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Background Patients living with life-limiting illnesses other than cancer constitute the majority of patients in need of palliative care globally, yet most previous systematic reviews of the cost impact of palliative care have not exclusively focused on this population. Reviews that tangentially looked at non-cancer patients found inconclusive evidence. Randomised controlled trials (RCTs) are the gold standard for treatment efficacy, while total health care costs offer a comprehensive measure of resource use. In the sole review of RCTs for non-cancer patients, palliative care reduced hospitalisations and emergency department visits but its effect on total health care costs was not assessed. The aim of this study is to review RCTs to determine the difference in costs between a palliative care approach and usual care in adult non-cancer patients with a life-limiting illness. Methods A systematic review using a narrative synthesis approach. The protocol was registered with PROSPERO prospectively (no. CRD42020191082). Eight databases were searched: Medline, CINAHL, EconLit, EMBASE, TRIP database, NHS Evidence, Cochrane Library, and Web of Science from inception to January 2023. Inclusion criteria were: English or German; randomised controlled trials (RCTs); adult non-cancer patients (> 18 years); palliative care provision; a comparator group of standard or usual care. Quality of studies was assessed using Drummond’s checklist for assessing economic evaluations. Results Seven RCTs were included and examined the following diseases: neurological (3), heart failure (2), AIDS (1) and mixed (1). The majority (6/7) were home-based interventions. All studies were either cost-saving (3/7) or cost-neutral (4/7); and four had improved outcomes for patients or carers and three no change in outcomes. Conclusions In a non-cancer population, this is the first systematic review of RCTs that has demonstrated a palliative care approach is cost-saving or at least cost-neutral. Cost savings are achieved without worsening outcomes for patients and carers. These findings lend support to calls to increase palliative care provision globally.

Abstract Background Ethnic differences influence end-of-life health behaviours and use of palliative care services. Use of formal Advance care planning is not common in minority ethnic heritage communities. Older adults expect and trust their children to be their decision makers at the end of life. The study aim was to construct a theory of the dynamics that underpin end-of-life conversations within families of African and Caribbean heritage. This is a voice not well represented in the current debate on improving end-of-life outcomes. Methods Using Charmaz’s constructivist grounded theory approach, a purposive sample of elders, adult-children, and grandchildren of African and Caribbean Heritage were recruited. In-person and online focus groups were conducted and analysed using an inductive, reflexive comparative analysis process. Initial and axial coding facilitated the creation of categories, these categories were abstracted to constructs and used in theory construction. Results Elders (n = 4), adult-children (n = 14), and adult grandchildren (n = 3) took part in 5 focus groups. A grounded theory of living and dying between cultural traditions in African and Caribbean heritage families was created. The constructs are (a) Preparing for death but not for dying (b) Complexity in traditions crosses oceans (c) Living and dying between cultures and traditions (d) There is culture, gender and there is personality (e) Watching the death of another prompts conversations. (f) An experience of Hysteresis. Discussion African and Caribbean cultures celebrate preparation for after-death processes resulting in early exposure to and opportunities for discussion of these processes. Migration results in reforming of people’s habitus/ world views shaped by a mixing of cultures. Being in different geographical places impacts generational learning-by-watching of the dying process and related decision making. Conclusions Recognising the impact of migration on the roles of different family members and the exposure of those family members to previous dying experiences is important. This can provide a more empathetic and insightful approach to partnership working between health care professionals and patients and families of minority ethic heritage facing serious illness. A public health approach focusing on enabling adult-children to have better end of life conversations with their parents can inform the development of culturally competent palliative care.

