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  1. Article: Concerns and priority outcomes for children with advanced cancer and their families in the Middle East: A cross-national qualitative study.

    Boufkhed, Sabah / Yurduşen, Sema / Alarjeh, Ghadeer / Ahmed, Fahad / Alrjoub, Waleed / Guo, Ping / Alajarmeh, Sawsan / Şengelen, Meltem / Cemaloğlu, Mustafa / Aydın, Burça / Alnassan, Anwar / Al-Awady, Shireen / Kutluk, Tezer / Shamieh, Omar / Harding, Richard

    Frontiers in oncology

    2023  Volume 13, Page(s) 1120990

    Abstract: Introduction: Palliative care access is limited in the Middle-East, with few specialist centers and forcibly displaced migrants facing additional struggles to access care. Little is known about the specificities of providing palliative care to children ... ...

    Abstract Introduction: Palliative care access is limited in the Middle-East, with few specialist centers and forcibly displaced migrants facing additional struggles to access care. Little is known about the specificities of providing palliative care to children and young people (CYP) with cancer. They are rarely asked directly their concerns and needs, which limits the provision of quality patient-centered care. Our study aims to identify the concerns and needs of CYP with advanced cancer and their families, in Jordan and Turkey.
    Method: A qualitative cross-national study in Jordan and Turkey with framework analysis was conducted two pediatric cancer centers in Jordan and Turkey. In each country, 25 CYP, 15 caregivers and 12 healthcare professionals participated (N=104). Most caregivers (70%) and healthcare professionals (75%) were women.
    Results: We identified five areas of concern: (1) Physical pain and other symptoms (e.g. mobility, fatigue); (2) Psychological concerns and needs (e.g. anger, psychological changes); (3) Spirituality, uncertainty over the future and use of "Tawakkul" (e.g. use of religion as a coping mechanism); (4) Negative impact on social life (e.g. social isolation, loss of support); (5) Burden on caregiver and their families (e.g. financial issues, siblings left behind). Psychological concerns were a priority for both CYPs and caregivers (particularly for refugee and displaced families) but often overlooked during routine care. CYP were able to share their own concerns and care priorities.
    Conclusions: Advanced cancer care must ensure assessment and management of concerns across the concerns identified. Developing child- and family-centered outcomes would ensure monitoring the quality of care. Spirituality had a more important role compared to similar investigation in other regions.
    Language English
    Publishing date 2023-03-14
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1120990
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Providing person-centered palliative care in conflict-affected populations in the Middle East: What matters to patients with advanced cancer and families including refugees?

    Guo, Ping / Alajarmeh, Sawsan / Alarjeh, Ghadeer / Alrjoub, Waleed / Al-Essa, Ayman / Abusalem, Lana / Giusti, Alessandra / Mansour, Asem H / Sullivan, Richard / Shamieh, Omar / Harding, Richard

    Frontiers in oncology

    2023  Volume 13, Page(s) 1097471

    Abstract: Introduction: Universal health coverage highlights palliative care as an essential component of health services. However, it is unclear what constitutes person-centered care in populations affected by conflict, as they may have specific concerns in the ... ...

    Abstract Introduction: Universal health coverage highlights palliative care as an essential component of health services. However, it is unclear what constitutes person-centered care in populations affected by conflict, as they may have specific concerns in the dimensions of physical, emotional, social, and spiritual wellbeing. This study aimed to identify what matters to patients with advanced cancer and family caregivers in Jordan including refugees, to inform appropriate person-centered assessment and palliative care in conflict-affected populations.
    Methods: Cross-sectional face-to-face, semi-structured interviews were conducted at two sites in Amman. Adult patients with advanced cancer and family caregivers were purposively sampled to maximize diversity and representation. Interviews were digitally audio recorded, anonymized, and transcribed verbatim for thematic analysis.
    Findings: Four themes were generated from 50 patients (22 refugees; 28 Jordanians) and 20 caregivers (7 refugees; 13 Jordanians) (1). Information, communication, and decision-making. Truth-telling and full disclosure from clinicians was valued, and participants expressed concerns that information was not shared in case patients would disengage with treatment. (2) Priorities and concerns for care and support. Participants' top priority remained cure and recovery (which was viewed as possible). Other priorities included returning to their "normal" life and their "own" country, and to continue contributing to their family. (3) Role of spirituality and Islam. Most participants had strong faith in God and felt that having faith could comfort them. For refugees whose social network was fractured due to being away from home country, prayer and Quran reading became particularly important. (4) Unmet support needs of family caregivers. Family caregivers were affected physically and emotionally by worrying about and caring for the patients. They needed support and training, but often could not access this.
    Discussion: Truth-telling is highly valued and essential to achieving person-centered care and informed decision-making. This study also reveals specific concerns in conflict-affected populations, reflecting the experience of prior losses and fracturing of existing social networks and support. The role of religion is crucial in supporting refugee communities, and consideration should be paid to the needs of patients and caregivers when caring for a patient at home without access to their communities of origin and the support they accessed.
    Language English
    Publishing date 2023-03-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1097471
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study.

    Alarjeh, Ghadeer / Boufkhed, Sabah / Alrjoub, Waleed / Guo, Ping / Yurduşen, Sema / Ahmed, Fahad / Abdal-Rahman, Mousa / Alajarmeh, Sawsan / Alnassan, Anwar / Al-Awady, Shireen / Kutluk, Tezer / Harding, Richard / Shamieh, Omar

    Frontiers in oncology

    2023  Volume 13, Page(s) 1118992

    Abstract: Introduction: Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences ... ...

