The International Journal of Whole Person Care
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Bringing diversity of experience into decision-making about surgery: developing an app for that
Get PDFObjectiveTo design and pilot a mobile application to support decision-making about surgery for breast cancer patients, drawing from a collection of narratives from a diverse sample of Canadian women that used video/audio recordings (published on www.healthexperiences.ca). BackgroundThis idea came from the results of a larger research project where we collected a wide range of women’s stories about having breast cancer using qualitative research methods and video/audio recording. The women we interviewed for this project said that they felt overwhelmed by the amount of information in the period between diagnosis and surgery, and at the same time they felt they needed more specific information relevant to their needs, personal situation and preferences. They also wanted to learn from other women’s experiences of surgery. This project therefore aims to develop an information tool that can respond to that need by offering information in a more personalized manner. This project is funded by the QBCF [Quebec Breast Cancer Foundation]. MethodsSecondary analysis of existing data. Development of recommender system. Design and evaluation involving patients, clinicians and informatics experts. ResultsWe will present our analysis regarding women’s experiences related to surgery, decision-making, preferences and expectations, and need for experiential information. We will then present the development to date of a personalized information application using a computerized recommender system, including a summary of challenges and opportunities encountered along the way. ConclusionDeveloping reliable, evidence-based tools and electronic applications based on other peoples’ experiences offers a novel approach to support informed healthcare decision-making
Mindfulness group for mentally ill patients in remission
Get PDFFor the last four years the Institut de Pleine Conscience Appliquée de Montréal (IPCAM) and the Department of Psychiatry of the St. Mary Hospital Center, an affiliated McGill Community Hospital, have been offering a weekly 140 minutes session to mentally ill patients in remission. The sessions are held outside the hospital in the institute.The objectives of the authors are:1. To empower the Health Care Professionals (HCP) and the Expert in Mindfulness (EIM) to start such a co-op group for patients who otherwise might feel unable to discuss their mental health problems while trying to integrate mindfulness practice.2. To describe the outlines of such a group, such as the referral forms, the expected goals for attendance, the meditation exercises and some particular aspects of the sharing periods.3. To propose to the HCP and the EIM some practical tips in order to orient the patients in healthy habits of acceptance of themselves rather than maintaining themselves in maladaptive thoughts, emotions and behaviours. As we all know people who have had a difficult childhood could use mindfulness inadvertently for avoidance rather than acceptance.4. Finally to share with the HCP and the EIM the enriching experience of such a co-op group for the leaders as much as for the participants
Conversations that count: Advance Care Planning as preventative medicine
Get PDFBackground: Fundamental to the concept of Advance Care Planning (ACP) is empowering individuals and communities to recognise death as an inevitable part of life.Methods: ACP facilitators and clinical champions in the Canterbury region of New Zealand have been very active in engaging the community. This has occurred through consumer presentations, the creation of specific pages on the Canterbury District Health Board (CDHB) consumer information website (HealthInfo) and support of the National ACP awareness campaign ‘Conversations that Count’.Results: ‘Consumer power’ has been invaluable in driving the uptake of ACP in the CDHB. A survey of 49 GPs in 2015 found many were reluctant to start ACP conversations or felt they ‘did not have time’. The turning point was the realisation that patients are not only wanting but are actively asking to have these important conversations and to create Advance Care Plans (ACPlans). 1200 electronic ACPlans have now now been created in Canterbury, with 80% generated in primary care.The ACP pages on HealthInfo are consistently in the top 20 pages viewed each month which indicates that the community is seeking information and wanting to take control. Uptake and demand for consumer presentations and ‘Conversations that Count’ resources also continues to grow year on year.Discussion: Increased awareness and understanding of ACP gives people the opportunity to think and frame their reasoning, so they are better prepared to have well informed discussions with health care professionals. It helps them be clearer in their mind about their own limits and concerns. It is important for people to consider the question - “what is O.K for me and what isn’t?”. In this context, ACP conversations can be seen as preventative medicine.Patients need to be as well equipped as possible to be active participants in healthcare decisions, especially regarding end of life. Through the ACP process, unnecessary suffering, confusion and conflict can be reduced or prevented and unwanted or burdensome treatment that is not in line with their goals and priorities can be averted.Conclusion: Valuing and honouring a person’s participation in their health care decision-making is important for all healthcare organisations. Prioritising ACP is an effective way of making this happen.
