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Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study.

https://arctichealth.org/en/permalink/ahliterature151147
Source
Schizophr Res. 2009 Aug;113(1):101-6
Publication Type
Article
Date
Aug-2009
Author
Patricia J Martens
Harvey Max Chochinov
Heather J Prior
Randall Fransoo
Elaine Burland
Author Affiliation
Department of Community Health Sciences, University of Manitoba, Manitoba Centre for Health Policy, 408-727 McDermot Avenue, Winnipeg, Manitoba, Canada. Pat_Martens@cpe.umanitoba.ca
Source
Schizophr Res. 2009 Aug;113(1):101-6
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adult
Community Health Planning - methods
Early Detection of Cancer
Female
Humans
Logistic Models
Manitoba - epidemiology
Mass Screening
Middle Aged
Probability
Retrospective Studies
Schizophrenia - epidemiology
Uterine Cervical Neoplasms - diagnosis - epidemiology
Abstract
Barriers to cervical cancer screening (Pap tests) may exist for women experiencing schizophrenia.
This study analyzed healthcare records of all women in the province of Manitoba, Canada to: (a) compare cervical cancer screening rates of women with and without schizophrenia; and (b) determine factors associated with screening uptake.
This study took place in Manitoba, Canada, utilizing anonymized universal administrative data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy.
All females aged 18-69 living in Manitoba December 31, 2002, excluding those diagnosed with invasive or in situ cervical cancer in the study period or previous 5 years.
To determine factors associated with Papanicolaou (Pap) test uptake (1+ Pap test in 3 years, 2001/02-2003/04), logistic regression modeling included: diagnosis of schizophrenia, age, region, average household income, continuity of care (COC), presence of major physical comorbidity. Good COC was defined as at least 50% of ambulatory physician visits from the same general/family practitioner within two years.
Women with schizophrenia (n=3220) were less likely to have a Pap test (58.8% vs. 67.8%, p
PubMed ID
19419843 View in PubMed
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"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home.

https://arctichealth.org/en/permalink/ahliterature139178
Source
J Clin Ethics. 2010;21(3):201-11
Publication Type
Article
Date
2010
Author
Susan McClement
Michelle Lobchuk
Harvey Max Chochinov
Ruth Dean
Author Affiliation
Faculty of Nursing, University of Manitoba, Winnipeg. susan.mcclement@cancercare.mb.ca
Source
J Clin Ethics. 2010;21(3):201-11
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Death
Canada
Female
Humans
Long-Term Care - ethics
Male
Middle Aged
Nurses' Aides - ethics - standards
Nursing Homes - manpower - standards
Terminal Care - ethics - standards
Abstract
Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.
Notes
Comment In: J Clin Ethics. 2010 Fall;21(3):179-8821089987
PubMed ID
21089989 View in PubMed
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Burden to others and the terminally ill.

https://arctichealth.org/en/permalink/ahliterature162607
Source
J Pain Symptom Manage. 2007 Nov;34(5):463-71
Publication Type
Article
Date
Nov-2007
Author
Harvey Max Chochinov
Linda J Kristjanson
Thomas F Hack
Thomas Hassard
Susan McClement
Mike Harlos
Author Affiliation
Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. harvey.chochinov@cancercare.mb.ca
Source
J Pain Symptom Manage. 2007 Nov;34(5):463-71
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adaptation, Psychological
Aged
Cost of Illness
Female
Humans
Male
Manitoba
Neoplasms - complications
Neuropsychological Tests
Palliative Care
Stress, Psychological - etiology - psychology
Terminal Care - psychology
Abstract
Studies of patients who are terminally ill consistently identify strong associations between "sense of burden to others" and marked end-of-life distress. However, little research has addressed the issue of burden to others among patients nearing death. The aim of this study was to carefully examine "burden to others" and clarify its relationship with various psychosocial, physical, and existential issues arising in patients who are terminally ill. A cohort of 211 patients with end-stage cancer was assessed, using an assortment of validated psychometrics to document psychosocial, physical, and existential aspects of their end-of-life experience. This included an assessment of their sense of "burden to others." Forty percent of participants indicated a negligible sense of burden to others, scoring within the lowest quarter on an ordinal measure of "burden to others;" 25% scored within the second lowest quarter; 12% within the third quarter; and 23% within the highest or most severe range. The most highly correlated variables with "sense of burden to others" included depression (r=0.460; df=201, P
PubMed ID
17616329 View in PubMed
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Desire for euthanasia or physician-assisted suicide in palliative cancer care.

