-
Palliative & Supportive Care Oct 2023In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes... (Review)
Review
OBJECTIVES
In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals.
METHODS
A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021.
RESULTS
In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting.
SIGNIFICANCE OF RESULTS
Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Patients; Adaptation, Psychological; Communication
PubMed: 37646464
DOI: 10.1017/S1478951523001165 -
International Journal of Nursing Studies Sep 2023Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient... (Review)
Review
BACKGROUND
Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting.
OBJECTIVES
To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines.
DESIGN
A convergent integrated mixed-methods systematic review was conducted using the JBI approach.
DATA SOURCE
English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.
REVIEW METHODS
Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques.
RESULTS
Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators.
CONCLUSIONS
These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings.
PROSPERO REGISTRATION
CRD42021250885.
Topics: Humans; Pressure Ulcer; Inpatients
PubMed: 37453248
DOI: 10.1016/j.ijnurstu.2023.104557 -
JAMA Nov 2023Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by...
IMPORTANCE
Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.
OBJECTIVE
To determine whether adding sigh breaths improves clinical outcomes.
DESIGN, SETTING, AND PARTICIPANTS
A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours.
INTERVENTIONS
Sigh volumes producing plateau pressures of 35 cm H2O (or 40 cm H2O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient's physician(s) treating the patient as they wished.
MAIN OUTCOMES AND MEASURES
The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.
RESULTS
Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (Pā=ā.08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, -0.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261) in those receiving usual care (Pā=ā.05). No differences were observed in nonfatal adverse events comparing patients with sighs (80/259 [30.9%]) vs those without (80/261 [30.7%]).
CONCLUSIONS AND RELEVANCE
In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02582957.
Topics: Humans; Male; Adult; Adolescent; Female; Respiration; Ventilators, Mechanical; Inpatients; Respiratory Distress Syndrome; Ventilator-Induced Lung Injury
PubMed: 37877609
DOI: 10.1001/jama.2023.21739 -
JAMA Dec 2023
Topics: Humans; Patients; Physician's Role; Physician-Patient Relations
PubMed: 37976055
DOI: 10.1001/jama.2023.24051 -
Nature Feb 2024
Topics: Animals; Dogs; Humans; Neoplasms; Stress, Psychological; Therapy Animals; Patients
PubMed: 38287181
DOI: 10.1038/d41586-024-00243-0 -
Allergy and Asthma Proceedings Nov 2023
Topics: Humans; Physician-Patient Relations; Patient Participation; Patients
PubMed: 37919846
DOI: 10.2500/aap.2023.44.230066 -
Sleep Sep 2023
Topics: Humans; Sleep; Patients; Patient-Centered Care
PubMed: 37248858
DOI: 10.1093/sleep/zsad125 -
Advances in Kidney Disease and Health Jan 2024Patient involvement in research can improve the relevance of research, consequently enhancing the recruitment, retention, and uptake of interventions and policies... (Review)
Review
Patient involvement in research can improve the relevance of research, consequently enhancing the recruitment, retention, and uptake of interventions and policies impacting patient outcomes. Despite this, patients are not often involved in the design and conduct of research. The research agenda and innovations are frequently determined by the interest of health and industry professionals rather than proactively aligning with the priorities of patients. It is now being encouraged and recommended to engage patients in research priority setting to ensure interventions and trials report outcomes valuable to patients, moving away from a history of overlooking the outcomes that reflect the feel and function of patients. Involving patients ensures constant innovative research in nephrology, as this broader depth of evidence fortifies reliability and validity through knowledge gained from lived experience. Findings from such research can enhance clinical practice and strengthen decision-making and policy to support better outcomes. We aim to outline principles and strategies for patient involvement in research, including setting research priorities, identifying and designing interventions, selecting outcomes, and disseminating and translating research. Principles and strategies including engagement, education and training, empowerment, and connection and community provide guidance in patient involvement. There are increasing efforts to involve patients across all stages of research including setting research priorities. Efforts are rising to involve patients across all stages of research including priority setting, identifying and designing interventions, selecting outcomes, and dissemination and translation. Patient involvement throughout the research cycle drives innovative investigations ensuring funding, efforts, and resources are directed toward priorities of patients, contributing to catalyst advancements in care and outcomes.
Topics: Humans; Nephrology; Reproducibility of Results; Patients; Patient-Centered Care
PubMed: 38403395
DOI: 10.1053/j.akdh.2023.12.004 -
Allergy and Asthma Proceedings Jan 2024
Topics: Humans; Physician-Patient Relations; Patient Participation; Patients
PubMed: 38151727
DOI: 10.2500/aap.2024.45.230082 -
Best Practice & Research. Clinical... Sep 2023The elderly segment of the population is growing rapidly worldwide. Older patients comprise a disproportionate percentage of the surgical caseload. Physiological changes... (Review)
Review
The elderly segment of the population is growing rapidly worldwide. Older patients comprise a disproportionate percentage of the surgical caseload. Physiological changes are inevitable with aging; some may impact a patient's response to anesthesia and surgery. Careful evaluation of an elderly patient preoperatively is vital to proper patient selection for ambulatory surgeries, particularly for complex and lengthy procedures. Cognitive issues, frailty, and geriatric syndromes make a patient vulnerable and sometimes unsuitable for certain ambulatory procedures. Preoperative planning and interventions may improve outcomes for the elderly patient undergoing ambulatory surgery.
Topics: Aged; Humans; Ambulatory Surgical Procedures; Patients; Anesthesia; Anesthesiology; Frailty
PubMed: 37938081
DOI: 10.1016/j.bpa.2022.12.004