Impact on staff

Mental health of hospital consultants: the effects of stress and satisfaction at work

This survey of consultant doctors explored factors contributing to stress and burnout. It found that stress was associated with dealing with patients’ suffering and that burnout was more prevalent among consultants who felt insufficiently trained in communication and management skills.

Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. (1996) Mental health of hospital consultants: the effects of stress and satisfaction at work The Lancet; 347(9003):pp724-8

Read the abstract on the U.S. National Library of Medicine National Institutes of Health website (accessed 11/05/2011)

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Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital

A qualitative study using focus groups with staff to explore the impact of implementing the Liverpool Care Pathway (LCP) in an Italian hospital. The study reports that following implementation of LCP, staff became more aware of the challenges of communication with dying patients and their families and felt less confident.

Di Leo S, Beccaro M, Finelli S, Borreani C, Costantini M. (2011) Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital Palliative Medicine. Published online 14/01/2011.

Read the abstract on the Palliative Medicine website (accessed 11/05/2011)

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A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings

Clinicians who respond to at least one patient cue have shorter consultation times with GPs reducing time by 12.5% and surgeons by 10.7%.

Levinson w, Gorawara-Bhat R, Lamb J. (2000) A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings JAMA; 284: pp1021-1027.

Read the abstract on the Journal of American Medical Association website (accessed 11/05/2011)

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Training hospice nurses to elicit patient concerns

A study of the impact of assessment skills training for hospice nurses. The paper discusses the impact of training on skill levels and on their ability to elicit their patients’ concerns It concludes that simple skills training is insufficient to change clinical behaviour, and discusses other factors which should be addressed in future training programmes

Heaven CM, Maguire P (1996) Training hospice nurses to elicit patient concerns Journal of Advanced Nursing;23(2): pp280–6.

Read the abstract on the Wiley online library website (accessed 11/05/2011)

Impact on people nearing end of life and/or their carers

Effective physician-patient communication and health outcomes: a review

Literature review of randomised controlled trials and analytic studies demonstrated a correlation between effective physician-patient communication and improved patient health outcomes , influencing emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control.

Stewart MA (1996) Effective physician-patient communication and health outcomes: a review Canadian Medical Association Journal; 152 (9): pp1423-33

Read the abstract on or download the full article from the PubMed Central website (accessed 11/05/2011)

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Associations between end of life discussions, patient mental health, medical care near death and caregiver bereavement adjustment

Care planning has been shown to improve people’s quality of life.

Wright A, Zhang B, Ray A et al (2008) Associations between end of life discussions, patient mental health, medical care near death and caregiver bereavement adjustment Journal of the American Medical Association; 300 (14): pp1665-1673

Download the article from the Journal of the American Medical Association website (accessed 11/05/2011)

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Communication between patients with breast cancer and health care providers: determinants and implications

Effective communication contributes to patient’s psychological adjustment and quality of life adherence to treatment, enhanced information recall and patient satisfaction.

Lerman C, Daly M, Walsh WP et al. (1993) Communication between patients with breast cancer and health care providers: determinants and implications. Cancer ;72:pp2612–2620

Read the abstract onthe Wiley online library website (accessed 11/05/2011)

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The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

This study found advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.

Karen M Detering, Andrew D Hancock, Michael C Reade, William Silvester, (2010) The impact of advance care planning on end of life care in elderly patients: randomised controlled trial BMJ; 340:c1345: pp847

Download this article from the BMJ website (accessed 11/05/2011)

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Disclosing the cancer diagnosis: the patients’ experiences

Survey of cancer patients on how they were given their cancer diagnosis and the impact. It found patient satisfaction when people thought doctors were personally interested, understood the information, gave longer consultation time and when the information was given in the doctor’s office.

Loge JH, Kaasa S, Hytten K. (1997) Disclosing the cancer diagnosis: the patients’ experiences European Journal of Cancer; 33:pp878–882.

Read the abstract on teh European Journal of Cancer website (accessed 11/05/2011)

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Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment

Prospective, longitudinal US cohort study to examine the association between end of life discussions and the care given near to death, and on psychological distress and quality of life. Study found that patients engaging in end of life discussions were more likely to prefer treatment focused on relieving pain and discomfort over life-extending therapies and have completed a do-not-resusitate order. Quality of life in last days was found to decrease with increasing medical interventions. This quality of life for the dying was associated with improved quality of life for the bereaved

Wright A, Zhang B, Ray A, Mack J et al. (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment JAMA; Vol 300 (14): pp1665-1673

Read this article on the Journal of The American Medical Association website (accessed 11/05/2011)

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Missed Opportunities during Family Conferences about End-of-Life Care in the Intensive Care Unit

Research indicates that patients, relatives and carers make decisions to prolong life and treatment of patients in ICU who ultimately die based on insufficient knowledge and poor communication. The study showed that professionals missed opportunities to listen and respond to family; to acknowledge and address emotions; to explore patient preferences.

J. Randall Curtis, Ruth A. Engelberg, Marjorie D. Wenrich, Sarah E. Shannon, Patsy D. Treece and Gordon D. Rubenfeld (2005) Missed Opportunities during Family Conferences about End-of-Life Care in the Intensive Care Unit American Journal of Critical Care Medicine; vol 171: pp844-849

Read the abstract on the American Journal of Respiratory and Critical Care Medicine website (accessed 11/05/2011)

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Surrogate decision makers understanding of dementia patients’ prior wishes for end of life care
The most common wish of patients with dementia, after symptom control, was ‘not to be kept alive by machines or extraordinary measures’

Black Betty S et al. (2009) Surrogate decision makers understanding of dementia patients’ prior wishes for end of life care Journal of Ageing and Health; 21: pp627-650

Read the abstract on the Journal of Ageing and Health website (accessed 11/05/2011)