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1. Person-Centered Palliative Care

Author

Spruijt, Odette, Manyari, Dante E., Halpin-Evans, Rachel, Glare, Paul, Mezzich, Juan E., editor, Appleyard, W. James, editor, Glare, Paul, editor, Snaedal, Jon, editor, and Wilson, C. Ruth, editor

Published
2023
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2. The empty-handed doctor : responding to the suffering of patients approaching the end of life

Author

Spruijt, Odette

Subjects
616.02
Abstract

The relief of suffering is at the heart of palliative care practice. Yet there has been little exploration of how palliative care doctors, working in different countries and cultures, recognise and respond to their patients’ suffering. This research sought to develop a deeper understanding of suffering in the palliative care context, as witnessed by doctors in India and Australia. Through narrative interviews, 18 doctors spoke of how they recognised suffering, and what it meant to them to respond to suffering. The narratives chosen for analysis spoke to the dialogical encounter in which doctors sought to connect with their patients in common humanity, to recognise the particular nature of suffering and to meet in an intersubjective, relational space. The concept of intersubjectivity provided a lens for analysis of these narratives. Here, ‘intersubjective’ is used to describe the interhuman experience in which the subjectivities of ‘I’ and ‘Thou’, described in Martin Buber’s dialogical ontology, are brought to the encounter. I use the term ‘dialogical encounter’ to describe the meaningful connection between doctor and patient, as experienced by the doctor, where there is a sense of recognition of the ‘other’ and possible emergence of the ‘in-between’ realm (Buber, 1970). A key finding is that the relief of suffering in palliative care involves dialogical encounter between doctor and patient. In this in-between realm of interhuman encounter, suffering is transformed or relieved through the recognition and confirmation of the person who is suffering. Rather than being unidirectional, dialogical encounter is mutual, with the doctor also receiving from the patient, within the normative limits of the therapeutic relationship. The cultural differences apparent in suffering between India and Australia were unified in the experience of dialogical encounter by doctors in both countries. This thesis reinforces the primacy of the doctor–patient relationship in the relief of suffering and encourages renewed attention to preserving the conditions for the flourishing of this relationship in modern medical practice.

Published
2020
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4. Redefining Palliative Care—A New Consensus-Based Definition

Author

Radbruch, Lukas, De Lima, Liliana, Knaul, Felicia, Wenk, Roberto, Ali, Zipporah, Bhatnaghar, Sushma, Blanchard, Charmaine, Bruera, Eduardo, Buitrago, Rosa, Burla, Claudia, Callaway, Mary, Munyoro, Esther Cege, Centeno, Carlos, Cleary, Jim, Connor, Stephen, Davaasuren, Odontuya, Downing, Julia, Foley, Kathleen, Goh, Cynthia, Gomez-Garcia, Wendy, Harding, Richard, Khan, Quach T., Larkin, Phillippe, Leng, Mhoira, Luyirika, Emmanuel, Marston, Joan, Moine, Sebastien, Osman, Hibah, Pettus, Katherine, Puchalski, Christina, Rajagopal, M.R., Spence, Dingle, Spruijt, Odette, Venkateswaran, Chitra, Wee, Bee, Woodruff, Roger, Yong, Jinsun, and Pastrana, Tania

Published
2020
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5. Facilitators of palliative care quality improvement team cohesion

Author

Connell, Natalie B., primary, Zupanc, Sophia N., additional, Lorenz, Karl A., additional, Bhatnagar, Sushma, additional, Fereydooni, Soraya, additional, Gamboa, Raziel C., additional, Ganesh, Archana, additional, Satija, Aanchal, additional, Singh, Nainwant, additional, Spruijt, Odette, additional, and Giannitrapani, Karleen F., additional

Published
2023
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6. Situational analysis of the quality of palliative care services across India: a cross-sectional survey

Author

Ghoshal, Arunangshu, primary, Khan Joad, Anjum, additional, Spruijt, Odette, additional, Nair, Shobha, additional, Rajagopal, MR, additional, Patel, Firuza, additional, Damani, Anuja, additional, Deodhar, Jayita, additional, Goswami, Dinesh, additional, Joshi, Geeta, additional, Butola, Savita, additional, Singh, Charu, additional, Rao, Seema Rajesh, additional, Bhatwadekar, Madhura, additional, Muckaden, Mary Ann, additional, and Bhatnagar, Sushma, additional