    Abstract Introduction: Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan.
    Methods: A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed.
    Findings: Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers' suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients' and caregivers' health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child's care and prognosis, which posed challenges to communication with staff.
    Discussion: The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children's ability to engage in primary research and to express preferences, and parents' ability to share views on this sensitive topic.
    Language English
    Publishing date 2023-04-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1118992
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005-2016.

    Guo, Ping / Chukwusa, Emeka / Asad, Majed / Nimri, Omar / Arqoub, Kamal / Alajarmeh, Sawsan / Mansour, Asem / Sullivan, Richard / Shamieh, Omar / Harding, Richard

    Journal of palliative medicine

    2021  Volume 24, Issue 11, Page(s) 1616–1625

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Adult ; Aged ; Cross-Sectional Studies ; Hospital Mortality ; Humans ; Jordan ; Palliative Care ; Refugees
    Language English
    Publishing date 2021-04-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2020.0476
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Compounded trauma: A qualitative study of the challenges for refugees living with advanced cancer.

    Guo, Ping / Alajarmeh, Sawsan / Alarja, Ghadeer / Alrjoub, Waleed / Al-Essa, Ayman / Abusalem, Lana / Mansour, Asem / Sullivan, Richard / Shamieh, Omar / Harding, Richard

    Palliative medicine

    2021  Volume 35, Issue 5, Page(s) 916–926

    Abstract: Background: Although palliative care is now an essential health service under Universal Health Coverage, ensuring access and appropriate care for refugees is a specific challenge for this large population.: Aim: To identify the needs and experiences ... ...

    Abstract Background: Although palliative care is now an essential health service under Universal Health Coverage, ensuring access and appropriate care for refugees is a specific challenge for this large population.
    Aim: To identify the needs and experiences of adult refugees in Jordan with advanced cancer and informal caregivers.
    Design: A qualitative study using semi-structured interviews.
    Setting/participants: Participants were purposively sampled at two Jordanian hospitals to achieve heterogeneity by age, gender, country of origin, and primary diagnosis.
    Results: Twenty-nine refugees (22 patients, 7 caregivers) participated, and four themes were generated: (1) Psychological distress and sustaining social support. Refugees often experienced unmet psychosocial needs. However, psychosocial support was reported either absent or limited. (2) Knowledge and uncertainty. Lack of information and poor communication between healthcare providers and patients caused significant distress due to uncertainty. (3) Family anxiety and support roles. Being away from the home country cut patients and caregivers off from their wider social support network, which added increased anxiety and responsibilities to caregivers. (4) Compounded trauma and poverty. Many refugees have experienced trauma related to war that may affect their physical and mental health. They faced serious financial crises caused by the rising cost of medicines and treatment.
    Conclusions: This study reveals the impact of fractured families and networks on social support in advanced cancer, and the compounding trauma of the disease for refugees. Detailed person-centred assessment and emphasis on psychosocial support is essential, and home-based care should not presume community support for patients to remain at home.
    MeSH term(s) Adult ; Caregivers ; Humans ; Neoplasms/therapy ; Palliative Care ; Qualitative Research ; Refugees
    Language English
    Publishing date 2021-03-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639247-7
    ISSN 1477-030X ; 0269-2163
    ISSN (online) 1477-030X
    ISSN 0269-2163
    DOI 10.1177/02692163211000236
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Developing a global practice-based framework of person-centred care from primary data: a cross-national qualitative study with patients, caregivers and healthcare professionals.

    Giusti, Alessandra / Pukrittayakamee, Panate / Alarja, Ghadeer / Farrant, Lindsay / Hunter, Joy / Mzimkulu, Olona / Gwyther, Liz / Williams, Nokuzola / Wannarit, Kamonporn / Abusalem, Lana / Alajarmeh, Sawsan / Alrjoub, Waleed / Thongchot, Lakkana / Janwanishstaporn, Satit / Edilbi, Adib / Al-Ani, Ruba / Shamieh, Omar / Guo, Ping / Bashan Nkhoma, Kennedy /
    Venkatapuram, Sridhar / Harding, Richard

    BMJ global health

    2022  Volume 7, Issue 7

    Abstract: Introduction: Person-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of ... ...

    Abstract Introduction: Person-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of countries which are low- and middle-income. This study aimed to appraise and adapt a PCC model across three serious physical conditions in three middle-income countries and generate an evidence-based framework and recommendations for globally relevant PCC.
    Methods: Cross-national, cross-sectional qualitative study. In depth, semistructured interviews conducted with: advanced cancer patients in Jordan (n=50), their caregivers (n=20) and healthcare professionals (HCPs) (n=20); chronic obstructive pulmonary disease patients in South Africa (n=22), their caregivers (n=19) and HCPs (n=22); heart failure patients in Thailand (n=14), their caregivers (n=10) and HCPs (n=12). Data were analysed using framework analysis. Santana
    Results: The findings both reveal specific practical actions that contribute towards delivering PCC and highlight new cross-national domains of person-centredness: interdependency and collectivism; bringing care into the home and community; equity and non-discrimination; addressing health and illness within the context of limited resources; and workforce well-being.
    Conclusion: The data suggest that PCC requires particular structural features of the healthcare system to be in place, such as professional education in PCC values and partnerships with community-based workers. These structures may better enable PCC processes, including tailored information sharing and providing genuine opportunities for patients to do the things that matter to them, such as making informed care decisions and sustaining social relationships. PCC must also accommodate a collectivist perspective and support the well-being of the workforce.
    MeSH term(s) Caregivers ; Cross-Sectional Studies ; Delivery of Health Care ; Humans ; Patient-Centered Care ; Qualitative Research
    Language English
    Publishing date 2022-07-13
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2059-7908
    ISSN 2059-7908
    DOI 10.1136/bmjgh-2022-008843
    Database MEDical Literature Analysis and Retrieval System OnLINE

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