Lise Fillion

Family caregivers (FC) often experience higher distress levels than their relative with cancer. Many cancer centers have implemented distress screening programs, but most of them concentrate their efforts on patients, with little attention to their FC. To fill this gap, a pragmatic intervention has been designed to improve supportive care for FC of patients with lung cancer. This article describes the study protocol of a single-center randomized controlled trial to assess its effectiveness. A total of 120 lung cancer patients and their FC are randomly assigned to the experimental group (exposed to intervention, N = 60) or to the control group (usual care, N = 60). The intervention includes: (1) systematic FC distress screening and problem assessment near their relative’s cancer diagnosis, and every 2 months, (2) privileged contact with an oncology nurse (ON) away from the patient to address FC problems and (3) liaison by the ON with the family physician of FC reporting high distress (thermometer score ≥5/10), or problems relying on FP expertise. In both groups, FC, patient and process-of-care outcomes are measured at baseline and every 3 months, up to 9 months. The primary endpoint is FC distress measured by the Hospital Anxiety and Depression Scale (HADS) and the Psychological Distress Index used in the Quebec Health Survey (PDQHS). Individual interviews with 10 FC and a focus group with the oncology team will be conducted at the study end to further document the effectiveness of the intervention and its impact on quality of life (for FC) and practice organization (for the oncology team). This trial will assess the effectiveness of an innovative intervention based on interprofessional collaboration between primary care and oncology care. It targets a population in great need, yet often neglected, and has the potential to clearly improve patient and caregiver experience of cancer care, and reduce the burden of disease. ClinicalTrials.gov, ID: NCT02531464 . Registered on 15 July 2015.

Working in palliative care (PC) can be challenging, distressing, and rewarding. This chapter discusses and presents some suggestions to deal with particular challenges in introducing the meaning-centered intervention (MCI) for PC clinicians. Its format and content are founded on the meaning-centered psychotherapy developed for cancer patients. Frankl’s existential therapeutic approach, called logotherapy, serves as the underlying theoretical framework. The chapter describes the intervention, the purpose of which is to create strategies for enhancing meaning at work and for preventing burnout. The chapter provides an understanding of workplace stress, stressors specific to PC, psychosocial risk factors that may lead to burnout, and key ingredients retained for intervention. Elaboration and content of the MCI-PC are described. Quantitative and qualitative studies conducted with PC nurses are presented. Results support the assumption that the MCI-PC can enhance meaning at work by increasing perceived benefits and by linking coherently values and intention, choices and actions.

Les auteures s’intéressent à la sensibilité éthique dans un contexte hospitalier, plus précisément aux soins intensifs. L’objectif de leur recherche est d’élaborer et de mettre en place un modèle d’intervention en vue d’intégrer une approche de soins de fin de vie dans deux unités de soins intensifs. Deux groupes formés de professionnelles et de professionnels ont été invités à réfléchir aux risques éthiques dans leur unité à partir de l’éthique narrative. Cette approche a permis de mettre en évidence les zones à clarifier et de réfléchir aux changements qui devraient être apportés au sein de ces deux unités. La vision en matière de soins de fin de vie, la communication avec la famille ainsi que le développement et le maintien des compétences dans ce domaine ont constitué les principales composantes de l’intervention. Les résultats ont permis de constater les enjeux de pouvoir liés à la collaboration interprofessionnelle pouvant freiner la perception des enjeux éthiques et l’expression de la sensibilité éthique à l’intérieur des équipes de soins intensifs.