Published
2022
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7. Responding to palliative care training needs in the coronavirus disease 2019 era: The context and process of developing and disseminating training resources and guidance for low- and middle-income countries from Kerala, South India

Author

Daniel, Sunitha, Venkateswaran, Chitra, Sunder, Poornima, Nair, Shoba, Chittazhathu, Rajashree, Manuel, Athul, Raghavan, Biju, M, Sunil M., Rijju, Vineetha, Vijay, Geetha, Rao, Seema, Prabhu, Anupama, Parameswaran, Uma, Spruijt, Odette, Rajagopal, M., and Leng, Mhoira

Subjects
Coronavirus infections, Palliative care, Coronaviruses, Epidemics -- India, Health, World Health Organization
Abstract

Byline: Sunitha. Daniel, Chitra. Venkateswaran, Poornima. Sunder, Shoba. Nair, Rajashree. Chittazhathu, Athul. Manuel, Biju. Raghavan, Sunil. M M, Vineetha. Rijju, Geetha. Vijay, Seema. Rao, Anupama. Prabhu, Uma. Parameswaran, Odette. Spruijt, [...]

Published
2020

8. Psychosocial aspects of COVID-19 in the context of palliative care - A quick review

Author

Rao, Seema, Spruijt, Odette, Sunder, Poornima, Daniel, Sunitha, Chittazhathu, Rajashree, Nair, Shoba, Leng, Mhoira, M, Sunil M., Raghavan, Biju, Manuel, Athul, Rijju, Vineetha, Vijay, Geetha, Prabhu, Anupama, Parameswaran, Uma, and Venkateswaran, Chitra

Subjects
Palliative care -- Psychological aspects, Coronaviruses -- Psychological aspects, Medical personnel -- Psychological aspects, COVID-19 -- Psychological aspects, Health
Abstract

Byline: Seema. Rao, Odette. Spruijt, Poornima. Sunder, Sunitha. Daniel, Rajashree. Chittazhathu, Shoba. Nair, Mhoira. Leng, Sunil. M M, Biju. Raghavan, Athul. Manuel, Vineetha. Rijju, Geetha. Vijay, Anupama. Prabhu, Uma. Parameswaran, [...]

Published
2020

9. Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India

Author

Satija, Aanchal, primary, Lorenz, Karl A., additional, Spruijt, Odette, additional, Ganesh, Archana, additional, Singh, Nainwant, additional, Connell, Natalie B., additional, Gamboa, Raziel C., additional, Fereydooni, Soraya, additional, Chandrashekaran, Shivani, additional, Hennings, Tayler, additional, Giannitrapani, Karleen F., additional, and Bhatnagar, Sushma, additional

Published
2022
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10. Considerations for Fostering Palliative Care Awareness in Developing Contexts: Strategies From Locally Initiated Projects in India

Author

Singh, Nainwant, primary, Giannitrapani, Karleen F., additional, Satija, Aanchal, additional, Ganesh, Archana, additional, Gamboa, Raziel, additional, Fereydooni, Soraya, additional, Hennings, Tayler, additional, Chandrashekaran, Shivani, additional, Spruijt, Odette, additional, Bhatnagar, Sushma, additional, and Lorenz, Karl A., additional

Published
2022
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12. Building Palliative Care Quality Improvement Team Cohesion

Author

Giannitrapani, Karleen F., primary, Connell, Natalie, additional, Zupanc, Sophia, additional, Bhatnagar, Sushma, additional, Fereydooni, Soraya, additional, Gamboa, Raziel, additional, Ganesh, Archana, additional, Satija, Aanchal, additional, Singh, Nainwant, additional, Spruijt, Odette, additional, and Lorenz, Karl, additional

Published
2022
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13. Effect of Cancer Pain Guideline Implementation on Pain Outcomes among Adult Outpatients with Cancer-Related Pain A Stepped Wedge Cluster Randomized Trial

