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Biomedical subjects

Sanchia Aranda

Publications and source records attributed to Sanchia Aranda.

15 recordsLinked to original sources
PubMed2006

Development and evaluation of an audiovisual information resource to promote self-management of chemotherapy side-effects.

Based on a theoretical framework, we developed an audiovisual resource to promote self-management of eight common chemotherapy side-effects. A patient needs analysis identified content domains, best evidence for preparing patients for threatening medical procedures and a systematic review of effective self-care strategies informed script content. Patients and health professionals were invited to complete a written evaluation of the video. A 25-min video was produced. Fifty health professionals and 37 patients completed the evaluation. All considered the video informative and easy to understand. The majority believed the video would reduce anxiety and help patients prepare for chemotherapy. Underpinned by a robust theoretical framework, we have developed an evidence-based resource that is perceived by both patients and health professionals as likely to enhance preparedness for chemotherapy.

Adult↗
PubMed2006

Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review.

PURPOSE: Patients' desire for hastened death within the context of advanced disease and palliative care is a controversial topic, frequently discussed in the international literature. Much of the discussion has focused on opinion and debate about ethical matters related to hastened death. Not many research studies seem to have specifically targeted why palliative care patients may desire hastened death, and few have focused on clinical guidelines for responding to such requests. METHODS: Using a systematic literature review process, we evaluated the research evidence related to the reasons patients express a desire for a hastened death, and the quality of clinical guidelines in this area. RESULTS: Thirty-five research studies met the inclusion criteria related to reasons associated with a desire for hastened death. The factors associated with a desire to die were often complex and multifactorial; however, psychological, existential and social reasons seem to be more prominent than those directly related to physical symptoms, such as pain. Much of the evidence supporting the reasons for these statements is based on: (a) patients' perceptions of how they may feel in the future, and (b) health professionals' and families' interpretations of why desire to die statements may have been made. Several publications provided expert opinion for responding to requests for physician-assisted suicide and euthanasia. In keeping with this limited research base, there is a lack of evidence-based guidelines for clinical care that addresses the desire to die among terminally ill patients. Most literature has focused on discipline specific responses, with minimal exploration of how clinicians might respond initially to a statement from a patient regarding a desire to die. CONCLUSIONS: In order to advance understanding of the complex issue of desire for hastened death in the context of palliative care, research should focus on studies with patients who have actually made a desire to die statement and the development of guidelines to help health professionals respond. Direction for research in this area is described.

Attitude to Death↗
PubMed2006

Responding to desire to die statements from patients with advanced disease: recommendations for health professionals.

It is not uncommon for patients with advanced incurable disease to express a desire to hasten their death. Health professionals often have difficulty responding to such statements, and find it challenging to ascertain why these statements are made. Health professionals may struggle to determine whether a 'desire to die' statement (DTDS) is about a request for hastened death, a sign of psychosocial distress, or merely a passing comment that is not intended to be heard literally as a death wish. Given the lack of guidelines to assist health professionals with this issue, we have prepared multidisciplinary recommendations for responding to a DTDS, underpinned by key principles of therapeutic communication and a systematic review of empirical literature. Where the relevant literature was lacking, the recommendations were drafted by the authors (clinicians and/ or academics from the following disciplines: nursing, medicine, psychiatry, psychology, sociology, aged care and theology), based on their expert opinion. Multiple drafts of the recommendations were circulated to the authors for refinement until consensus was reached. Strategies for advancing the evidence base for the maturation of guidelines in this area are offered.

Attitude of Health Personnel↗
PubMed2006

The role of meaning in advanced cancer-integrating the constructs of assumptive world, sense of coherence and meaning-based coping.

This study used qualitative methods to elicit the thoughts and attitudes of patients with advanced cancer. Our two interrelated aims were to explore how participants experience and apply meaning; and to consider whether this experience can be understood within an integrated framework of assumptive world (AW), sense of coherence (SOC) and meaning-based coping (MBC). Using semi-structured interviews, 26 conversations were held overall with 10 participants. Transcriptions were analysed for themes of lived-experience and for evidence of the principal elements of AW, SOC, and MBC. Findings suggest three interrelated domains that form an adaptive pathway towards coherence and sense of self. While this pathway is essentially linear it is also responsive to the ongoing stressful nature of advanced cancer.

Adaptation, Psychological↗
PubMed2006

Predicting family caregiver psychosocial functioning in palliative care.

BACKGROUND: Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning. PURPOSE: This secondary analysis of baseline data from a larger study sought to determine if it was possible to predict the psychosocial functioning of family caregivers who were supporting a relative with advanced incurable cancer. METHOD: Data from 35 primary family caregivers obtained at the start of home-based palliative care services and five weeks later was used in the analysis. Instruments to measure caregiver preparedness, competence, mastery, social support, anxiety, and self-efficacy were used. RESULTS: Cluster and logistic analyses revealed that self-reported "anxiety" and "competence" subscale total scores at time of commencement of home-based palliative care services were associated with caregivers at risk of lower levels of psychosocial functioning five weeks later. CONCLUSIONS: This study suggests that it may be possible to identify family caregivers who are at risk for poorer psychosocial functioning. However, replication in a larger sample is required before this screening approach can be recommended for clinical use.