A new communication skills training program for palliative care fellow-physicians
Get PDFThis presentation describes a novel educational program associated with a Palliative Care Post-Graduate Medical Fellowship embedded within a university teaching hospital. The educational objectives of this program will be presented, as will the pedagogical methods and initial trainee responses to this program. Grounded in both an action-reflection model, as well as the discrimination model of clinical supervision (Bernard & Goodyear, 2009), the objective of this new program is to help physicians develop their clinical skills in understanding and negotiating the complex psychosocial issues associated with advanced cancer care. Secondary objectives include developing increased self-awareness in the domains of death, dying, bereavement and supportive counselling. This program was constructed in parallel with the learning objectives of two Canadian accreditation bodies in Palliative Medicine and was drawn on an established Spiritual Care pedagogical method for tertiary health care settings (Lambert, 2013). Training includes two 90 minute bi-monthly meetings, comprising either a verbatim case report or a reflective practice group. In the former, medical fellows presented a case to a peer-group that centered largely on psychological and not medical issues. Fellows receive feedback on their communication skills, as well as on case conceptualization and treatment planning. Trainees also participate in a reflective practice group to provide an additional opportunity to deepen self-awareness, as well as reflect on how their attitudes, values and assumptions affect the role of a palliative care physician. The presentation will also report initial trainee responses to the program based on exit interviews. This training model can also easily be transferred to the training of various health care disciplines associated with palliative care. Considerations for adjustment of the program to other practice settings will be encouraged from attendees. The syllabus for the program will be provided upon request. Pedagogical methodsA didactic approach will be used to outline the basic structure of the program. To illustrate the intersections of theory and practice, the workshop will include presentations of several group case vignettes. Participants will be invited to provide feedback on the potential strengths and limitations of this program. Expected outcomesPeople attending this workshop will obtain practical information concerning a new communication skills training program, as well as techniques and strategies they may wish to bring to their particular practice setting. This training model can also easily be transferred to the training of various health care disciplines associated with palliative care
Mindful Leadership in Interprofessional Teams
Get PDFIn interprofessional health teams the need for coordinating leadership and the (dynamical) need for appropriate clinical expertise to come to the fore involves a tension between the traditional role of the team leader as authority figure and the collaborative leadership which enables individual team members to emerge as leaders in their area of expertise and to relinquish this leadership as needed. Complexity analysis points to an understanding of leadership as an emergent property of the team. We discuss how a framework of mindful leadership addresses the implications of this emergent leadership model, and how Appreciative Inquiry provides a structured process for examination of team vision, values and behaviour standards
Exploration of Touch in Faculty of Medicine? Presentation and exploration of touch and perspective in practice
Get PDFIn the medical profession, doctors are called in different ways to touch the patient: from the simple handshake to body examinations or sometimes a simple touch of the hand on a shoulder showing support and comforting. Touching does not necessarily mean being in an interpersonal contact of quality with someone. Yet reflection on touch is nearly absent from medical training. This workshop aims to promote awareness of the following: how to touch, feeling the contact with other and being touched ourselves. It is an introductory class on awareness of the elements involved in a quality touch that can confirm the other person in his/her personal integrity and dignity. Awakening the “Sensible” Being (ASB) is a formative practice geared toward care giving and support that includes manual practice. It examines how experiencing one’s own body and its movement stimulates the development of self-awareness and awareness of others, both of which are desirable qualities for healthcare professionals. Through exercises, the participants will be able to explore touch in general and with ASB protocols. We will use also time of reflexivity and of writing about the experience. The workshop will be divided as follows: 1) Introduction: Theorical perspectives and Phenomenology of touch and “being in contact”. 2) Experiential: time in class will be alternating between exploration of different types of touch, interspersed with short writing periods on the lived experience. 3) Conclusion: time to share our lived experiences, and presentation of the results from a research done on ASB (Lachance, 2016).
Playing jeopardy by not treating the whole person with arthritis
Get PDFAvailability of potent medications, earlier diagnosis and use of drug combinations should have made rheumatoid arthritis yesterday’s disease. Unfortunately the majority of patients never reach remission. The focus of treatment has been based on the biomedical model aiming to reduce inflammation, regulate the immune system, and prevent joint damage – all worthy outcomes. A whole person care approach would add to patient care by including attention to the psychosocial aspects of illness that contribute to clinical outcomes. Two studies using data from a longitudinal cohort followed out to four years with early arthritis patients will be highlighted. The first identified predictors of pain one year after baseline in 211 patients. While overall pain decreased over time, emotion-oriented coping contributed to pain intensity and affective pain. The second study examined the link between depression and clinical outcomes four years later using data from 275 patients. It was found that when depression persisted into the first year it was the most potent predictor of disease activity at each follow-up visit. Moreover, the proportion of patients who ever reached remission decreased from 84.3% to 31.3% for patients with depressive symptoms at 12 months. vailability of potent medications, earlier diagnosis and use of drug combinations should have made rheumatoid arthritis yesterday’s disease. Unfortunately the majority of patients never reach remission. The focus of treatment has been based on the biomedical model aiming to reduce inflammation, regulate the immune system, and prevent joint damage – all worthy outcomes. A whole person care approach would add to patient care by including attention to the psychosocial aspects of illness that contribute to clinical outcomes. Two studies using data from a longitudinal cohort followed out to four years with early arthritis patients will be highlighted. The first identified predictors of pain one year after baseline in 211 patients. While overall pain decreased over time, emotion-oriented coping contributed to pain intensity and affective pain. The second study examined the link between depression and clinical outcomes four years later using data from 275 patients. It was found that when depression persisted into the first year it was the most potent predictor of disease activity at each follow-up visit. Moreover, the proportion of patients who ever reached remission decreased from 84.3% to 31.3% for patients with depressive symptoms at 12 months. It is recommended that both curing and healing be considered when treating arthritis patients given the importance of psychosocial factors to the trajectory of the disease. This could be done by screening for and treating depression in arthritis patients. Antidepressant medications and/or psychological interventions such as Mindfulness-Based Stress Reduction or Cognitive Behavioural Therapy are options to be considered
Beyond numbers: learning from the experience of kidney-transplant recipients
Get PDFThe present article presents the findings of a phenomenological study, which sought to explore the subjective experience of kidney transplantation amongst young people who lived the transition from pediatric to adult care. This study was conducted using a qualitative phenomenological approach, involving semi-directed interviews with five people, three of whom received their kidney transplants as children, the other two as young adults. An in-depth analysis of their narratives revealed the paradoxical nature of the kidney transplant experience for these individuals; existing between self and other, sickness and health, and at times, between life and death. The liminal nature of transplantation was found to be an important quality of the experience, thus leading to an analysis of the experience in relation to the theoretical concepts of liminality and rites of passage. This analysis culminates in the introduction of the term transliminal-self, to encompass the complexity of the experience. Finally, the article concludes with a discussion regarding the relevance of the subjective experience for the practice of medical and allied health professionals who work with transplant recipients.