Author

Lovell, Melanie R., Phillips, Jane L., Luckett, Tim, Lam, Lawrence, Boyle, Frances M., Davidson, Patricia M., Cheah, Seong L., McCaffrey, Nicola, Currow, David C., Shaw, Tim, Hosie, Annmarie, Koczwara, Bogda, Clarke, Stephen, Lee, Jessica, Stockler, Martin R., Sheehan, Caitlin, Spruijt, Odette, Allsopp, Katherine, Clinch, Alexandra, Clark, Katherine, Read, Alison, Agar, Meera, Lovell, Melanie R., Phillips, Jane L., Luckett, Tim, Lam, Lawrence, Boyle, Frances M., Davidson, Patricia M., Cheah, Seong L., McCaffrey, Nicola, Currow, David C., Shaw, Tim, Hosie, Annmarie, Koczwara, Bogda, Clarke, Stephen, Lee, Jessica, Stockler, Martin R., Sheehan, Caitlin, Spruijt, Odette, Allsopp, Katherine, Clinch, Alexandra, Clark, Katherine, Read, Alison, and Agar, Meera

Abstract

IMPORTANCE: An evidence-practice gap exists for cancer pain management, and cancer pain remains prevalent and disabling. OBJECTIVES: To evaluate the capacity of 3 cancer pain guideline implementation strategies to improve pain-related outcomes for patients attending oncology and palliative care outpatient services. DESIGN, SETTING, AND PARTICIPANTS: A pragmatic, stepped wedge, cluster-randomized, nonblinded, clinical trial was conducted between 2014 and 2019. The clusters were cancer centers in Australia providing oncology and palliative care outpatient clinics. Participants included a consecutive cohort of adult outpatients with advanced cancer and a worst pain severity score of 2 or more out of 10 on a numeric rating scale (NRS). Data were collected between August 2015 and May 2019. Data were analyzed July to October 2019 and reanalyzed November to December 2021. INTERVENTIONS Guideline implementation strategies at the cluster, health professional, and patient levels introduced with the support of a clinical champion. MAIN OUTCOMES AND MEASURES: The primary measure of effect was the percentage of participants initially screened as having moderate to severe worst pain (NRS ≥ 5) who experienced a clinically important improvement of 30% or more 1week later. Secondary outcomes included mean average pain, patient empowerment, fidelity to the intervention, and quality of life and were measured in all participants with a pain score of 2 or more 10 at weeks 1, 2, and 4. RESULTS: Of 8099 patients screened at 6 clusters, 1564 were eligible, and 359 were recruited during the control phase (mean [SD] age, 64.2 [12.1] years; 196 men [55%]) and 329 during the intervention phase (mean [SD] age, 63.6 [12.7] years; 155 men [47%]), with no significant differences between phases on baseline measures. The mean (SD) baselineworst pain scoreswere 5.0 (2.6) and 4.9 (2.6) for control and intervention phases, respectively. The

Published
2022

14. Effect of Cancer Pain Guideline Implementation on Pain Outcomes Among Adult Outpatients With Cancer-Related Pain

Author

Lovell, Melanie R., primary, Phillips, Jane L., additional, Luckett, Tim, additional, Lam, Lawrence, additional, Boyle, Frances M., additional, Davidson, Patricia M., additional, Cheah, Seong L., additional, McCaffrey, Nicola, additional, Currow, David C., additional, Shaw, Tim, additional, Hosie, Annmarie, additional, Koczwara, Bogda, additional, Clarke, Stephen, additional, Lee, Jessica, additional, Stockler, Martin R., additional, Sheehan, Caitlin, additional, Spruijt, Odette, additional, Allsopp, Katherine, additional, Clinch, Alexandra, additional, Clark, Katherine, additional, Read, Alison, additional, and Agar, Meera, additional

Published
2022
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17. Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India

Author

Lorenz, Karl, Dy, Sydney, DeNatale, Michelle, Rabow, Michael W., Spruijt, Odette, Anderson, Karen, Agar, Meera, Mickelsen, Jake, Vallath, Nandini, Lorenz, Karl, Dy, Sydney, DeNatale, Michelle, Rabow, Michael W., Spruijt, Odette, Anderson, Karen, Agar, Meera, Mickelsen, Jake, and Vallath, Nandini

Abstract

The article collates the narratives of experiences of the international faculty who mentored the quality improvement teams from India since 2017.

