Papers and chapters by Luke Feathers
PlosONE, 2016
Objective:
To examine how palliative medicine doctors engage patients in end-of-life (hereon, Eo... more Objective:
To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk.
Design:
Conversation analysis of video- and audio-recorded consultations.
Participants:
Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors.
Setting:
Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.
Results:
Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce – then later further articulate – EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk.
There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term.
Conclusions:
Through communicating – via open elaboration solicitations – in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
Patient Education and Counseling, 2016
Objectives:
To contribute to understandings about acceptability and risks entailed on video-based... more Objectives:
To contribute to understandings about acceptability and risks entailed on video-based research on healthcare communication.
To generate recommendations for non-covert video-based research on healthcare communication – with a focus on maximising its acceptability to participants, and managing and reducing its risks.
Methods:
A literature review and synthesis of (a) empirical research on participant acceptability and risks of video-recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific).
Results:
36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication:
• Most people regard video-based research as acceptable and worthwhile, whilst also carrying risks
• Concerns that recording could be detrimental to healthcare delivery are not confirmed by existing evidence
• Numerous procedures to enhance acceptability and feasibility have been documented, and our recommendations collate these
Conclusion and Practice Implications:
The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available
Papers by Luke Feathers
Supportive and Palliative Care
National evidence suggests that whilst up to 67% patients wish to die in their own home, only 21%... more National evidence suggests that whilst up to 67% patients wish to die in their own home, only 21% of patients actually do so. Recent Leicester City data reviewing emergency admissions and mortality suggests that recognising those patients who are not going to recover is inadequate in both primary and secondary care. Current systems and skills appear to be failing dying patients and their families, with local financial modelling also suggesting significant savings if appropriate care arrangements had been anticipated and implemented. To improve care for this vulnerable patient group, a local enhanced service (LES) was commissioned and an innovative three strand approach developed in conjunction with local providers and experts. Firstly, a clinical template for an Emergency Health Care Plan (EHCP) was created, using unique macros developed collaboratively with palliative care physicians, geriatricians and IT experts. This SystemOne template allows care plans for pre-defined conditions...
Supportive and Palliative Care
Effective communication is a core skill for professionals. Skilled communication is also regarded... more Effective communication is a core skill for professionals. Skilled communication is also regarded as one of the key domains of leadership that doctors should develop. Postgraduate training in communication skills is not embedded within training programmes other than GPs. This pilot study examines the feasibility and outcomes of communications skills training for doctors in their Core Medical Training. Doctors completed a pre and post training questionnaire at three months to rank, knowledge and understanding of palliative care issues and their confidence in the 'talking and supporting' aspects of end of life care. Dealing with anger & confrontation was the training need identified most. Although some identified the general need to develop skills in 'breaking bad news' or 'discuss sensitive topics', many cited needs in specific scenarios: "Dealing with patients who don't understand the prognosis/or who don't want to know" "Increase in co...
Supportive and Palliative Care
Research using video-recordings of actual consultations is increasingly providing better understa... more Research using video-recordings of actual consultations is increasingly providing better understandings of healthcare communication, and grounding new and effective interventions. Video-recordings provide details inaccessible through interviews and ethnographic observations. Initial work in a Health Association funded study involved consulting stakeholders and collating existing guidance to inform reasonable and ethical procedures for video-research in a hospice. To gather hospice patients', their significant others' and staffs' perspectives on acceptable and feasible approaches to collecting video-recordings of hospice consultations for research and teaching about expert communication skills. To collaboratively produce a protocol for making and using recordings. Patients and family members (n=14), experienced doctors and nurses (n=9), and educators (n=5) from a large hospice participated in audio-recorded qualitative interviews or focus groups, discussing: procedures fo...
Supportive and Palliative Care
In 2012 a study to explore hospice nursing and medical staff knowledge of, and attitudes towards,... more In 2012 a study to explore hospice nursing and medical staff knowledge of, and attitudes towards, organ and tissue donation was undertaken. The study identified that the barriers to discussing tissue and organ donation were multiple and the results highlighted several recommendations:▸ Increase staff awareness and knowledge ▸ Introduce guidelines on who can donate what and how ▸ Increase patient awareness of the option of tissue donation ▸ Explore when is the right time to ask a patient about their wishes relating to organ and tissue donation PUTTING RESEARCH FINDINGS INTO PRACTICE: To address these, key links have been established with the National and local acute Trust Organ and Tissue Donation Teams. This has enabled the facilitation of a teaching and awareness session for clinical staff to enhance their knowledge about who can donate, which tissues can be donated, the process of donation, and what to do if a patient expresses a wish to be a donor. Exploring when to ask a patient...