https://arctichealth.org/en/permalink/ahliterature163554
Source
Health Psychol. 2007 May;26(3):314-23
Publication Type
Article
Date
May-2007
Author
Keith G Wilson
Harvey Max Chochinov
Christine J McPherson
Merika Graham Skirko
Pierre Allard
Srini Chary
Pierre R Gagnon
Karen Macmillan
Marina De Luca
Fiona O'Shea
David Kuhl
Robin L Fainsinger
Andrea M Karam
Jennifer J Clinch
Author Affiliation
Institute for Rehabilitation Research and Development, The Rehabilitation Centre, The Ottawa Hospital, Ottawa, ON, and Department of Psychiatry, University of Manitoba, Winnipeg, Canada. kewilson@ottawahospital.on.ca
Source
Health Psychol. 2007 May;26(3):314-23
Date
May-2007
Language
English
Publication Type
Article
Keywords
Aged
Attitude to Death
Canada
Female
Humans
Interviews as Topic
Male
Middle Aged
Neoplasms
Palliative Care
Patient satisfaction
Prospective Studies
Suicide, Assisted
Abstract
To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death.
In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively.
Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns.
There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p
PubMed ID
17500618 View in PubMed
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Dignity in the terminally ill: a cross-sectional, cohort study.

https://arctichealth.org/en/permalink/ahliterature187218
Source
Lancet. 2002 Dec 21-28;360(9350):2026-30
Publication Type
Article
Author
Harvey Max Chochinov
Thomas Hack
Thomas Hassard
Linda J Kristjanson
Susan McClement
Mike Harlos
Author Affiliation
Department of Psychiatry, University of Manitoba, Winnipeg, Canada. chochin@cc.UManitoba.CA
Source
Lancet. 2002 Dec 21-28;360(9350):2026-30
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Cohort Studies
Cross-Sectional Studies
Educational Status
Female
Humans
Male
Manitoba
Neoplasms
Palliative Care
Quality of Life
Questionnaires
Right to Die
Abstract
Considerations of dignity are often raised in reference to the care of dying patients. However, little research that addresses this issue has been done. Our aim was to identify the extent to which dying patients perceive they are able to maintain a sense of dignity, and to ascertain how demographic and disease-specific variables relate to the issue of dignity in these individuals.
We did a cross-sectional study of a cohort of terminally ill patients with cancer, who had a life expectancy of less than 6 months. We enrolled 213 patients from two palliative care units in Winnipeg, Canada, and asked them to rate their sense of dignity. Our main outcome measures included: a 7-point sense of dignity item; the symptom distress scale; the McGill pain questionnaire; the index of independence in activities of daily living (IADL); a quality of life scale; a brief battery of self-report measures, including screening for desire for death, anxiety, hopelessness, and will to live; burden to others; and requirement for social support.
16 of 213 patients (7.5%; 95% CI 4-11) indicated that loss of dignity was a great concern. These patients were far more than likely than the rest of the cohort to report psychological distress and symptom distress, heightened dependency needs, and loss of will to live.
Loss of dignity is closely associated with certain types of distress often seen among the terminally ill. Preservation of dignity should be an overall aim of treatment and care in patients who are nearing death.
Notes
Comment In: Lancet. 2002 Dec 21-28;360(9350):1997-812504390
Comment In: Lancet. 2003 Mar 1;361(9359):78312620760
PubMed ID
12504398 View in PubMed
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Dignity in the terminally ill: a developing empirical model.