Published
2021

21. The empty-handed doctor:Responding to the suffering of patients approaching the end of life

Author

Spruijt, Odette and Spruijt, Odette

Abstract

The relief of suffering is at the heart of palliative care practice. Yet there has been little exploration of how palliative care doctors, working in different countries and cultures, recognise and respond to their patients’ suffering. This research sought to develop a deeper understanding of suffering in the palliative care context, as witnessed by doctors in India and Australia. Through narrative interviews, 18 doctors spoke of how they recognised suffering, and what it meant to them to respond to suffering. The narratives chosen for analysis spoke to the dialogical encounter in which doctors sought to connect with their patients in common humanity, to recognise the particular nature of suffering and to meet in an intersubjective, relational space. The concept of intersubjectivity provided a lens for analysis of these narratives. Here, ‘intersubjective’ is used to describe the interhuman experience in which the subjectivities of ‘I’ and ‘Thou’, described in Martin Buber’s dialogical ontology, are brought to the encounter. I use the term ‘dialogical encounter’ to describe the meaningful connection between doctor and patient, as experienced by the doctor, where there is a sense of recognition of the ‘other’ and possible emergence of the ‘in-between’ realm (Buber, 1970). A key finding is that the relief of suffering in palliative care involves dialogical encounter between doctor and patient. In this in-between realm of interhuman encounter, suffering is transformed or relieved through the recognition and confirmation of the person who is suffering. Rather than being unidirectional, dialogical encounter is mutual, with the doctor also receiving from the patient, within the normative limits of the therapeutic relationship. The cultural differences apparent in suffering between India and Australia were unified in the experience of dialogical encounter by doctors in both countries. This thesis reinforces the primacy of the doctor–patient relationship in the relief of suf

Published
2020

22. Palliative care and COVID-19 in the Australian context: a review of patients with COVID-19 referred to palliative care

Author

Mendis, Ruwani, primary, Haines, Anita, additional, Williams, Loretta, additional, Mitchener, Kirsten, additional, Grimaldi, Fiona, additional, Phillips, Marianne, additional, Shaw, Margaret, additional, Nguyen, Thy Pham Hoai, additional, Dabscheck, Adrian, additional, Spruijt, Odette, additional, and Coperchini, Maria, additional

Published
2021
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23. Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India

Author

Giannitrapani, Karleen F., primary, Satija, Aanchal, additional, Ganesh, Archana, additional, Gamboa, Raziel, additional, Fereydooni, Soraya, additional, Hennings, Taylor, additional, Chandrashekaran, Shivani, additional, Mickelsen, Jake, additional, DeNatale, Michelle, additional, Spruijt, Odette, additional, Bhatnagar, Sushma, additional, and Lorenz, Karl A., additional

Published
2020
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25. Factors Affecting Sustainability of Quality Improvement Initiatives in Palliative Care: Experiences from Seven Diverse Palliative Care Institutions in India (S739)

Author

Ganesh, Archana, primary, Satija, Aanchal, additional, Lorenz, Karl, additional, Giannitrapani, Karleen, additional, Spruijt, Odette, additional, Gamboa, Raziel, additional, Chandrashekaran, Shivani, additional, Fereydooni, Soraya, additional, Hennings, Tayler, additional, and Bhatnagar, Sushma, additional

Published
2020
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26. Myths that Inhibit the Spread of Palliative Care in India (S733)

Author

Gamboa, Raziel, primary, Bhatnagar, Sushma, additional, Satija, Aanchal, additional, Ganesh, Archana, additional, Fereydooni, Soraya, additional, Hennings, Tayler, additional, Chandrashekaran, Shivani, additional, Spruijt, Odette, additional, Lorenz, Karl, additional, and Giannitrapani, Karleen, additional

Published
2020
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27. Responding to palliative care training needs in the coronavirus disease 2019 era: The context and process of developing and disseminating training resources and guidance for low- and middle-income countries from Kerala, South India

Author

Venkateswaran, Chitra, primary, Daniel, Sunitha, additional, Sunder, Poornima, additional, Nair, Shoba, additional, Chittazhathu, RajashreeK, additional, Manuel, AthulJoseph, additional, Raghavan, Biju, additional, Sunil Kumar, MM, additional, Rijju, Vineetha, additional, Vijay, Geetha, additional, Rao, Seema, additional, Prabhu, AnupamaV, additional, Parameswaran, Uma, additional, Spruijt, Odette, additional, Rajagopal, MR, additional, and Leng, Mhoira, additional

Published
2020
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28. Psychosocial aspects of COVID-19 in the context of palliative care – A quick review

