Evidence-based practices and competencies in palliative care

Evidence-based practices and competencies in palliative care

The research project Evidence-based Palliative Care and Competence (including end-of-life care, EOL) began in 2018 as a continuation of and complement to the project “Family Members of Cancer Patients in the Acute Care Phase”, which began in the 1990s.

  • The purpose of the project is to define, evaluate and enhance evidence-based palliative care in terms of patient care, families as part of patient care and professional requirements. The ultimate goal is to improve quality of care and patients safety, and to encourage active and equal role of the family and welfare to promote family empowerment.

The study consists of three domains: patient care, families as part of patient care and professional requirements.

The first domain

Patient care

includes ongoing studies related to dignity of care, shared decision-making and advanced care plans. The aims of the domain are:

  • to define and to describe the dying patients’ dignity in palliative hospital care,
  • to explore dying cancer patients’ experiences of encounters with others in palliative and EOL care units,
  • to describe patients´ participation in shared decision making in palliative care and to evaluate patients´ participation in shared decision making,
  • to define evidence-based practices for advance care planning (ACP) and to evaluate their implementation and appropriateness for healthcare professionals, patients, and family members. The aim is also to develop an assessment tool for ACP.

The second domain

Families as part of patient care

consists of studies regarding family participation in palliative patient care in hospitals and at home, psychosocial support interventions for adult family members of palliative care cancer patients in inpatient care, and coping by family members. The aims of the domain are:

  • to evaluate how family is a part of inpatient palliative patient care, to investigate factors related to it and consequences participation may have in an international cross-sectional study
  • to examine the patient’s end-of-life care at home as experienced by family members
  • to develop and evaluate feasibility and effectiveness of a multi-component intervention to promote family as a part of palliative patient care in inpatient settings
  • to develop and evaluate feasible best practices to promote family as a part of palliative patient care

The third domain

Professional requirements

is related to EOL care and palliative care competences, interprofessional competence and nurses’ tasks and attitudes regarding palliative sedation. The aims of the domain are:

  •  to define nursing staffs´ competence demand in palliative care and to evaluate nursing staff’s  competence of palliative care.
  •  to describe interprofessional competence in palliative care and evaluate the level of interprofessional competence
  • to analyze the practices and attitudes of nurses concerning palliative sedation
  • to develop a digital learning environment for cancer patients’ palliative care, and evaluate the effectiveness of digital learning environment to nurses’ knowledge and attitude
  • to describe experiences of nurses from complete care and multi-professional collaboration in end of life care at health centre ward

Phases

Theoretical phase

The research projects will be conducted in four phases: theoretical, instrumentation, evaluation, and development interventions. These phases are described in detail below

The theoretical phase consists of three parts

  1. The systematic literature reviews of evidence-based practices and the competencies required in palliative and end-of-life care.
  2. Empirical data collected through semi-structured interviews with patients and their family members in specialized and primary health care as well as family members who had a loved one die in hospice. Health care professionals will be interviewed individually and in focus groups.
  3. The third part includes the analysis of the content areas of palliative and end-of-life care and competencies through the method of meta-ethnography.

 

 

 

Instrument

In the absence of validated instruments, they ,will be developed. Developing will be based on the results of the theoretical phase. The content areas which were emerged by synthesis will be operationalized and evaluated (content validity) by using delphi- method. Pilot testing will be conducted by health care professionals. Data will be analyzed by using statistical analysis.

Evaluation

Evidence based practices and competence will be evaluated all over Finland as well as in partner countries. The psychometric properties of the instruments will evaluated as well. Data will be collected from patients and family members, and health care professionals in specialized care and in primary health care.

Intervention

A psychosocial supporting nursing intervention for the adult family members of palliative care cancer patients will be developed and to pilot study the feasibility and effectiveness of the intervention.

A digital learning environment of cancer patients´ palliative care will be developed and its effectiveness will be evaluated by using quasi-experimental design.

Principal investigator

Elina Haavisto Professorelina.haavisto@utu.fi

Research team

Professor, PhD, RN Elina Haavisto, University of Turku, Head of the research project
Professor, PhD, RN Kaija Saranto, University of Eastern Finland
Professor, PhD, MD Päivi Korhonen, University of Turku
Docent, PhD, University lecturer Minna Stolt, University of Turku
Principal lecturer, Docent, PhD, RN Satu Elo, Oulu University of Applied Sciences, University of Oulu
PhD, RN, Director Sanna-Mari Pudas-Tähkä, Hospice of Western Finland
MD, special competence in palliative medicine Kristiina Halminen, Hospice of Western Finland
PhD, Development manager Mervi Siekkinen, Turku University Hospital Cancer Centre  and FICAN West
Docent, PhD, Harri Ketamo, University of Tampere
President, Dr.Tech, Docent Jari Multisilta, Satakunta University of Applied Sciences
MNSc, nurse director Tuula Huumonen, Oncology nursing, Hospital District of Satakunta