https://arctichealth.org/en/permalink/ahliterature191688
Source
Soc Sci Med. 2002 Feb;54(3):433-43
Publication Type
Article
Date
Feb-2002
Author
Harvey Max Chochinov
Thomas Hack
Susan McClement
Linda Kristjanson
Mike Harlos
Author Affiliation
Department of Psychiatry-PX246, University of Manitoba, PsycHealth Centre, Winnipeg, Canada. chochin@cc.umanitoba.ca
Source
Soc Sci Med. 2002 Feb;54(3):433-43
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adaptation, Psychological
Anecdotes as Topic
Attitude to Death
Cost of Illness
Family Relations
Humans
Interviews as Topic
Manitoba
Neoplasms - psychology
Professional-Patient Relations
Quality of Life
Right to Die
Skilled Nursing Facilities - utilization
Terminal Care
Terminally Ill - psychology
Abstract
Despite use of the term dignity in arguments for and against a patient's self-governance in matters pertaining to death, there is little empirical research on how this term has been used by patients who are nearing death. The objective of this study was to determine how dying patients understand and define the term dignity, in order to develop a model of dignity in the terminally ill. A semi-structured interview was designed to explore how patients cope with their advanced cancer and to detail their perceptions of dignity. Interviews were audiotaped and transcribed verbatim. A consecutive sample of 50 consenting patients with advanced terminal cancer were recruited over a 15-month period of time from an urban extended care hospital housing a specialized unit for palliative care. This unit provides both inpatient services. and coordinates end-of-life care community based programming. Data were analysed using latent content analysis and constant comparison techniques. Four members of the research team independently coded the transcribed data, to develop conceptually meaningful categories of responses. Operational definitions were written for major categories, themes and sub-themes. Three major categories emerged from the qualitative analysis, including illness-related concerns; dignity conserving repertoire; and social dignity inventory. These broad categories and their carefully defined themes and sub-themes form the foundation for an emerging model of dignity amongst the dying. The concept of dignity and the dignity model offer a way of understanding how patients face advancing terminal illness. This will serve to promote dignity and the quality of life of patients nearing death.
PubMed ID
11824919 View in PubMed
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Dignity therapy: a feasibility study of elders in long-term care.

https://arctichealth.org/en/permalink/ahliterature127040
Source
Palliat Support Care. 2012 Mar;10(1):3-15
Publication Type
Article
Date
Mar-2012
Author
Harvey Max Chochinov
Beverley Cann
Katherine Cullihall
Linda Kristjanson
Mike Harlos
Susan E McClement
Thomas F Hack
Tom Hassard
Author Affiliation
Department of Psychiatry, University of Manitoba, Winnipeg, Canada. harvey.chochinov@cancercare.mb.ca
Source
Palliat Support Care. 2012 Mar;10(1):3-15
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - psychology - therapy
Caregivers - psychology
Feasibility Studies
Female
Frail Elderly - psychology
Humans
Long-Term Care - psychology
Male
Manitoba
Memory, Episodic
Middle Aged
Narration
Palliative Care - psychology
Personhood
Psychotherapy - methods
Rehabilitation Centers
Abstract
The purpose of this study was to assess the feasibility of dignity therapy for the frail elderly.
Participants were recruited from personal care units contained within a large rehabilitation and long-term care facility in Winnipeg, Manitoba. Two groups of participants were identified; residents who were cognitively able to directly take part in dignity therapy, and residents who, because of cognitive impairment, required that family member(s) take part in dignity therapy on their behalf. Qualitative and quantitative methods were applied in determining responses to dignity therapy from direct participants, proxy participants, and healthcare providers (HCPs).
Twelve cognitively intact residents completed dignity therapy; 11 cognitively impaired residents were represented in the study by way of family member proxies. The majority of cognitively intact residents found dignity therapy to be helpful; the majority of proxy participants indicated that dignity therapy would be helpful to them and their families. In both groups, HCPs reported the benefits of dignity therapy in terms of changing the way they perceived the resident, teaching them things about the resident they did not previously know; the vast majority indicated that they would recommend it for other residents and their families.
This study introduces evidence that dignity therapy has a role to play among the frail elderly. It also suggests that whether residents take part directly or by way of family proxies, the acquired benefits--and the effects on healthcare staff--make this area one meriting further study.
PubMed ID
22329932 View in PubMed
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Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life.

