction; Hospitals, General; Humans; Noise; Orientation, Spatial; Patient Satisfaction; Patients; Socialization; Stress, Psychological
PubMed: 27742819
DOI: 10.1177/1937586716672041 -
Journal of Medical Genetics Jan 2023This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for... (Review)
Review
This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for articles published between January 2010 and March 2021. Studies evaluating the use of patient-facing digital tools in the context of genetic service delivery were included. Two reviewers screened and extracted patient-reported and system-focused outcomes from each study. Data were synthesised using a descriptive approach. Of 3226 unique studies identified, 87 were included. A total of 70 unique digital tools were identified. As a result of using digital tools, 84% of studies reported a positive outcome in at least one of the following patient outcomes: knowledge, psychosocial well-being, behavioural/management changes, family communication, decision-making or level of engagement. Digital tools improved workflow and efficiency for providers and reduced the amount of time they needed to spend with patients. However, we identified a misalignment between study purpose and patient-reported outcomes measured and a lack of tools that encompass the entire genetic counselling and testing trajectory. Given increased demand for genetic services and the shift towards virtual care, this review provides evidence that digital tools can be used to efficiently deliver patient-centred care. Future research should prioritise development, evaluation and implementation of digital tools that can support the entire patient trajectory across a range of clinical settings. PROSPERO registration numberCRD42020202862.
Topics: Humans; Patients; Genetic Services
PubMed: 36137613
DOI: 10.1136/jmg-2022-108653 -
British Journal of Nursing (Mark Allen... May 2023Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients' access to those services. There is limited...
BACKGROUND
Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients' access to those services. There is limited evidence on patients' perceptions of this swift shift in service provision.
AIMS
The purpose of this qualitative systematic review was to explore patient experiences of teleconsultations within NHS cancer surgery follow-up services to better understand patient perceptions, satisfaction and acceptability of teleconsultations within cancer services.
METHODS
Medline, Embase, PubMed and Google Scholar were searched up to 1 July 2022. Qualitative studies were synthesised using the Braun and Clarke framework.
FINDINGS
There were three overarching themes: accessibility; patient experience; and consultation.
CONCLUSION
Teleconsultations were widely accepted among cancer surgical patients. However, there were reports of a lack of rapport building and emotional support because of the absence of visual cues and patient camaraderie.
Topics: Humans; Patients; Remote Consultation; United Kingdom
PubMed: 37219975
DOI: 10.12968/bjon.2023.32.10.S24