Aurélie Van Lancker

Oncology health workers' views and experiences on caring for ethnic minority patients: A mixed method systematic review

OBJECTIVES To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients. DESIGN Systematic review of qualitative and quantitative studies. DATA SOURCES The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles. REVIEW METHODS Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies. RESULTS Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients. CONCLUSIONS Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution.

Frequency and intensity of symptoms and treatment interventions in hospitalized older palliative cancer patients: a multicentre cross-sectional study

AIM To increase the knowledge of the frequency and intensity of symptoms and the treatment interventions in older palliative cancer patients. BACKGROUND Research on symptoms and the treatment modalities in older palliative cancer patients is scarce. Insight into these aspects is needed to enable healthcare professionals to alleviate the burden. DESIGN A cross-sectional study. METHODS Four hundred hospitalized older palliative cancer patients participated in the study between March 2013 - February 2015. Two validated instruments were used to assess 40 symptoms in multiple domains and collect data on the treatment modalities in older palliative cancer patients. RESULTS Patients reported on average approximately 14 symptoms. Dry mouth, physical fatigue, lack of energy, lack of appetite and difficulty moving outside were the most prevalent. Psychological pain, psychological fatigue, lack of willpower, lack of energy and physical fatigue were reported as intensive. On average, 5·15 disciplines were consulted per patient. Few patients were referred to a palliative support team, spiritual consultant or psychologist. Patients received a variety of interventions to increase life expectancy and alleviate symptoms and the side effects of treatment. The occurrence of symptoms was associated with different clinical and treatment variables such as having a geriatric risk profile. CONCLUSIONS Older patients receiving palliative cancer care are confronted with multiple symptoms. Psychological symptoms are more often reported as intensive. Greater attention should be given to the early referral of patients to palliative care teams, assessment and management of multiple symptoms, particularly psychological symptoms.

Symptom clustering in hospitalised older palliative cancer patients: A cross-sectional study

BACKGROUND Accurate detection of symptoms is essential in palliative care. Identification of clustering of symptom is valuable to develop target interventions. This area is largely understudied in older palliative cancer patients. OBJECTIVES To identify symptom clustering in older palliative cancer patients, and patient groups based on the clustering of symptoms, and to evaluate the difference in functional dependence and experiencing life as not meaningful between the identified patient groups. DESIGN A cross-sectional study. SETTING Geriatric and non-geriatric wards of seven acute care hospitals. PARTICIPANTS 400 palliative cancer patients aged 65 years and older. METHODS Symptoms were collected using a validated instrument which assesses physical, psychological, functional, social, and existential symptoms by means of a structured interview with a researcher. An agglomerative hierarchical clustering analysis was used to analyse the data. RESULTS The cluster analysis revealed five groups of symptoms: (1) urological and gastrointestinal symptoms, and their treatment complications, (2) psychological and existential symptoms, (3) pain, constipation, sleeplessness and airway problems, (4) functionality problems, and (5) fatigue-related symptoms. Three patient groups were identified: (1) symptom-free group, (2) physical discomfort group, and (3) physical and psychological discomfort group. In the last group, significant more patients had a geriatric risk profile and less of them received chemotherapy. Patients in this group were more often functionally dependent and experienced their life as not meaningful. CONCLUSION Five groups of symptoms were identified. Three patient groups were identified which reported different levels of functionality and experiencing life as meaningful. Healthcare professionals should be triggered to detect symptom clusters and be alert to the presence of the other symptoms in the cluster when identifying one symptom. They should also be alert to patients with a geriatric risk profile because of their higher risk of experiencing physical and psychological symptoms and the influence these symptoms have on being functionally dependent and experiencing life as not meaningful.

Pain Intensity in Hospitalized Adults: A Multilevel Analysis of Barriers and Facilitators of Pain Management