Abstract Background Dignity is integral to palliative care. Illness can diminish it, causing hopelessness and the wish to hasten death. Yet, dignity is a complex multidimensional phenomenon, influenced by values and context. Understanding its varying interpretations can inform practice and policy. The aim of the study is to explore the understanding of dignity in adult patients with palliative care needs from a Lebanese perspective and how it is preserved during illness and while receiving health services. Design Qualitative interview study underpinned with a social constructionist lens. Fourteen patients recruited from home-based hospice and outpatient clinics in Lebanon. Data analysed using reflexive thematic analysis. Results Four themes were developed across all the interviews: (a) Dignity anchored through faith in God and religious practices; (b) Family support in maintaining physical, psychological wellbeing, and social connectedness; (c) Physical fitness, mental acuity, and healthy appearance through which patients may escape the stigma of disease, (d) accessible, equitable, and compassionate healthcare. Discussion Dignity is elusive and difficult to define but faith and religious beliefs play a significant contribution in this study. For the participants, illness is seen as a natural part of life that does not necessarily diminish dignity, but it is the illness related changes that potentially affect dignity. Findings show the importance of family and children in preserving dignity during illness and how their active presence provide a sense of pride and identity. Participants aspired to restore physical, social, and mental well-being to reclaim their dignity and normalize their lives. Challenges related to physical appearance, memory loss, vitality, and social stigma associated with illness diminished dignity. Accessible, equitable and compassionate healthcare services are also crucial in preserving dignity. Participants valued clear communication, respect, and empathy from healthcare providers and identified affordability of care essential for maintaining dignity. Conclusion Faith in God, and strong family ties are dominant elements to maintaining dignity in the Lebanese context. Relational connectedness with family, children or God is also a need in maintaining dignity in other communal countries with variations in emphasis. The study indicates that religious and cultural context shapes the needs and perceptions of dignity during illness. These findings are likely to be transferable to many Middle Eastern countries but also countries with strong religious and family ties globally.

Abstract Background Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts. Methods All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines. Results Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1—Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3—Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures. Conclusions Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials. Trial registration PROSPERO Registration No. CRD42021228778.

Qualitative data collection using online focus groups is increasing in popularity. However this may change the way discussion is created and steered by the participants and facilitators in these focus groups and so potentially influence the data collected. In a focus group study exploring end of life family conversations in African and Caribbean heritage communities, two focus groups were held face-to-face and a further three took place online using the online video conference software, Microsoft teams. Sociograms and an interaction questionnaire were used to analyse participant interactions in each group. The study involved 21 participants across the five groups. The use of sociograms showed that direct participant to participant interactions were rarer in the online groups, most interactions went via the facilitator who as a result retained more power over the direction of the conversation. Participants responses analysed using the interaction questionnaire showed that participants were stimulated by the experiences of others in both contexts. The facilitator found it harder to create rapport in the online groups than in the face-to-face groups where conversation between participants seemed to flow more smoothly. The observer notes suggested that non-verbal communication was less evident in the online groups. In larger groups people made more use of turn taking using the hands-up function and chat box than in smaller groups where all participants could see each other more easily on screen. Researchers need to be aware of the impact of different delivery modalities on group interactions and how this may change the power dynamics of who is controlling the narrative and therefore the data generated. Group facilitators may need find it useful to develop skills needed to maximise the conversational element of online forms of data collection.

Conclusions: Consideration should be given to how psychological factors, such as locus of control and learned helplessness, may constitute underlying mechanisms impacting emotional regulation in those experiencing diabetes distress. Clinicians should consider including and leading discussions around distress during appointments, as well as using approaches that promote patient autonomy and empowerment.

Abstract Introduction With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies. Method A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English. Results The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one’s feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth). Conclusion Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Abstract Aim To synthesize evidence on the concept of reassurance in nursing practice. Design Integrative review. Review Method PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962). Results Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

Background: Studies have highlighted how advanced prostate cancer causes biographical disruption and presents challenges to masculine identities for men. This article draws on a wider study that focused on the experiences of men living with advanced prostate cancer and their caregivers. Although men’s experience of advanced illness is not overlooked in the literature, only a small body of work has taken an in-depth look at men’s experiences with advanced prostate cancer and their caregivers in a non-Westernised cultural and social context. Objective: To explore how advanced prostate cancer impacts on men’s masculine identity from the perspective of patients and their caregivers. Methods: A qualitative study of men living with advanced prostate cancer ( n = 23) and family caregivers ( n = 23) in Ghana. We used the Consolidated Criteria for Reporting Qualitative Studies (COREQ) as the reporting guideline. Results: The findings from this study highlight profound challenges for most men to their masculine identities, from both the treatment and the symptoms of advanced prostate cancer within a non-Westernised, patriarchal society. Four main themes were developed. These were the impact on masculinity in terms of: (1) physical changes, (2) sexual ability, (3) socio-economic roles and (4) expressing emotions. Changes in physical appearance, feeling belittled, having no active sexual life and the inability to continue acting as provider and protector of the family made some men describe their situation as one of moving out of the ‘frying pan into the fire’. Conclusion: This study revealed the impact of advanced prostate cancer on masculine identity. These narratives add a new dimension to what is already known about the impacts on men’s masculine identities when dealing with advanced prostate cancer. This knowledge can help improve the care provided to men with advanced prostate cancer with emphasis on the cultures, beliefs and aspirations of these men and their caregivers.

