Harnessing the power of clinician judgement. Identifying risk of deteriorating and dying in people with a haematological malignancy: A Delphi study.
Delphi approach
clinical indicators
end of life
haematological malignancies
identifying dying
mixed-methods
nursing
palliative care
Journal
Journal of advanced nursing
ISSN: 1365-2648
Titre abrégé: J Adv Nurs
Pays: England
ID NLM: 7609811
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
04
02
2018
revised:
21
08
2018
accepted:
09
10
2018
pubmed:
31
10
2018
medline:
7
5
2019
entrez:
31
10
2018
Statut:
ppublish
Résumé
To provide expert consensus on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. Identification of people who are at risk of deteriorating and dying is essential to facilitate patient autonomy, appropriate treatment decisions, and effective end-of-life care. A three-step modified Delphi approach. The study was conducted over 6 months (September 2015-March 2016) to gather opinion from an international panel of experts (N = 27) on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. The first round was informed by a systematic review of prognostic factors present in the final months of life for people with a haematological malignancy. Consensus was achieved if 70% of responses fell within two points on a seven-point Likert-type scale. Consensus was achieved on the following 11 clinical indicators: (a) advancing age; (b) declining performances status; (c) presence of co-morbidities; (d) disease status; (e) persistent infections (bacterial and viral); (f) fungal infections; (g) severe graft versus host disease; (h) requiring high care; (i) signs of frailty; (j) treatment limitations; and (k) anorexia and/or weight loss. Consensus was also achieved on associated themes and statements for each indicator. The findings of this study indicate that subjective clinician-assessed indicators that are contextually relevant to the nature of haematological malignancies are markers of risk. This study has provided valuable preliminary findings on the topic and will inform future research.
Sections du résumé
AIM
OBJECTIVE
To provide expert consensus on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying.
BACKGROUND
BACKGROUND
Identification of people who are at risk of deteriorating and dying is essential to facilitate patient autonomy, appropriate treatment decisions, and effective end-of-life care.
DESIGN
METHODS
A three-step modified Delphi approach.
METHODS
METHODS
The study was conducted over 6 months (September 2015-March 2016) to gather opinion from an international panel of experts (N = 27) on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. The first round was informed by a systematic review of prognostic factors present in the final months of life for people with a haematological malignancy. Consensus was achieved if 70% of responses fell within two points on a seven-point Likert-type scale.
FINDINGS
RESULTS
Consensus was achieved on the following 11 clinical indicators: (a) advancing age; (b) declining performances status; (c) presence of co-morbidities; (d) disease status; (e) persistent infections (bacterial and viral); (f) fungal infections; (g) severe graft versus host disease; (h) requiring high care; (i) signs of frailty; (j) treatment limitations; and (k) anorexia and/or weight loss. Consensus was also achieved on associated themes and statements for each indicator.
CONCLUSION
CONCLUSIONS
The findings of this study indicate that subjective clinician-assessed indicators that are contextually relevant to the nature of haematological malignancies are markers of risk. This study has provided valuable preliminary findings on the topic and will inform future research.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
161-174Subventions
Organisme : National Health and Medical Research Council Centre for Research Excellence in End-of-Life Care
Organisme : Queensland University of Technology
Organisme : Royal Brisbane and Women's Hospital
Organisme : Centaur Memorial Fund for Nurses
Informations de copyright
© 2018 John Wiley & Sons Ltd.