International partners

Professor Hanne Konradsen, University of Copenhagen, Herlev og Gentofte Hospital
Karolinska Institutet
Associate Professor, Dr Andreas Charalambous Chair, Nursing Department
EONS President, Member of IASLC NAHP Committee, Cyprus University of Technology, Oncology and Palliative Care
Professor Cristina Monforte Royo, Universitat Internacional de Catalunys, Department of Nursing Science
PhD, RN, Rector Ulle Ernits, Nursing College (higher education), Estonia
PhD, RN, Kristi Rannus, Chief Nurse, Oncology and Hematology Clinic, North Estonia Medical Centre
PhD Professor Angela Kydd, Robert Gordon University, Scotland
PhD Professor Catriona Kennedy, Robert Gordon University, Scotland

Post-doc research related to topic

Anne Kuusisto, Advance care plan
PhD, RN Jaana-Maija Koivisto

Doctoral candidates in the programme

Pauliina Kesonen, Interprofessional competence in palliative care
Johanna Aappola, Nursing staffs´ competence in palliative care in primary Health care and developing a competence instrument
Satu Laine, Dying patients’ dignity in palliative hospital care
Lotta Kuosmanen, Patient participation in shared decision making in palliative care
Johanna Kero, Digital learning environment advancing nurse’s knowledge and attitude for cancer patients’ palliative care
Anu Soikkeli-Jalonen, Psychosocial support intervention for adult family members of palliative care cancer patients in inpatient care

Master and bachelor students in the field of the programme (ongoing theses)

Linda Heino, Palliative sedation
Ani Lesonen, End-of-life care in health centers as experienced by nurses
Petra Auramo, Family members’ experiences of end-of-life care at home
Johanna Saarinen, Family participation in palliative patient care in hospital

Graduated doctoral candidates

Anu Soikkeli-Jalonen, Instruments for assessing nurses’ palliative care knowledge and
skills in specialised care setting: An integrative review

 

 

Funded by

State Research Funding (Hospital District of Satakunta)
The Research Foundation for Nursing Education
The Finnish Cultural Foundation
The Finnish Association of Nursing Research
Finnish Nurses Associaton
Doctoral Programme in Nursing Science (DPNurs)
Faculty of Medicine Postgraduate Education Unit (PGE)
Sanni Stenroosin opintorahasto, Eurajoki

 

Publications

Original Scientific Publications in International Peer-Reviewed Journals

Kuusisto A, Santavirta J, Saranto K, Haavisto E Social and health care professionals’ perception of advance care planning for patients with cancer in palliative care. Accepted for publication in Journal Clinical Nursing.

Lemetti T, Hupli M, Partanen E, Haavisto E. Cancer patients’ experiences of realization of relatives’ participation in hospital care: a qualitative interview study. Accepted for publication in Scandinavian Journal of Caring Science.

Haavisto E, Soikkeli-Jalonen A, Tonteri M, Hupli M. 2020. Nurses´ required and-of-life care competence in health centres inpatient ward – a qualitative descriptive study. Scandinavian Journal of Caring Science. https://doi.org10.1111/scs.12874.

Kuusisto A, Santavirta J, Saranto K, Korhonen P, Haavisto E. 2020. Advance care planning in cancer patient palliative care: A scoping review. Journal of Clinical Nursing. https://doi.org 10.1111/jocn.15216.

Soikkeli-Jalonen A, Stolt M, Hupli M, Lemetti T, Kydd A, Kennedy C, Haavisto E. 2019. Instruments for assessing nurses´ palliative care knowledge and skills in specialised care setting: an integrative review. Journal of Clinical Nursing. https://doi.org 10.1111/jocn.15146.

Partanen E, Klemetti T, Haavisto E. 2018. Participation of relatives in the care of cancer patients: a scoping literature review. European Journal of Cancer Care. https://doi.org 10.1111/ecc.12821.

Eriksson E, Arve S, Lauri S. 2006. Informational and emotional support received by relatives before and after the cancer patient’s death. European Journal of Oncology Nursing 10, 48–58.

Hokkanen H, Eriksson E, Ahonen O, Salanterä S. 2004. Adolescents with cancer: Experience of life and how it could be made easier. Cancer Nursing 27(4): 325–35.

Sainio C, Eriksson E. 2003. Keeping cancer patients informed: A challenge for nursing. European Journal of Oncology Nursing  7(1): 39–49.

Eriksson E, Somer S, Lauri S. 2002. How elatives adjust following the death of a cancer patient in hospice. Cancer Nursing 24(6): 436-45.