Background Despite an enhanced interest and evolution in pain management, prevalence remains high. Interventions to optimize pain-related care can only be effective if barriers are identified and accounted for. Aim To assess pain intensity and examine its association with patient- (including health literacy defined in this study as “requiring help to read health information”), nurse-, and system-related (including social capital defined as “the importance of network and norms at work”) barriers/facilitators to pain management. Methods A two-center, cross-sectional study was performed between October 2012 and April 2013. The study included patients and nurses of 39 noncritical wards of two hospitals in Belgium. Patients who were 18 years of age or older and without impaired cognition or consciousness were eligible to take part. All nurses working in the included ward were invited to participate. Pain intensity and patient-related barriers were collected by a structured and standardized questionnaire, completed in dialogue with the patient. Nurses completed the questionnaire on the nurse- and system-related barriers and the social capital scale. Multilevel analysis was used to analyze the data because of the hierarchical structure of the data. Results The average pain of all patients across all wards on a 0–10 scale was 2.2 (SD = 3.6). The multilevel analysis indicates that pain intensity can be explained by variables at patient and ward levels. A significant independent association was found between higher pain intensity and younger age, receiving pain medication, the conviction of patients that pain medication does not improve pain, inadequate health literacy in patients, nurses without advanced education, and nurse’s concerns about side effects. Social capital did not emerge as predictor of pain intensity. Discussion Patient and nurse level factors should be taken into account in hospitals when setting up strategies to improve pain management.

The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study.

AIM To evaluate the effectiveness of an e-learning course compared with a face-to-face lecture on medication calculation. BACKGROUND The current knowledge on medication calculation of nursing students and nurses is insufficient to provide safe care. DESIGN A stratified-clustered quasi-experimental study. METHODS A random selection of nursing schools were allocated to the e-learning course (intervention group) (seven schools; 189 students) or face-to-face lecture (control group) (six schools, 222 students). Students in both groups completed a validated medication calculation test (maximum score: 16) prior to the course (T0), immediately after the course (T1) and 3 months later (T2). A linear mixed model was used for data analysis. RESULTS Medication calculation skills improved significantly more by the face-to-face lecture than e-learning course. Students in both groups significantly improved in medication calculation skills immediately after the course (T1) and 3 months later. The results flattened at T2 with a significant decline in the intervention group between T1 and T2 and a non-significant decline in the control group. Based on a subgroup analysis, improvement in medication calculation skills at T2 could only be observed in vocational-level (sub degree) nursing students receiving a face-to-face course. CONCLUSIONS Both medication calculation courses had a positive effect on medication calculation skills. Students receiving traditional face-to-face lecture improved significantly more than the students receiving the e-learning course.

An instrument to collect data on frequency and intensity of symptoms in older palliative cancer patients: A development and validation study

PURPOSE To develop and validate an instrument to collect data on symptoms (frequency/intensity) in older palliative cancer patients. METHODS A four-phase instrument development and validation study was performed. A preliminary version of the instrument was developed through a literature review. Face- and content validity were assessed in a Delphi-procedure with eleven experts. Cognitive interviewing with 24 older cancer patients was performed to enhance content validity of the instrument. Test-retest was performed to assess the stability. RESULTS An 40-item instrument was developed. The Assessment Symptoms Palliative Elderly (ASPE) collects data on frequency and intensity of 24 physical, 10 psychological, 3 functional, 1 spiritual and 2 social symptoms. Content validity was excellent (I-CVI 81.8%-100.0% and S-CVI 92.9%). Cognitive interviewing allowed to improve the content validity. Test-retest showed substantial to almost perfect agreement for 87.5% of the items. No item had poor or fair agreement. CONCLUSION This study resulted in the development of the ASPE which reflects good properties for face- and content validity and reliability. Cognitive interviewing has a valuable contribution in the validation process. The instrument can be used to gain insight in symptoms in older palliative cancer patients.

A comparison of symptoms in older hospitalised cancer and non-cancer patients in need of palliative care : a secondary analysis of two cross-sectional studies

BackgroundEvidence on the differences in symptom patterns between older palliative cancer and non-cancer patients is lacking. The purpose of the study was to determine the differences in symptoms between older hospitalised palliative cancer and non-cancer patients.MethodsA secondary analysis of two multi-centre cross-sectional studies was performed. A validated instrument was used to assess the frequency and intensity of 40 symptoms in older hospitalised palliative cancer patients (n = 100) and older palliative non-cancer patients (n = 100). The data were collected between March 2013 and June 2015. Differences between groups were measured statistically.ResultsOverall, similarities in symptom patterns were observed between cancer and non-cancer patients. Some minor differences were detected between the groups. Non-cancer patients experienced significantly more physical symptoms and functional dependence than cancer patients. Patients with cancer experienced higher levels of frequency and intensity of psychological symptoms compared to non-cancer patients.ConclusionsHealthcare professionals should be aware of the high occurrence of symptoms in both cancer and non-cancer patients, and they should be educated about the systematic assessment of symptoms in multiple domains by accounting for the occurrence of generic symptoms and disease-specific symptoms.