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Title: Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation
Authors: Yang, Grace Meijuan 
Dionne-Odom, J. Nicholas
Foo, Yi Han
Chung, Ariel Hui Mei
Kamal, Nur Haidah Ahmad
Tan, Laurence
Yu, Chou Chuen
Khanh, Le Mai
Koh, Audrey Rui Xuan
Teo, Irene 
Yoon, Sungwon 
Bakitas, Marie
Keywords: Caregivers
Culturally competent care
Palliative Care
Patient participation
Qualitative research
Issue Date: 22-Jun-2021
Publisher: BioMed Central Ltd
Citation: Yang, Grace Meijuan, Dionne-Odom, J. Nicholas, Foo, Yi Han, Chung, Ariel Hui Mei, Kamal, Nur Haidah Ahmad, Tan, Laurence, Yu, Chou Chuen, Khanh, Le Mai, Koh, Audrey Rui Xuan, Teo, Irene, Yoon, Sungwon, Bakitas, Marie (2021-06-22). Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation. BMC Palliative Care 20 (1) : 86. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: ENABLE (Educate, Nurture, Advise, Before Life Ends) is a nurse coach-led, early palliative care model for patients with advanced cancer and their family caregivers. Content covered includes problem-solving, advance care planning, symptom management and self-care. The aim was to evaluate the cultural acceptability of ENABLE among patients with advanced cancer and their caregivers in Singapore and identify modifications for an adapted ENABLE-SG model. Methods: Qualitative formative evaluation with a thematic analysis approach in two hospitals in Singapore, involving patients (n = 10), family caregivers (n = 11) and healthcare professionals (n = 10) who care for patients with advanced cancer. Semi-structured interviews were conducted to explore (i) the main needs and challenges facing individuals with advanced cancer and their family caregivers; (ii) patient involvement in healthcare decision making; and (iii) content and delivery of ENABLE. Results: While physical needs were largely well met, participants expressed that psychosocial care was delivered too late in the illness trajectory. Healthcare decision making approaches varied from a patient-centred shared decision-making model to a family-centred model where patients may not know their cancer diagnosis and prognosis. The content was considered to be relevant, comprehensive and practical; financial assistance, adjustment to body image, and evaluation of complementary therapy were also recommended. Face-to-face rather than telephone sessions were preferred to facilitate rapport building. Conclusions: ENABLE was broadly acceptable with some modifications, including adjusting the content to ensure it can be delivered even if the patient is not fully aware of cancer diagnosis and delivering the first session face-to-face with flexibility for subsequent sessions. © 2021, The Author(s).
Source Title: BMC Palliative Care
ISSN: 1472-684X
DOI: 10.1186/s12904-021-00799-y
Rights: Attribution 4.0 International
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