Sainio C, Eriksson E, Lauri S. 2001. Patient participation in decision making about care. The cancer patient’s point of view. Cancer Nursing 24(3): 172–79.

Sainio C. Lauri S, Eriksson E. 2001. Cancer Patients’ views and experiences of participation in decision making, Nursing Ethics 8(2): 97–113.

Eriksson E. 2001. Caring for cancer patients. Relatives’ assessments of received care. European Journal of Oncology Nursing 10: 48–55.

Eriksson E, Lauri S. 2000. Informational and emotional support for cancer patients’ relatives. European Journal of Cancer Care 9: 8-15.

Eriksson E, Lauri S. 1999. Participation of relatives in the care of cancer patients. European Journal of Oncology Nursing 4(2): 99–107.

Kero J, Koivisto J-M, Lee S, Haavisto E. Dyspnoea care for patients with cancer in hospital palliative care wards: a qualitative study of nurses perspectives. Submitted.

Heino L, Stolt M, Haavisto E. Nurses` practice and attitudes regarding palliative sedation: A scoping review. Submitted.

Eriksson S, Soikkeli-Jalonen A, Koivisto J-M, Cleland Silva T, Kausamo K, Haavisto E. Encounters of dying cancer patient in palliative care units. Submitted.

Soikkeli-Jalonen A, Mishina K, Virtanen H, Charalambous A, Haavisto E. Supporting interventions for loved ones of palliative care patients in inpatient care – A systematic review Submitted.

Kuosmanen L, Hupli M, Ahtiluoto S, Haavisto E. Patient participation in shared decision making in palliative care – an integrative review. Submitted.

 

Conference abstracts

Läheisen kokemuksia syöpää sairastavan potilaan kotisaattohoidosta – integratiivinen kirjallisuuskatsaus. Auramo P, Vierula J, Stolt M, Haavisto E. XVI Kansallinen hoitotieteellinen konferenssi perustutkimuksesta innovaatioihin hoitotieteessä Kuopio 30.9.-1.10.2020.

Sairaalahoidossa olevien syöpää sairastavien kuolevien potilaiden kokemia kohtaamisia. Eriksson S, Soikkeli-Jalonen A, Koivisto J- M, Cleland S, Haavisto E. XVI Kansallinen hoitotieteellinen konferenssi perustutkimuksesta innovaatioihin hoitotieteessä Kuopio 30.9.-1.10.2020.

Ennakoiva hoitosuunnitelma syöpää sairastavan potilaan palliatiivisessa hoidossa – Scoping review. Kuusisto A, Santavirta J, Saranto K, Korhonen P, Haavisto E. XVI Kansallinen hoitotieteellinen konferenssi perustutkimuksesta innovaatioihin hoitotieteessä Kuopio 30.9.-1.10.2020.

Partanen E, Lemetti T, Haavisto E. Omaisen osallistuminen syöpäpotilaan hoitoon sairaalassa–  scoping katsaus. XV Kansallinen hoitotieteellinen konferenssi 26.-27.9.2019, Vaasa.

Tonteri M, Hupli M, Haavisto E. Sairaanhoitajien saattohoito-osaaminen terveyskeskussairaalassa. XV Kansallinen hoitotieteellinen konferenssi 26.-27.9.2019, Vaasa.

Partanen E, Hupli M, Lemetti T, Haavisto E. Omaiset osallistumassa hoitoon sairaalassa -syöpäpotilaiden kokemuksia. Tutkimustieto hoitotaidoksi: Hoitotyön tutkimuksen 18. vuosipäivä 2019.

Haavisto E, Soikkeli-Jalonen, Stolt M, Hupli M, Lemetti, Kennedy C, Kydd A.  Sairaanhoitajalta edellytettävät tiedot ja taidot palliativisessa hoidossa – integroitu katsaus arviointimittareista. Satakunnan sosiaali-, terveys- ja hyvinvoinnin tutkimuksen päivä 21.2.2020. Porin yliopistokeskus, Pori.

Kuusisto A, Korhonen P, Santavirta J, Saranto K, Haavisto E. Ennakoiva hoitosuunnitelma syöpää sairastavan potilaan palliatiivisen hoidon jatkuvuuden turvaajana – kartoittava kirjallisuuskatsaus. Satakunnan sosiaali-, terveys- ja hyvinvoinnin tutkimuksen päivä. 21.2.2020. Porin yliopistokeskus, Pori.

Kesonen P, Salminen L, Haavisto E. Moniammatillinen yhteistyö ja sen edellyttämä osaaminen palliatiivisen hoidon yksiköissä – kirjallisuuskatsaus. Satakunnan sosiaali-, terveys- ja hyvinvoinnin tutkimuksen päivä 21.2.2020. Porin yliopistokeskus, Pori.