À partir de l’expérience au CHU de Québec, une réflexion sur la sensibilisation et la formation des équipes soignantes à dépister la détresse est réalisée. Le contexte canadien et québécois ainsi que l’initiative au CHU de Québec permettent dans un premier temps d’introduire le dépistage comme une stratégie et une procédure permettant de favoriser l’accès à des soins de soutien centrés sur les besoins de la personne atteinte de cancer. Comme l’implantation de ces nouveaux modèles de soins centrés sur la personne se veut systématique, cela nécessite à la fois des changements organisationnels ainsi que des changements de comportements des cliniciens. Ces différents enjeux doivent être pris en considération dans les programmes de formation. La formation des équipes soignantes et l’intégration du dépistage à la pratique sont donc discutées à la fois comme un changement organisationnel et à la fois comme un changement de pratique clinique. Le changement organisationnel est décrit comme une série d’étapes incluant notamment la préparation et la consolidation. Le changement de pratiques implique une modification des comportements des cliniciens et comporte plusieurs obstacles potentiels. Le modèle de soins centrés sur la personne implique par ailleurs de prendre en compte les préférences de la personne soignée tout en considérant les valeurs de l’ensemble des acteurs impliqués dans l’organisation. De plus, ce type de modèle nécessite des compétences à la collaboration interprofessionnelle. La formation des équipes soignantes en matière de dépistage de la détresse va bien au-delà de l’habilitation clinique. From the experience at the Centre Hospitalier Universitaire (CHU) of Québec, a reflection on training health care teams in screening for distress is proposed. Canadian and Quebec contexts as well as the initiative at the CHU of Quebec are first introduced. Screening for distress is proposed as a strategy and a process to facilitate access to supportive care, based on the needs of the person with cancer. Because the implementation of this person-centered care model is conducted systematically, it involves both organizational and clinical practice changes. These issues must be considered in training programs. Thus, health care teams training in screening for distress are discussed as both an organizational change and a change in clinical practice. Organizational change is described as a series of steps, including the preparation and consolidation. The change in practice involves a change in clinician behaviors and includes several potential barriers. The person-centered care model also implies taking into account the preferences of the person being cared for, while considering the values of all stakeholders in the organization. In addition, this type of model requires skills in inter-professional collaboration. Training of health care teams in screening for distress goes far beyond clinical empowerment.

Professional navigation: A comparative study of two Canadian models

The purpose of this study was to describe stressors experienced by nurses in providing end-of-life palliative care (EoL/PC) in intensive care units (ICUs). A descriptive qualitative design was used. A total of 42 nurses from 5 ICUs in the province of Quebec, Canada, participated in 10 focus groups. Stressors were found to be clustered in 3 categories: organizational, professional, and emotional. The major organizational stressors were lack of a palliative care approach, interprofessional difficulty, lack of continuity in life-support and treatment plans, and conflicting demands. Professional stressors included lack of EoL/PC competencies and difficulty communicating with families and collaborating with the medical team. Emotional stressors were described as value conflicts, lack of emotional support, and dealing with patient and family suffering.The authors conclude that providing EoL/PC is stressful for ICU nurses and that education and support programs should be developed to ensure quality EoL/PC in the critical care environment.

To elaborate, refine, and validate the professional navigation framework in a Canadian context. A two-step approach consisting of a qualitative evaluative design and formal consultations. Two applications of professional navigators in Quebec and Nova Scotia, Canada. Patient navigators, medical oncology specialists, nurses and oncology staff, administrators, family physicians, patients with cancer, and patients' families and significant others. Individual interviews (n = 49) and focus groups (n = 10) were conducted with professional navigators, patients and family members, front-line staff, family physicians, and health administrators. Formal consultations (n = 13) occurred with clinical experts, managers, and researchers from across Canada. The interview guide was based on an evaluative conceptual framework integrating questions related to the implementation process of the role of professional navigators and their organizational and clinical functions. Results support a bi-dimensional framework and define key role functions. The first dimension, health system-oriented, refers to continuity of care. The second dimension, patient-centered, corresponds to empowerment. For each dimension, related concepts were illustrated from data. Examples of outcomes also were suggested. The framework brings clarity to the role and functions of professional navigators and suggests relevant outcomes for program evaluations. With a clear definition of their role, professional navigators may be more efficient and less challenged in terms of setting priorities and making decisions while having to face demands from the health system and patients. The integrative framework could improve the effectiveness of cancer navigation programs.

