The International Journal of Whole Person Care
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Using the serious illness conversation guide to improve the quality of life of hematology-oncology patients: a pilot study
Get PDFIntroduction:
Hematology-oncology patients are more likely to receive high intensity care (HIC), including ICU admission and active cancer treatment, than solid cancer patients near end of life (EOL). This prevents patients and their families from realistically planning for the future, and diminishes quality of life (QOL). We previously conducted a retrospective study to understand factors influencing HIC outcomes at EOL in hematology patients at McGill-affiliated hospitals. While non-curative goals, early level of intervention (LOI) discussions and palliative care (PC) involvement lowered the likelihood of HIC at EOL, the median time of LOI discussion and PC involvement to death was 22 and 9 days respectively. We hypothesize that a timely discussion aligning patient perspectives and goals with their treating team could improve QOL at EOL.
Methods:
We are conducting a pilot study looking at the impact of using the Serious Illness Conversation Guide (SICG), a validated conversation tool in the general oncology population, on the QOL of hematology patients. Participants are identified by their treating doctor or nurse practitioner to be at risk of dying in the next year. The primary aim is to decrease death in acute care. Secondary aims include reporting other HIC outcomes, time from LOI discussion and PC consult to death, and the short term benefit to QOL. In addition, qualitative analysis will explore participant perspectives on benefits of the SICG and areas to improve, and explore EOL QOL topics relevant to hematology patients. We have currently enrolled 2 patients. Interim analysis is projected for September 2023.
 
Simulating a situation of homelessness: nursing students' perceptions of learning through virtual embodiment
Get PDFIndividuals experiencing homelessness encounter unique challenges in accessing and receiving care in our health systems[1,2,3,4] Preparing emerging health professionals to respond to their complex health needs will require innovative educational approaches that promote person-centered care, and stimulate critical reflection and action towards the personal, interpersonal and structural factors that shape health care delivery.[5,6,7]
This presentation reports on preliminary findings of phase 1 of a critical qualitative case study of nursing student’s perceptions of learning about the experience of homelessness, through a virtual reality educational experience. The study design was informed by critical transformative learning theories and theories of embodiment. Twenty nursing students were engaged in a virtual reality experience of 12 minutes, followed by a 1:1 debrief interview. The debrief interview used an adapted version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework to elicit students’ reflections on the experience. The interviews were audio recorded and transcribed verbatim.
Data analysis involved a process of reading all of the transcripts for a sense of the whole, mindmapping each of the transcripts, identifying themes that permeated the data set, and coding data in Quirkos software. Six preliminary themes include: a) seeing the person through story, b) destabilizing assumptions and questioning stereotypes, c) embodied emotional awareness, d) challenges to care, e) recognizing vulnerability of people experiencing homelessness, and f) quality of the immersive experience in learning.
The findings contribute to our knowledge about virtual reality simulation as an innovative approach to fostering learning about homelessness in health professions education.
 
A Medical Student Study of Rural Health Concerns, Community Determinants and Whole Person Care
No full textBackground: Following a short rural health placement in the second year of medical school five students opted, as an extra-curricular activity, to conduct an exploratory research project into the wellbeing and health concerns of rural residents in the Wheatbelt of Western Australia. The project was conducted in collaboration with the local shires. The aim was to document, analyse and understand the health concerns and experience of rural residents.
Methods: A phenomenological research approach was employed. Seventeen rural residents selected by the shires, and four key informants responded to open-ended interviews. Their narratives were subjected to a thematic analysis.
Results: The narratives described a wide range of health concerns relating to health services, mental illness, transportation, accommodation, marginalisation of the community, bureaucratisation of administration, community fragmentation and the desire for community partnerships. Frustration and inconvenience from community factors were associated with anxiety, depression, isolation, and loss of wellbeing.
Discussion: The respondents described a dysfunctional and under resourced local rural community. They defined numerous health concerns related to deficiencies in community cohesion and integration. They illustrated how whole person health involving prevention, acute and chronic treatment and aged care are all impacted by rural community circumstances. The narratives highlight the need for community development at the population level and for community context to be a principal focus in the clinical practice of whole person care in rural communities.
Reflections on teaching mindfulness to teenagers: from research to clinic
Get PDFIncreased stress reactivity during adolescence has been associated with vulnerability for psychiatric disorders in adulthood and mindfulness-based interventions (MBI) seem to be an option to stress. However, there is still debate on how to best teach MBI to teenagers. For the last 6 years, authors have been proposing the “Mindfulteen” (MT) to teenagers between 12 and 19 years in Geneva. The MT was first applied in different clinical trials and in a qualitative study and, as the results were encouraging, is now proposed in a clinical context at the University Hospital. Authors aim to share here some lessons learned from this experience: 1. Motivation and curiosity are key to engagement, and this is particularly important in school settings; 2. Even if adaptation is needed for different age groups, the program’s core remains easily the same; 3. Short formal practices with not much silence are needed, and metaphors can help; 4. Clarifying the intention of each practice can improve engagement, and the same explicit attitude can be brought into inquiry; 5. A trauma-sensitive approach is crucial, especially in clinical settings; 7. Proposing different versions of the same practice facilitates home practice; 8. Even if participants are not practicing between sessions, it doesn’t mean that they are not integrating mindfulness into their lives; 9. Creative and playful activities can provide rich mindful moments. In conclusion, there are open questions about teaching mindfulness to adolescents and authors believe that sharing and exchanging experiences is important to find some of the answers. 
Why the hermeneutic wager
Get PDFWhile progressing through my ongoing cancer treatments, in particular the reflection or re-reflections guided by Richard Kearney’s hermeneutic wager. I prefer a wager over the traditional cancer metaphors because it replaces the blatant harshness of a battle in a war. I am not saying in any way of form to be a passive observer during one’s cancer treatment journey, but to replace the winner-looser paradigm with carnage associated with war, shrapnel dismembered bodies unrecognizable to themselves and others. This does not mean that I am not standing up to and confronting cancer with vigor and intensity.
The wager offers dignity during participation where all the “cards” are delt from both the cancer and the treatments with the integrity of the whole person who is living with cancer with their healthcare team and family play together as a community to successfully support the wager’s cause. The wager is respectful and addresses the risks involved and is fully c onscientious of outcomes as an unpredictable event. This wager is comprised of five reflections and/or conversations to engage in that I have adapted to learn about living with cancer and its treatments. The hermeneutic wager has five points of reflection: imagination, humility, commitment, discernment, and hospitality. These will be used to provide examples of how to offer insight into one’s experiences. Through these kinds of reflections on cancer, uncertainty can help us develop wings for the journey into the unknown uncertainty that often a diagnosis of cancer requires