https://arctichealth.org/en/permalink/ahliterature173271
Source
J Clin Oncol. 2005 Aug 20;23(24):5520-5
Publication Type
Article
Date
Aug-20-2005
Author
Harvey Max Chochinov
Thomas Hack
Thomas Hassard
Linda J Kristjanson
Susan McClement
Mike Harlos
Author Affiliation
Department of Psychiatry, Family Medicine, Community Health Sciences, and Faculty of Nursing, University of Manitoba, Canada. harvey.chochinov@cancercare.mb.ca
Source
J Clin Oncol. 2005 Aug 20;23(24):5520-5
Date
Aug-20-2005
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Aged
Attitude to Death
Australia
Cost of Illness
Family Relations
Humans
Manitoba
Middle Aged
Neoplasms - psychology
Patient satisfaction
Quality of Life
Right to Die
Spirituality
Statistics, nonparametric
Stress, Psychological
Terminal Care - methods
Terminally Ill - psychology
Abstract
This study examined a novel intervention, dignity therapy, designed to address psychosocial and existential distress among terminally ill patients. Dignity therapy invites patients to discuss issues that matter most or that they would most want remembered. Sessions are transcribed and edited, with a returned final version that they can bequeath to a friend or family member. The objective of this study was to establish the feasibility of dignity therapy and determine its impact on various measures of psychosocial and existential distress.
Terminally ill inpatients and those receiving home-based palliative care services in Winnipeg, Canada, and Perth, Australia, were asked to complete pre- and post-intervention measures of sense of dignity, depression, suffering, and hopelessness; sense of purpose, sense of meaning, desire for death, will to live, and suicidality; and a post-intervention satisfaction survey.
Ninety-one percent of participants reported being satisfied with dignity therapy; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family. Post-intervention measures of suffering showed significant improvement (P = .023) and reduced depressive symptoms (P = .05). Finding dignity therapy helpful to their family correlated with life feeling more meaningful (r = 0.480; P = .000) and having a sense of purpose (r = 0.562; P = .000), accompanied by a lessened sense of suffering (r = 0.327; P = .001) and increased will to live (r = 0.387; P = .000).
Dignity therapy shows promise as a novel therapeutic intervention for suffering and distress at the end of life.
Notes
Comment In: J Clin Oncol. 2005 Aug 20;23(24):5427-816110001
PubMed ID
16110012 View in PubMed
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Does a diagnosis of schizophrenia reduce rates of mammography screening? A Manitoba population-based study.

https://arctichealth.org/en/permalink/ahliterature151086
Source
Schizophr Res. 2009 Aug;113(1):95-100
Publication Type
Article
Date
Aug-2009
Author
Harvey Max Chochinov
Patricia J Martens
Heather J Prior
Randall Fransoo
Elaine Burland
Author Affiliation
Department of Psychiatry, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada. harvey.chochinov@cancercare.mb.ca
Source
Schizophr Res. 2009 Aug;113(1):95-100
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - epidemiology - radiography
Community Health Planning
Early Detection of Cancer
Female
Humans
Mammography
Manitoba - epidemiology
Mass Screening
Middle Aged
Probability
Retrospective Studies
Schizophrenia - diagnosis - epidemiology
PubMed ID
19427766 View in PubMed
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17 records – page 1 of 2.