Introduction: Over the last decades, psychosocial factors were identified by many studies as significant predictive variables in the development of disability related to common low back disorders, which thus contributed to the development of biopsychosocial prevention interventions. Biopsychosocial interventions were supposed to be more effective than usual interventions in improving different outcomes. Unfortunately, most of these interventions show inconclusive results. The use of screening questionnaires was proposed as a solution to improve their efficacy. The aim of this study was to validate a new screening questionnaire to identify workers at risk of being absent from work for more than 182 cumulative days and who are more susceptible to benefit from prevention interventions. Methods: Injured workers receiving income replacement benefits from the Quebec Compensation Board (n = 535) completed a 67-item questionnaire in the sub-acute stage of pain and provided information about work-related events 6 and 12 months later. Reliability and validity of the 67-item questionnaire were determined respectively by test–retest reliability and internal consistency analysis, as well as by construct validity analyses. The Cox regression model and the maximum likelihood method were used to fix a model allowing calculation of a probability of absence of more than 182 days. Criterion validity and discriminative capacity of this model were calculated. Results: Sub-sections from the 67-item questionnaire were moderately to highly correlated 2 weeks later (r = 0.52–0.80) and showed moderate to good internal consistency (0.70–0.94). Among the 67-item questionnaire, six sub-sections and variables (22 items) were predictive of long-term absence from work: fear-avoidance beliefs related to work, return to work expectations, annual family income before-taxes, last level of education attained, work schedule and work concerns. The area under the ROC curve was 73%. Conclusions: The significant predictive variables of long-term absence from work were dominated by workplace conditions and individual perceptions about work. In association with individual psychosocial variables, these variables could contribute to identify potentially useful prevention interventions and to reduce the significant costs associated with LBP long-term absenteeism.

Le dépistage de la détresse est proposé comme une première étape pour optimiser la réponse aux besoins des patients atteints de cancer. Ce changement de pratique peut contribuer à une meilleure coordination des soins, une fonction clé des intervenants pivots en oncologie. Décrire les perceptions d’acteurs clés face à l’implantation du dépistage de la détresse par des intervenants pivots en oncologie au Québec et en Nouvelle-Écosse. Étude descriptive pré/post implantation. Des entrevues ont été réalisées avec des intervenants pivots en oncologie (infirmières pivot en oncologie du Québec et cancer patient navigators de la Nouvelle-Écosse), des membres d’équipe d’oncologie psychosociale et spirituelle du Québec et des gestionnaires des deux provinces, avant et après le processus d’implantation. Des avantages et des défis similaires ont été soulignés dans les deux sites par les différents groupes d’acteurs participants. Le dépistage de la détresse a été perçu comme un changement de pratique important, améliorant le fonctionnement de l’équipe d’oncologie et les soins centrés sur le patient. Des recommandations pour faciliter le processus d’implantation sont suggérées. Cette étude soutient la pertinence d’impliquer les intervenants pivots en oncologie dans le processus d’implantation du dépistage de la détresse. Screening for Distress is suggested as a first step to optimize response to cancer patients’ needs. This change of practice may positively impact coordination of care, a key function of professional cancer navigators. To describe the perceptions of implementing Screening for Distress with professional cancer navigators from the perspective of key actors in Quebec and Nova Scotia. A descriptive pre- and post-implementation study was performed. Interviews were conducted with professional navigators (pivot nurses in oncology from Quebec and cancer patient navigators from Nova Scotia), psychosocial and spiritual oncology staff from Quebec, and health administrators from both provinces, prior to and following the implementation process. Different actors described similar advantages and challenges within both sites. Screening for Distress was perceived as an important change of practice, improving oncology team functioning and patient-centered care. Recommendations to facilitate the implementation process were suggested. This study supports the relevance of involving professional navigators in the implementation process of Screening for Distress.