The purpose of this study was to describe pediatric oncology nurse managers' (NMs) perspectives of palliative care/end-of-life (PC/EOL) communication. The study, guided by group-as-a-whole theory and empirical phenomenology, was part of a larger, multisite study aimed at understanding pediatric oncology nurses' experiences of PC/EOL communication. Nurses were assigned to focus groups based on length or type of experience (i.e., nurses with 5 years' work experience and NMs). Eleven NMs from three Midwestern pediatric hospitals with large oncology programs participated in one focus group. The participants' mean years of experience was 15.8 in nursing and 12 in pediatric oncology; 90% had a BSN or higher degree; all had supervisory responsibilities. The authors identified 2,912 meaning statements, which were then analyzed using Colaizzi's method. Findings include NMs' overall experience of "Fostering a Caring Climate," which includes three core themes: (1) Imprint of Initial Grief Experiences and Emotions; (2) Constant Vigilance: Assessing and Optimizing Family-Centered Care; and (3) Promoting a Competent, Thoughtful, and Caring Workforce. Findings indicate that pediatric oncology NMs draw on their own PC/EOL experiences and their nursing management knowledge to address the PC/EOL care learning needs of nursing staff and patient/family needs. NMs need additional resources to support nursing staff's PC/EOL communication training, including specific training in undergraduate and graduate nursing programs and national and hospital-based training programs.
Medical decision making in the context of serious illness ideally involves a patient who understands his or her condition and prognosis and can effectively formulate and communicate his or her care preferences. To understand the relationships among these care processes, we analyzed baseline interview data from veterans enrolled in a randomized controlled trial of a palliative care intervention. Participants were 400 inpatient veterans admitted with a physician-estimated risk of one-year mortality more than 25%; 260 (65%) had cancer as the primary diagnosis. Patients who believed that they had a life-limiting illness (89% of sample) reported that their provider had communicated this to them more frequently than those who did not share that belief (78% vs. 22%, P
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Bible Translation Basics accomplishes two things: 1) it expresses these theoretical developments in communication at a basic level in non-technical language, and 2) it applies these developments to the task of Bible translation in very practical ways. Tried and tested around the world, people with a secondary school education or higher are able to understand how communication works and apply those insights to communicating Scripture to their audiences. Bible Translation Basics helps translators work with language communities to determine the kind of Scripture product(s) that are most relevant for them, given their abilities and preferences.
Herein, we discuss current available information on these interactions in breast cancer chemo-resistance. It is acknowledged that stromal cells extrinsically alter tumor cell drug responses with profound consequences for therapy efficiency, and it is therefore essential to understand the molecular mechanisms which contribute to these substantial alterations because they provide potential targets for improved cancer therapy. Although breast cancer patient survival has improved over the last decades, chemo-resistance still remains a significant obstacle to successful treatment.
To improve insight into tumor development and chemotherapeutic approaches, it is most important to understand the interplay between specific TME components, the associated cellular communication processes and resultant interactions of this network between cancer cells and the various tumor-associated cell populations. Here, we focus on the molecular communication between stromal cells, mainly MSCs and breast cancer cells, and the cell-to-cell signaling role and its effect on chemotherapy efficiency.
Future cancer therapy success depends on thoroughly understanding the many complex mechanisms involved, and establishing the pathways prominent in resistance to anti-cancer treatment. Developing methods of targeting them is then essential. There is also rapidly increasing research on the tumor micro-environment (TME) and its role in chemo-resistance acquisition, subsequent treatment failure and cancer recurrence. It is therefore critical that the TME is acknowledged as an important cancer-target strategy, and that further TME investigation is initiated.
Finally, recent research stresses that stromal-cell-mediated protection against cytotoxic drugs requires both secretory proteins and direct cell-cell interactions. Therefore, further research into these processes is anticipated to provide better understanding of their effects on therapy resistance and hasten the design of effective therapeutic strategies and personalized regimens for breast-cancer patients.
Communication errors among health care providers are complicated by a hierarchical reporting structure, gender, education, cultural background, stress, fatigue, ethnic differences, and social structure [2, 15,16,17,18]. It is reported that differences in communication styles between nurses and physician are one of the contributing factors to the communication errors . Nurse-physician communication is subject to the effects of differences in training and reporting expectations . A structured communication tool would be beneficial to effectively communicate the patient information, reduce the adverse events, promote patient safety, improve the quality of care, and increase health care provider satisfaction. The aim of this paper is to review the challenges of communication among health care providers in clinical setting, to review the use of the standardized Situation, Background, Assessment, Recommendation (SBAR) communication tool during handoff, and to compare the SBAR tool with other communication tools to assess the communication during patient handoff.
Adams and colleagues conducted a study to compare the D-BANQ (Demographics and Stability, Before I Began to Provide Care, As I Provided Care, and Next Care Provider, Needs to Know, Question) communication tool with WHO-SBAR (SBAR tool recommended by WHO) and CDPH-TJC (Joint Commission Communication During Patient Handoff). This study resulted in an alternative structure for handoff, D-BANQ, which aligns with WHO-SBAR and TJC-CDPH handoff structures and provides an easy-to-follow chronological format for the content that nurses identified as necessary to communicate during nursing activity. This study is supportive of both the WHO-SBAR and the TJC-CDPH structures for nursing handoff, and D-BANQ format provides additional refinement and clarification in communication thereby preventing errors and maximizing patient safety during handoff .
This narrative review identifies the challenges faced by health care providers during daily transfer of patient care and provides broader use of the SBAR communication tool for patient handoff in various health care settings including acute care. Another strength of this review is to provide greater insight into the SBAR tool by identifying the studies which have compared the SBAR tool with other communication tools for patient handoff as such readers can have a better understanding of SBAR tool usage.
Thus, in order to improve intervention design, we need a systematic method that incorporates an understanding of the nature of the behaviour to be changed, and an appropriate system for characterising interventions and their components that can make use of this understanding. These constitute a starting point for assessing in what circumstances different types of intervention are likely to be effective which can then form the basis for intervention design.
There are a number of possible objections to attempting to construct the kind of behavioural model described and link this to intervention types. The most obvious criticism is that the area is too complex and that the constructs too ill-defined to be able to establish a useful, scientifically-based framework. Another is that no framework can address the level of detail required to determine what will or will not be an effective intervention. The response to this is twofold: these are empirical questions and there is already evidence that characterising interventions by behaviour change techniques (BCTs) can be helpful in understanding which interventions are more or less effective [6, 17]; and not to embark on this enterprise is to give up on achieving a science of behaviour change before the first hurdle and condemn this field to opinion and fashion.
Several things became apparent when reviewing the frameworks. First of all, it was clear it would be necessary to define terms describing categories of intervention more precisely than is done in everyday language in order to achieve coherence. For example, in everyday language 'education' can include 'training,' but for our purposes it was necessary to distinguish between 'education' and 'training' with the former focusing on imparting knowledge and developing understanding and the latter focusing on development of skills. Similarly we had to differentiate 'training' from 'modelling.' In common parlance, modelling could be a method used in training, but we use the term more specifically to refer to using our propensity to imitate as a motivational device. A third example is the use of the term 'enablement.' In everyday use, this could include most of the other intervention categories, but here refers to forms of enablement that are either more encompassing (as in, for example, 'behavioural support' for smoking cessation) or work through other mechanisms (as in, for example, pharmacological interventions to aid smoking cessation or surgery to enable control of calorie intake). There is not a term in the English language to describe that we intend, so rather than invent a new term we have stayed with 'enablement.' 2b1af7f3a8