Author

Venkateswaran, Chitra, primary, Rao, SeemaRajesh, additional, Spruijt, Odette, additional, Sunder, Poornima, additional, Daniel, Sunitha, additional, Chittazhathu, RajashreeK, additional, Nair, Shoba, additional, Leng, Mhoira, additional, Sunil Kumar, MM, additional, Raghavan, Biju, additional, Manuel, AthulJoseph, additional, Rijju, Vineetha, additional, Vijay, Geetha, additional, Prabhu, AnupamaV, additional, and Parameswaran, Uma, additional

Published
2020
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31. Palliative care clinicians and online education in India: a survey

Author

Kiss-Lane, Tayler, primary, Spruijt, Odette, additional, Day, Thomas, additional, Lam, Vivian, additional, Ramchandran, Kavitha J, additional, Chan, Sandy, additional, Hsin, Gary, additional, Vallath, Nandini, additional, Bhatnagar, Sushma, additional, Rajagopal, MR, additional, and Lorenz, Karl A, additional

Published
2018
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32. Building Palliative Care Quality Improvement Team Cohesion.

Author

Giannitrapani, Karleen F., Connell, Natalie, Zupanc, Sophia, Bhatnagar, Sushma, Fereydooni, Soraya, Gamboa, Raziel, Ganesh, Archana, Satija, Aanchal, Singh, Nainwant, Spruijt, Odette, and Lorenz, Karl

Abstract

Background: The Palliative Care: Promoting Access in International Cancer Experience initiative (PC-PAICE) partnered with seven regionally diverse Indian palliative care (PC) sites to foster locally initiated quality improvement (QI) projects by training local teams on QI methods. We aimed to identify facilitators of QI team cohesion around team goals. Methodology: A quota sampling approach captured the perspectives of 44 stakeholders across 3 strata (organizational leaders, clinical leaders, and clinical team members) through a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). We used a combination of inductive and deductive approaches informed by theory to identify themes. Results: Theme 1: Allow a process to formalize and re-negotiate team roles and coordinate transfer of roles within the interdisciplinary PC team. Theme 2: Foster cross-disciplinary role agreement around shared and bounded QI project goals. Theme 3: Prioritize a non-hierarchical organizational climate of equity and respect for all PC team member involvement and input in the QI project work. Implications: Leveraging CFIR with role and team theories allowed us to identify facilitators of team cohesion, such as promoting a culture of equity and setting clear project goals. These insights demonstrate the value of team and role theories in implementation evaluation. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India

Author

Lorenz, Karl, Dy, Sydney, DeNatale, Michelle, Rabow, Michael W., Spruijt, Odette, Anderson, Karen, Agar, Meera, Mickelsen, Jake, Vallath, Nandini, Lorenz, Karl, Dy, Sydney, DeNatale, Michelle, Rabow, Michael W., Spruijt, Odette, Anderson, Karen, Agar, Meera, Mickelsen, Jake, and Vallath, Nandini

Abstract

Lorenz, K., Dy, S., DeNatale, M., Rabow, M. W., Spruijt, O., Anderson, K., ... & Vallath, N. (2021). Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India. Indian Journal of Palliative Care, 27(2), 235. https://doi.org/10.25259/IJPC_415_20

34. Patient-reported outcome measurement in palliative care: A hermeneutic narrative review.

Author

Collier A, Spruijt O, Minton O, and Broom A

Abstract

Objectives: Recent years have witnessed the rise of patient-reported outcome measures (PROMs) in palliative care (PC), particularly those focused on the standardized measurement of symptom burden. These measures seek to evaluate the quality of PC through the quantification of various aspects of potential suffering (e.g., sleeplessness, loss of appetite, and pain). Further, drawing on patient experience, they provide a framework for evaluating the effectiveness of, and at times expanding, PC services. The aim of this paper is to provide a theoretically informed normative critique of PROMS-PC through a critical engagement with heterogeneous literatures., Methods: A hermeneutic narrative review underpinned by a view of "knowing" as an ongoing social accomplishment and inspired by complexity theory., Results: This narrative review highlights some limitations to the development of PROMs, including the use of proxies to complete them, and how the outcomes may not always reflect either the character of PC or the key aspects of practice and experience therein., Significance of Results: In their current form, PROMs have the potential to skew understandings of service quality, for example, by privileging one aspect of quality, that is, physical symptoms over other aspects of quality such as communication with care providers.

Published
2023
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