Adaptation, Psychological↗
PubMed2005

Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer.

PURPOSE: To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue. PATIENTS AND METHODS: This randomized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers. Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart. Instruments included a numeric rating scale assessing confidence with managing fatigue; 11-point numeric rating scales measuring fatigue at worst, average, and best; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales; the Cancer Self-Efficacy Scale; the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30; and the Hospital Anxiety and Depression Scale. For each outcome, separate analyses of covariance of change scores between baseline (T1) and the three follow-up time points (T2, T3, and T4) were conducted, controlling for the variable's corresponding baseline value. RESULTS: Compared with the intervention group, mean difference scores between the baseline (T1) and immediate after the test (T2) assessments increased significantly more for the control group for worst and average fatigue, Functional Assessment of Cancer Therapy-Fatigue, and Piper fatigue severity and interference measures. These differences were not observed between baseline and T3 and T4 assessments. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue, cancer self-efficacy, anxiety, depression, or quality of life. CONCLUSION: Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term. However, further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue.

Adult↗
PubMed2005

A psycho-educational intervention for family caregivers of patients receiving palliative care: a randomized controlled trial.

This study describes an evaluation of a psycho-educational intervention for family caregivers of patients dying of cancer at home. In a randomized controlled trial, participants (n = 106) received standard home-based palliative care services (n = 52) or these services plus the new intervention (n = 54). Data were collected at three time points: upon commencement of home-based palliative care (Time 1), five weeks later (Time 2), and then eight weeks following patient death (Time 3). No intervention effects were identified with respect to preparedness to care, self-efficacy, competence, and anxiety. However, participants who received the intervention reported a significantly more positive caregiver experience than those who received standard care at both Times 2 and 3. The findings indicate that it is possible to increase caregiver rewards despite being immersed in challenging circumstances that often yield considerable negative psychosocial sequelae. Furthermore, it is feasible for health professionals to discuss emotive topics, such as impending death, with caregivers without adverse effects.

Adult↗
PubMed2004

A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings.

The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies. This randomized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aimed to optimize patients' ability to manage pain. One week post-intervention, patients receiving the pain management intervention (PMI) had a significantly greater increase in self-reported pain knowledge, perceived control over pain, and number of pain treatments recommended. Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain, concerns about addiction and side effects, being a "good" patient, and tolerance to pain relieving medication. The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes, which can potentially act as barriers to effective pain management.

Adult↗
PubMed2004

Meeting the supportive needs of family caregivers in palliative care: challenges for health professionals.

Caring for a dying relative is demanding, and family caregivers have acknowledged many unmet needs associated with their caregiver role. Consistently, caregivers of dying patients with cancer have reported that they need more support and information from health care professionals. Moreover, a number of palliative care clinicians and researchers have called for interventions to enhance the support offered to family caregivers. However, before researchers can develop and test palliative care interventions directed to families, it is important to identify barriers that may confront health care professionals with regard to the provision of supportive family care. For new interventions to be feasible they must be applicable within the constraints of current palliative care service delivery environments. This paper provides an account of issues that may impinge on optimal transference of supportive strategies from health care professionals to family caregivers of patients receiving palliative care. By acknowledging these barriers to supportive care, researchers and health care professionals can begin to design and implement interventions that are clinically relevant and more likely to be effective.

Caregivers↗
PubMed2004

Family caregivers' experiences and involvement with cancer pain management.

The purpose of this descriptive cross-sectional study was to describe family caregiver involvement in and perceptions of cancer pain management. A consecutively recruited cohort of 75 patient-caregiver dyads attending an outpatient oncology clinic completed self-report questionnaires comprising standardized and investigator-developed measures of pain behaviours and experiences. Family caregivers reported high levels of confidence and willingness to participate in pain management, and extensive involvement in pain management activities including supporting, decision making, and communicating about pain. At the same time, many caregivers experienced a great deal of distress and some difficulties in performing these activities. The significance and scope of these caregiving experiences suggest that developing the caregiver's ability to effectively contribute to pain management is an important priority in efforts to improve cancer pain management.

Adult↗
PubMed2002

Exploring documentation of end-of-life care of children with cancer.

This article presents the findings of a study that explored documentation surrounding the end-of-life care of children with cancer. An in-depth history audit of 18 children with cancer, who died from disease progression at a single tertiary paediatric centre during 1999, was performed to explore the extent and the ways in which the shift from cure to palliation was reflected in the child's medical record. The study found that while physical aspects of care were documented there was little evidence of the human-to-human aspects of care or processes of decision-making when cure was no longer a possibility. Relapse and disease progression were identified as critical junctures for families and health professionals and an important area for future research. Further, the medical records documented ill-defined periods of palliation, with the child's approaching death appearing as a gradual awareness rather than a distinct shift in goals of care from cure to palliation.

Adolescent↗