Using the Kipling method to explore the contextual factors of decision-making during advance care planning for older cancer patients, their family, and health-care professionals: A qualitative secondary analysis.

OBJECTIVES: Advance care planning (ACP) interventions are supposed to affect patients' autonomy and family health-care outcomes positively. However, the clinical benefits of ACP actualization and associated contextual factors merit questioning. Therefore, this study explores the critical contextual and procedural factors related to ACP decision-making based on the actual situation of older patients with cancer encountering end-of-life care in Taiwan. METHODS: This retrospective qualitative secondary analysis used the Kipling method (5W1H) to explore further the critical contextual and procedural factors related to ACP decision-making processes. We applied thematic analysis and dual coding for 35 narratives, including 10 patients with cancer, 10 family caregivers, and 15 health-care staff, derived from a preliminary qualitative study regarding palliative care decision-making among patients with advanced cancer, their families, and health-care staff. RESULTS: We identified 6 domains detailing the contextual factors for ACP decision-making: (1) WHO (decision makers); (2) WHAT (discussion content); (3) WHEN (care plan for which disease stage); (4) WHERE (patient's situational location); (5) WHY (reasons underpinning the decisions); and (6) HOW (the way to form the decisions). SIGNIFICANCE OF RESULTS: Using the Kipling method to elaborate the contextual factors for ACP decision-making among older patients with cancer strengthens the understanding of complicated end-of-life care decision-making procedure. This study also demonstrates the dynamic and cultural complexity and the various factors considered during end-of-life care and future ACP discussion.

Development of the Insomnia Screening Scale based on ICSD-II.

OBJECTIVE: Although various instruments have been developed to evaluate insomniac symptoms in individuals, none of them are based on the International Classification of Sleep Disorder, 2nd (ICSD-II). The purpose of this study is to develop a new scaling system, the Insomnia Screening Scale (ISS) to fit the new diagnostic criteria. METHODS: Study 1 was conducted to formulate the new items of the insomnia screening scale (ISS), which were divided into four major subscales, and establish the reliability and validity of the ISS in clinical insomniac subjects. Study 2 tested the external validity of the ISS, which was used in a community survey, and investigated the relationship between ISS and daytime function, especially working memory. RESULTS: The final version of the ISS has good internal consistency (α = 0.87-0.98), and explains 64% of the variance. The insomnia group had poor working memory performance on the cognitive tasks. CONCLUSIONS: The ICSD-II based ISS is a reliable and valid instrument for evaluating an individual's insomniac symptoms. The major difference between the ISS and the previous instruments is that the ISS not only assess the subjective insomniac and daytime symptoms but also examines the sleep environment and sleep opportunities of the participants.