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What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

ABSTRACT: The aims of the study were to examine a) patients' knowledge of palliative care, b) patients' expectations and needs when being admitted to a palliative care unit, and c) patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1) information about palliative care, (2) supportive care needs, (3) being treated in a palliative care unit, and (4) qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

SUBMITTER: Masel EK

PROVIDER: S-EPMC4936709 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

Masel Eva K EK Kitta Anna A Huber Patrick P Rumpold Tamara T Unseld Matthias M Schur Sophie S Porpaczy Edit E Watzke Herbert H HH

PloS one 20160707 7

<h4>Objective</h4>The aims of the study were to examine a) patients' knowledge of palliative care, b) patients' expectations and needs when being admitted to a palliative care unit, and c) patient's concept of a good palliative care physician.<h4>Methods</h4>The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients duri ...[more]

PMID: 27389693

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Project description:BackgroundNurturing effective physician-patient relationships is essential to the provision of patient-centred care. Palliative care physicians may apply boundary-crossings or breaches in professional standards to nurture effective physician-patient relationships. Being highly individualized and shaped by the physician's narratives, clinical experience, and contextual considerations, boundary-crossings are susceptible to ethical and professional violations. To better appreciate this concept, we employ the Ring Theory of Personhood (RToP) to map the effects of boundary-crossings on the physician's belief systems.MethodsAs part of the Tool Design SEBA methodology, a Systematic Evidence-Based Approach (SEBA) guided systematic scoping review was employed to guide the design of a semi-structured interview questionnaire with palliative care physicians. The transcripts were simultaneously content and thematically analysed. The themes and categories identified were combined using the Jigsaw Perspective and the resulting domains formed the basis for the discussion.ResultsThe domains identified from the 12 semi-structured interviews were catalysts and boundary-crossings. Boundary-crossings attempt to address threats to a physician's belief systems (catalysts) and are highly individualized. Employ of boundary-crossings depend on the physician's sensitivity to these 'catalysts', their judgement and willingness to act, and their ability to balance various considerations and reflect on their actions and their ramifications. These experiences reshape belief systems, understandings of boundary-crossings and may influence decision-making and practice, underscoring the potential for greater professional breaches when unchecked.ConclusionUnderlining its longitudinal effects, the Krishna Model underscores the importance of longitudinal support, assessment and oversight of palliative care physicians, and lays the foundation for a RToP-based tool to be employed within portfolios.

Project description:The objective of this review of reviews was to identify the reasons for missed nursing care and to shed light on how nurses prioritize what care they miss. Missed nursing care refers to essential nursing activities or tasks that are omitted or not completed as planned during a patient's care. This omission can result from various factors, such as staffing shortages, time constraints, or communication issues, and it can potentially compromise the quality of patient care and safety. Identifying and addressing missed nursing care is crucial to ensure optimal patient outcomes and the well-being of healthcare professionals. To be included, reviews had to use the systematic review process, be available in the English language, examine missed care in hospitals and at home, and include participants who were over eighteen years old. The review intended to answer the following questions: 'Why nursing care is missed?' 'How nurses prioritize what care they missed?'. An umbrella review was developed guided by the JBI methodology and using PRISMA-ScR. A total of 995 reviews were identified. According to the inclusion criteria, only nine reviews were finally evaluated. The findings indicate that care is missed due to staffing levels, organizational problems, and the working climate. Prioritization of care depends on acute care needs as well as educational and experiential background. Missed nursing care is associated with patient safety and the quality of provided nursing care. Specifically, it has negative impacts on patients, healthcare professionals, and healthcare service units. Organizational characteristics, nursing unit features, and the level of teamwork among nursing staff affect Missed Nursing Care. Individual demographic characteristics of the staff, professional roles, work schedules, and adequate staffing may potentially contribute to the occurrence of Missed Nursing Care, which is why they are under investigation. However, further consideration is needed regarding the management of patient needs and nurse prioritization.

Project description:BackgroundPhysicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary.ObjectiveTo understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care.DesignExploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services.ParticipantsSixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcriptsPrincipal findingsPhysicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment.ConclusionsPhysicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

Project description:We explored traits that promote plant invasions. External factors affecting invasion success consist of various abiotic and biotic constraints. How well plants perform under those depends on multiple characteristics, such as life history traits, genetic variation patterns, competitive and dispersal abilities, phenotypic plasticity, resistance, tolerance, and possibly allelopathic interactions. Since the introduction of invasive species is often connected with humans, their geographical distribution and differentiation may not reflect adaptation. However, a lack of adaptation may be compensated for by repeated introductions via mixing genotypes from multiple populations or through novel mutations. As a case study, we used data from the Global Invasive Species Database of IUCN and attempted to reveal factors contributing to invasiveness. The most prevalent features are that the dispersal is strongly human assisted, many species are used as ornamentals, disturbed habitats are favored, and most species are perennial. Distribution features show that the worst invasive species typically have a narrower native distribution, but both groups, i.e., most serious invasive and other listed invasive species, have commonly developed a multicontinental distribution. The change in the multicontinental distribution from 6% to 63% in most serious invasive species reflects their effectiveness in global dispersal and establishment. High proportions of invasive species in both groups have mixed reproduction systems, i.e., they have the ability to propagate both sexually and asexually (57% and 50%, respectively). This provides flexibility for spreading and establishment. A lower proportion of the worst invasive species was mainly/only sexual (23%, often hermaphrodites) when compared to other invasive plants (40%). In the case of sexual reproduction, hermaphroditism combined with self-compatibility may enhance invasiveness, since selfing allows fertilization and recombination even under low population densities. Overall, the ability for asexual propagation and, in the case of sexuality, hermaphroditism, is an asset in the invasion process.

Dataset Information

What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

Publications

What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

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