Abstract Background Caring for children living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is challenging and has a tremendous impact on the physical and psychological health of caregivers. Caregivers of children with HIV/AIDS need to adopt coping mechanisms to navigate these complexities as it influences the quality of care provided. The literature on coping strategies and support (formal and informal) available to caregivers of children living with HIV/AIDS is scant. This study aimed to explore the coping strategies and support systems for caregivers of children living with HIV/AIDS. Methods A phenomenological study design was adopted. A total of nine participants across three hospitals in the Tamale metropolis were interviewed using purposive sampling. The interviews were audio recorded, transcribed verbatim and analysed using Colaizzi's approach. Results Four main themes emerged from the analyses: (1) coping strategies, (2) types of support activities, (3) support from informal institutions and (4) support from formal institutions. The caregivers navigated the caring process with much spiritual coping. The caregivers had little or no support from informal institutions such as immediate family, faith and community leaders. Non‐governmental organizations were not visible in support, and there were no support groups for caregivers. Conclusion Support for caregivers and the active involvement of the immediate family in paediatric HIV care is imperative.

Abstract Background Patients with palliative needs experience high psychological and symptom distress that may lead to hopelessness and impaired sense of dignity. Maintaining patient dignity or the quality of being valued is a core aim in palliative care. The notion of dignity is often explained by functionality, symptom relief and autonomy in decision making. However, this understanding and its implications in Middle Eastern countries is not clear. The aim of this review is to 1) explore the understanding of dignity and how dignity is preserved in adult patients with palliative care needs in the Middle East 2) critically assess the findings against the Dignity Model dominant in western literature. Method Using an integrative review we searched four databases EMBASE, Psych-Info, CINAHL, and PubMed. These databases retrieve a broad literature on palliative care and are often chosen in other palliative care reviews. To enhance the search strategy, three online journals were hand searched, reference lists of review papers scanned, and forward citations sought. No time limits were applied. The retrieved papers were assessed independently by two authors including quality assessment using the Hawker’s appraisal tool. Results Out of the 5113 studies retrieved, 294 full texts were assessed. Sixteen studies were included for synthesis of which fourteen were published in Iran. Seven themes were developed after data analysis: Maintaining Privacy and Secrecy; Gentle communication with a dialogue that preserves hope instead of blunt truth-telling; Abundance characterised by accessibility to medical supplies and financial stability; Family Support where relatives deliver major assistance in care; Physical Fitness; Reliable health care, and Social justice that endorses equal care to all. Conclusion The results are compatible with the existing evidence from the Dignity Model ascertaining that dignity is socially mediated and influenced by interactions and physical fitness. Nevertheless, the findings highlight that patient dignity is also shaped by the socio-political, cultural, and economic conditions of the country, where family support, gentle communication and accessible health care are essential elements.

Narrative research methods invite people to share their experiences via storytelling. There is increasing interest as to how qualitative narrative inquiry can provide greater understanding into the lived experience around health and illness, particularly within the field of dementia. Narrative research is concerned with how humans make sense of and engage with the changes and disruptions of everyday life. However, narrative research is an emerging and evolving field with no single clearly defined approach to data analysis. In this article, we provide a methodological exemplar by applying Murray’s four levels of narrative analysis to longitudinal narrative interviews completed with couples living with Lewy body dementia. We describe how to analyse connections between the four levels and how to articulate this across different interview time points. This analysis process contributes to methodological knowledge by providing a strategy to connect the personal, interpersonal, positional and societal levels of analysis. The time taken for in-depth analysis of a co-created, dyadic longitudinal narrative approach requires careful consideration, but ultimately, it can provide a richer understanding of the lived experience, allowing for deeper social, clinical and academic insight.

