Publications by authors named "Ashley Pope"
Background: Although early palliative care is linked to improved health-related quality of life, satisfaction with care, and symptom management, the clinical strategies that nurses use to actively initiate this care are unknown.
Objectives: The aims of this study were to conceptualize the clinical strategies that outpatient oncology nurses use to introduce early palliative care and to determine how these strategies align with the framework of practice.
Methods: A constructivist-informed grounded theory study was conducted in a tertiary cancer care center in Toronto, Canada.
Article Synopsis
- The study looked at a new way to give early palliative care to adults with serious cancer, comparing it to regular symptom checks.
- 69 patients were involved, and those in the palliative care group got more help than those with just regular care.
- Early results showed that patients liked the new method and found it helpful for discussing their symptoms, which will help in planning future studies.
Context: Early palliative care (EPC) is widely recommended but its implementation may be challenging.
Objectives: We conducted a qualitative analysis of Canadian palliative care physicians' opinions about conditions necessary to provide EPC.
Methods: A survey assessing attitudes and opinions regarding EPC was distributed to physicians providing primary or specialized palliative care, as identified by the Canadian Society of Palliative Care Physicians.
Background: Family physicians' (FPs) long-term relationships with their oncology patients position them ideally to provide primary palliative care, yet their involvement is variable. We examined perceptions of FP involvement among outpatients receiving palliative care at a cancer center and identified factors associated with this involvement.
Methods: Patients with advanced cancer attending an oncology palliative care clinic (OPCC) completed a 25-item survey.
Public interest in medical assistance in dying and palliative care.
BMJ Support Palliat Care
December 2022
Objectives: Medical assistance in dying (MAiD) is legal in an increasing number of countries, but there are concerns that its availability may compromise access to palliative care. We assessed public interest in MAiD, palliative care, both, or neither, and examined characteristics associated with this interest.
Methods: We surveyed a representative sample of the adult Canadian public, accessed through a panel from May to June 2019.
Background: Early palliative care (EPC) improves the quality of life but may not be feasible for all patients with advanced cancer. Symptom screening has been suggested to triage patients for EPC, but scant evidence exists for this practice.
Methods: We conducted a subgroup analysis of a cluster-randomized controlled trial of EPC vs.
Palliative medicine outpatient clinic 'no-shows': retrospective review.
BMJ Support Palliat Care
November 2021
Article Synopsis
- Some patients didn't show up for their appointments at a cancer support clinic, which can mean they have unmet medical needs.
- Researchers looked at why these no-shows happened by comparing them to patients who did attend.
- They found that no-shows were often younger, lived farther away, and did not do as well health-wise, showing they needed new ways like virtual visits to help them attend.
Objective: WHO recommends early integration of palliative care alongside usual care to improve quality of life, although misunderstanding of palliative care may impede this. We compared the public's perceived and actual knowledge of palliative care, and examined the relationship of this knowledge to attitudes concerning palliative care.
Methods: We analysed data from a survey of a representative sample of the Canadian public, accessed through a survey panel in May-June 2019.
Purpose: We investigated relationships between domains of quality of dying and death in patients with advanced cancer and their caregivers' bereavement outcomes and the moderating effect of patient age at death.
Methods: Bereaved caregivers of deceased patients with advanced cancer who had participated in an early palliative care trial completed measures of grief (Texas Revised Inventory of Grief [TRIG]), complicated grief (Prolonged Grief Inventory [PG-13]), and depression (Center for Epidemiologic Studies-Depression [CESD-10]). They also completed the Quality of Dying and Death measure (QODD), which assesses patients' symptom control, preparation for death, connectedness with loved ones, and sense of peace with death.
Background: Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial.
Methods: Patients with advanced cancer were recruited from medical oncology clinics.
Early palliative care and quality of dying and death in patients with advanced cancer.
BMJ Support Palliat Care
October 2023
Objective: Early palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients' QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care.
Method: Bereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU).
Background: Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence.
Materials And Methods: Administrative databases were reviewed for two cohorts of patients: the pre-evidence cohort was seen in outpatient palliative care between June and November 2006, and the post-evidence cohort was seen between June and November 2015.