Opioids in Cancer Pain, 2007
Thorax, 2008
Breathlessness is a common and difficult symptom to treat in patients with cancer. Case reports s... more Breathlessness is a common and difficult symptom to treat in patients with cancer. Case reports suggest that nebulised furosemide can relieve breathlessness in such patients but few data are available. Patients with primary or secondary lung cancer and a Dyspnoea Exertion Scale score of >or=3 were recruited. Following familiarisation, patients received either nebulised furosemide 40 mg or nebulised 0.9% saline under double blind conditions or no treatment, in random order on 3 consecutive days. Patients undertook number reading and arm exercise tests to assess breathlessness and its impact, and were asked to report subjective benefit and any preference between nebulised treatments. 15 patients took part. There were no differences between furosemide, saline and no treatment in the outcomes of the number reading test (eg, mean number read per breath was 6.7, 6.4 and 6.7, respectively) or arm exercise test (eg, mean Borg score at maximum equivalent workload was 2.3, 2.5 and 2.7, respectively). No adverse effects were reported, although there was a small fall in forced expiratory volume in 1 s and forced vital capacity following saline. Six patients considered that their breathlessness improved with nebulised treatment, three preferring saline, one furosemide and two reporting they were of equal benefit. Our findings do not support a beneficial effect from nebulised furosemide in patients with cancer related breathlessness. Listed on the National Research Register (N0170118249) and the UK Clinical Research Network Portfolio Database (1428).
Postgraduate Medical Journal, 2009
A number of studies have explored doctors' views and experiences of cardiopulmonary resus... more A number of studies have explored doctors' views and experiences of cardiopulmonary resuscitation (CPR), but to our knowledge there has been no research to identify the information that doctors take into account when they make decisions about CPR. To investigate factors that influence decisions about CPR. Qualitative study involving six focus groups with 17 doctors and four medical students in Leicester, UK. Doctors and medical students considered a number of factors important when making decisions about CPR-namely, the patient's diagnosis, prognosis, age, quality of life, the opinions of doctors and other medical staff, and the wishes of patients and relevant others. The relative importance of each of these factors varied significantly and was influenced by the doctors' own beliefs and values. Doctors would benefit from greater support for their decision making in relation to resuscitation to reduce variability in clinical practice and to promote appropriate patient care. Identification of factors that influence doctors' individual beliefs, attitudes and values towards resuscitation and improvement in the quality of patient communication may help to guide policy in this area.
Journal of Pain and Symptom Management, 2003
Letters 305 morphine: implications for common intracellular mechanisms involved in morphine toler... more Letters 305 morphine: implications for common intracellular mechanisms involved in morphine tolerance and neuropathic pain. Pain 1995;61:353-364. 12. Mao JR, Price DD, Mayer DJ. Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interactions. Pain 1995;62:259-274. 13. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence.
Clinical Medicine, 2009
The decision to perform cardiopulmonary resuscitation (CPR) remains one of the most important and... more The decision to perform cardiopulmonary resuscitation (CPR) remains one of the most important and difficult decisions a physician must make. This study examined differences in CPR decision making among senior hospital clinicians. A questionnaire was sent out to consultants and specialist registrars in general medicine, elderly care and intensive care in a large UK district general hospital, with anonymous returns. Short clinical scenarios were presented, and participants stated their CPR decision and their confidence level. In total, 86 questionnaires were sent out and 54 replies (63%) were received. There were significant differences between specialties in making the decision to perform CPR and the confidence in doing so, with three cases producing polarised results within the specialties, despite equal confidence in the decision. There is lack of consensus with the CPR decisions made between specialties and within them. Formal training in recognition of futility should be encouraged for all clinicians.
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Papers and chapters by Luke Feathers
To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk.
Design:
Conversation analysis of video- and audio-recorded consultations.
Participants:
Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors.
Setting:
Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.
Results:
Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce – then later further articulate – EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk.
There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term.
Conclusions:
Through communicating – via open elaboration solicitations – in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
To contribute to understandings about acceptability and risks entailed on video-based research on healthcare communication.
To generate recommendations for non-covert video-based research on healthcare communication – with a focus on maximising its acceptability to participants, and managing and reducing its risks.
Methods:
A literature review and synthesis of (a) empirical research on participant acceptability and risks of video-recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific).
Results:
36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication:
• Most people regard video-based research as acceptable and worthwhile, whilst also carrying risks
• Concerns that recording could be detrimental to healthcare delivery are not confirmed by existing evidence
• Numerous procedures to enhance acceptability and feasibility have been documented, and our recommendations collate these
Conclusion and Practice Implications:
The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available
Papers by Luke Feathers
To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk.
Design:
Conversation analysis of video- and audio-recorded consultations.
Participants:
Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors.
Setting:
Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.
Results:
Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce – then later further articulate – EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk.
There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term.
Conclusions:
Through communicating – via open elaboration solicitations – in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
To contribute to understandings about acceptability and risks entailed on video-based research on healthcare communication.
To generate recommendations for non-covert video-based research on healthcare communication – with a focus on maximising its acceptability to participants, and managing and reducing its risks.
Methods:
A literature review and synthesis of (a) empirical research on participant acceptability and risks of video-recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific).
Results:
36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication:
• Most people regard video-based research as acceptable and worthwhile, whilst also carrying risks
• Concerns that recording could be detrimental to healthcare delivery are not confirmed by existing evidence
• Numerous procedures to enhance acceptability and feasibility have been documented, and our recommendations collate these
Conclusion and Practice Implications:
The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available