Introduction: The original use of face masks was to help protect surgical wounds from staff-generated nasal and oral bacteria. Currently governments across the world have instituted the mandatory use of masks and other face coverings so that face masks now find much broader usage in situations where close contact of people is frequent and inevitable, particularly inside public transport facilities, shopping malls and workplaces in response to the COVID-19. Objective: We conducted a rapid review to investigate the impact face mask use has had in controlling transmission of respiratory viral infections. Method: A rapid review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Five electronic databases (CINAHL, Embase, Medline, PsycINFO and Global Health) were searched from database inception to date, using pre-defined search terms. We included all studies of any design and used descriptive analysis to report summary statistics of search results. Data were extracted including sample characteristics, study design, respiratory virus being controlled, type of face masks used and their effectiveness. Results: 58 out of 84 studies met the inclusion criteria, of which 13 were classified as systematic reviews and 45 were quantitative studies (comprising randomised controlled trials, retrospective cohort studies, case control, cross-sectional, surveys, observational and descriptive studies). N = 27 studies were conducted amongst healthcare workers wearing face masks, n = 19 studies among the general population, n = 9 studies among healthcare workers the general population and patients wearing masks, and n = 3 among only patients. Face masks use have shown a great potential for preventing respiratory virus transmission including COVID-19. Conclusion: Regardless of the type, setting, or who wears the face mask, it serves primarily a dual preventive purpose; protecting oneself from getting viral infection and protecting others. Therefore, if everyone wears a face mask in public, it offers a double barrier against COVID-19 transmission.

Objective: Care in the emergency department focuses significantly on delivering lifesaving/ life-sustaining clinical actions, often with limited attention to health-related suffering even at the end-of-life. How healthcare staff experience and navigate through the end-of-life phase remains minimally explored. Thus, this study aimed to uncover the lived experiences of emergency department staff at the end-of-life. Methods: van Manen's hermeneutic phenomenological approach was used. Nineteen healthcare staff were purposively recruited and interviewed. Interviews were audio-taped, transcribed verbatim, and thematic categories formulated. The existential lifeworld themes (corporeality, relationality, spatiality, and temporality) were used as heuristic guides for reflecting and organizing the lived experiences of participants. Results: The overarching category, 'resuscitate and push', was captured as corporeality (resisting death and dying); relationality (connectedness to the body of the patient; and lacking support for family and self); spatiality (navigating through a liminal space and lack of privacy for patients); and temporality (having limited to no time for end-of-life care and grieving). The end-of-life space was unpleasant. Although participants experienced helplessness and feelings of failure, support systems to help them to navigate through these emotions were lacking. Grief was experienced covertly and concealed by the entry of a new patient. Conclusion: End-of-life in the emergency department is poorly defined. In addition to shifting from the traditional emergency care model to support the streamlining of palliative care in the department, staff will require support with navigating through the liminal space, managing their grief, and developing a better working relationship with patients/ families. [ABSTRACT FROM AUTHOR]

Most of the global cases of tuberculosis (TB) are found in Asia and Africa. This is largely due to deficient educational information, myths, beliefs and suboptimal service delivery as a result of inadequate infrastructure. Even though proper treatment can cure TB, bureaucratic difficulties and problems with caring for patients mean procedures to ensure that patients receive and complete treatment may stifle the treatment regimen. This paper looks at the service factors that affect adherence to TB treatment, while seeking to explore good practices to improve support for patients. It discusses a study that used a qualitative interpretive descriptive design involving interviews across health facilities in one district in Ashanti Region, Ghana. Ten patients were recruited in 2014 and interviewed. They revealed the challenges and facilitators that affected their adherence to their treatment. Three main themes were identified: institutional support, staff attitude and patients' unmet needs. Staff commitment, proper supervision of TB patients and individualising care encourages adherence, while organisational challenges, poor supervision of patients and unfriendly staff attitudes discourage the continuity of treatment. [ABSTRACT FROM AUTHOR]