Purpose: To evaluate factors associated with continuation of systemic anti-cancer therapy (SACT) after palliative care consultation, and SACT administration in the last 30 days of life, in outpatients with cancer referred to palliative care. Timing of referral was of particular interest.
Methods: Patient, disease, and treatment-related factors associated with SACT before and after palliative care, and in the last 30 days of life, were identified using 3-level multinomial logistic regression.
Background: Although outpatient palliative care clinics (OPCCs) provide a venue for early, pre-emptive referral to palliative care on a routine basis, some patients will continue to require urgent referrals. The purpose of this study was to characterise these urgent referrals to determine whether they reflect clinical need or convenience.
Methods: We retrospectively compared new patients in an OPCC who were seen urgently versus those seen at routine appointments.
We investigated correspondence between symptom severity and symptom bothersomeness in patients with advanced cancer. Symptom severity is commonly assessed in clinical cancer settings, but bothersomeness of these symptoms is less often measured. Participants with advanced cancer enrolled in a cluster-randomized trial of early palliative care completed the Edmonton Symptom Assessment System (ESAS) and the quality of life at the end of life (QUAL-E) measure as part of their baseline assessment.
View Article and Find Full Text PDFFactors associated with discharge disposition on an acute palliative care unit.
Support Care Cancer
November 2018
Purpose: Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients' discharge disposition on an APCU in a cancer center.
View Article and Find Full Text PDFBackground: Contact with bereaved caregivers is not standard practice among cancer physicians, and little is known about its impact on caregivers.
Objective: Our aim was to describe the experiences and opinions of caregivers regarding bereavement contact from healthcare providers (HCP).
Design: Semistructured qualitative interviews were conducted with 61 bereaved caregivers.
Background: Although timely palliative care is recommended for patients with advanced cancer, referrals to palliative care services are often late.
Objectives: To identify factors associated with early referral to an oncology palliative care clinic and to describe symptom severity according to timing of referral.
Design: We conducted a retrospective review of 337 patients with advanced cancer referred to outpatient palliative care at a comprehensive cancer center.
Context: Performance status measures are increasingly completed by patients in outpatient cancer settings, but are not well validated for this use.
Objectives: We assessed performance of a patient-reported functional status measure (PRFS, based on the Eastern Cooperative Oncology Group [ECOG]), compared with the physician-completed ECOG, in terms of agreement in ratings and prediction of survival.
Methods: Patients and physicians independently completed five-point PRFS (lay version of ECOG) and ECOG measures on first consultation at an oncology palliative care clinic.
Objective: To describe bereaved caregivers' experiences of providing care at home for patients with advanced cancer, while interacting with home care services.
Methods: Caregivers of patients who had completed a 4-month randomized controlled trial of early palliative care versus standard oncology care were recruited 6 months to 5 years after the patient's death. All patients except one (control) had eventually received palliative care.
Background: Early involvement of palliative care improves patient quality of life; however, quantitative studies have not yet demonstrated a similar effect for caregivers, for whom the construct of quality of life is less well developed.
Aim: To conceptualise quality of life of caregivers from their own perspective and to explore differences in themes between those who did or did not receive an early palliative care intervention.
Design: Qualitative grounded theory study.
Background: Early palliative care improves quality of life and satisfaction with care and is increasingly endorsed for patients with advanced cancer. However, little is known about the experience of receiving early palliative care from a patient and caregiver perspective.
Aim: The aim of this qualitative study was to determine, from a participant perspective, the experience of receiving early palliative care and elements of that care.
Introduction: Early integration of palliative care alongside oncology is being increasingly recommended, although the strategies and models for integration remain poorly defined. We solicited the opinions of patients and caregivers who participated in a randomized trial of early palliative care versus standard oncology care, regarding the respective roles of their oncologist (both groups) and palliative care physician (early palliative care group).
Materials And Methods: The study was performed at a comprehensive cancer center.
Context: The Edmonton Symptom Assessment System (ESAS) measures the severity of nine symptoms. Constipation and sleep disturbance are common in patients with cancer, but are not currently included in the ESAS.
Objectives: To validate the numerical rating scale (NRS) versions of ESAS and its revised version (ESAS-r), with the additional symptoms of constipation and sleep (CS), and to assess patient preference for either version.