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Namukwaya E, de Sousa AB, Lopes S, Touwen DP, van der Steen JT, Bélanger E, Brooks J, Yghemonos S, Sehmi K, Gomes B. EOLinPLACE: an international research project to reform the way dying places are classified and understood. Palliat Care Soc Pract 2024; 18:26323524231222498. [PMID: 38357678 PMCID: PMC10865961 DOI: 10.1177/26323524231222498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Background Whenever possible, a person should die where they feel it is the right place to be. There is substantial global variation in home death percentages but it is unclear whether these differences reflect preferences, and there are major limitations in how the place of death is classified and compared across countries. Objectives EOLinPLACE is an international interdisciplinary research project funded by the European Research Council aiming to create a solid base for a ground-breaking international classification tool that will enable the mapping of preferred and actual places towards death. Design Mixed-methods observational research. Methods and analysis We combine classic methods of developing health classifications with a bottom-up participatory research approach, working with international organizations representing patients and informal carers [International Alliance of Patients' Organizations (IAPO) and Eurocarers]. First, we will conduct an international comparative analysis of existing classification systems and routinely collected death certificate data on place of death. Secondly, we will conduct a mixed-methods study (ethnography followed by longitudinal quantitative study) in four countries (the Netherlands, Portugal, Uganda and the United States), to compare the preferences and experiences of patients with life-threatening conditions and their families. Thirdly, based on the generated evidence, we will build a contemporary classification of dying places; assess its content validity through focus groups with patients, carers and other stakeholders; and evaluate it in a psychometric study to examine construct validity, reliability, responsiveness, data quality and interpretability. Ethics Approved by the ethics committee of the University of Coimbra, Faculty of Medicine (CE-068-2022) and committees in each of the participating countries. Discussion The findings will provide a deeper understanding of the diversity in individual end-of-life pathways. They will enable key developments such as measurement of progress towards achievement of preferences when care can be planned. The project will open new directions in how to care for the dying. Trial registration Research Registry UIN 9213.
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Affiliation(s)
- Elizabeth Namukwaya
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Dorothea Petra Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny Theodora van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Joanna Brooks
- Population Health and Palliative Medicine, Master of Health Services Administration, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Kawaldip Sehmi
- International Alliance of Patients’ Organizations, London, UK
| | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Pólo III, Sub-Unidade 3, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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van der Steen JT, Nakanishi M, Van den Block L, Di Giulio P, Gonella S, in der Schmitten J, Sudore RL, Harrison Dening K, Parker D, Mimica N, Holmerova I, Larkin P, Martins Pereira S, Rietjens JAC, Korfage IJ. Consensus definition of advance care planning in dementia: A 33-country Delphi study. Alzheimers Dement 2024; 20:1309-1320. [PMID: 37985444 PMCID: PMC10916978 DOI: 10.1002/alz.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Existing advance care planning (ACP) definitional frameworks apply to individuals with decision-making capacity. We aimed to conceptualize ACP for dementia in terms of its definition and issues that deserve particular attention. METHODS Delphi study with phases: (A) adaptation of a generic ACP framework by a task force of the European Association for Palliative Care (EAPC); (B) four online surveys by 107 experts from 33 countries, September 2021 to June 2022; (C) approval by the EAPC board. RESULTS ACP in dementia was defined as a communication process adapted to the person's capacity, which includes, and is continued with, family if available. We identified pragmatic boundaries regarding participation and time (i.e., current or end-of-life care). Three interrelated issues that deserve particular attention were capacity, family, and engagement and communication. DISCUSSION A communication and relationship-centered definitional framework of ACP in dementia evolved through international consensus supporting inclusiveness of persons with dementia and their family. HIGHLIGHTS This article offers a consensus definitional framework of advance care planning in dementia. The definition covers all stages of capacity and includes family caregivers. Particularly important are (1) capacity, (2) family, (3) engagement, and communication. Fluctuating capacity was visualized in relation to roles and engaging stakeholders.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
- Department of Primary and Community Care, and Radboudumc Alzheimer CenterRadboud university medical centerNijmegenThe Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
- Department of Psychiatric NursingTohoku University Graduate School of MedicineAoba‐kuSendai‐shi MiyagyJapan
| | - Lieve Van den Block
- VUB‐UGent End‐of‐Life Care Research GroupVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Paola Di Giulio
- Department of Public Health Sciences and PediatricsTurin UniversityTurinItaly
| | - Silvia Gonella
- Direction of Health ProfessionsCity of Health and Science University Hospital of TurinTurinItaly
| | - Jürgen in der Schmitten
- Institute for General Practice/Family MedicineMedical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Rebecca L. Sudore
- Division of GeriatricsDepartment of MedicineUniversity of California [more locations]San FranciscoCaliforniaUSA
- San Francisco Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Karen Harrison Dening
- Research & PublicationsDementia UKLondonUK
- Faculty of Health & Life SciencesDe Montfort UniversityLeicesterUK
| | - Deborah Parker
- IMPACCT/School of Nursing and MidwiferyFaculty of HealthUniversity of TechnologySydneyAustralia
| | - Ninoslav Mimica
- University Psychiatric Hospital VrapčeSchool of MedicineUniversity of ZagrebZagrebCroatia
| | - Iva Holmerova
- Faculty of HumanitiesCentre of Expertise in Longevity and Long‐Term Care and Centre of GerontologyCharles UniversityPragueCzech Republic
| | - Philip Larkin
- Palliative and Supportive Care Service and Institute of Higher Education and Research in HealthcareUNIL, Université de LausanneCHUV, Centre hospitalier universitaire VaudoisFaculté de biologie et de médecine – FBM Institut universitaire de formation et de recherche en soins – Hôpital NestléLausanneSwitzerland
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics – Ethics and Sustainability Research AreaUniversidade Católica PortuguesaCatólica Porto Business SchoolPortoPortugal
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of DesignOrganisation and StrategyFaculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Ida J. Korfage
- Department of Public HealthErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Aworinde J, Evans CJ, Gillam J, Ramsenthaler C, Davies N, Ellis‐Smith C. Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study. Health Expect 2024; 27:e13987. [PMID: 38343168 PMCID: PMC10859658 DOI: 10.1111/hex.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Shared decision-making intends to align care provision with individuals' preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners. METHODS A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model. RESULTS Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) 'knowing the person and personalisation of care', involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) 'engaging and considering the perspectives of all involved in decision-making' required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) 'Training and support activities' to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms. CONCLUSIONS The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Sussex Community NHS Foundation TrustBrightonUK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Department of Health SciencesZurich University of Applied Sciences (ZHAW)WinterthurSwitzerland
- Hull York Medical School, Wolfson Palliative Care Research CentreUniversity of HullHullEngland
| | - Nathan Davies
- Research Department of Primary Care and Population HealthCentre for Aging Population Studies, University College LondonLondonUK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
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Wolverson E, Appleyard S, Stirland S, Gower Z. The palliative care symptoms of people with dementia on admission to a mental health ward. Int J Geriatr Psychiatry 2023; 38:e5995. [PMID: 37681496 DOI: 10.1002/gps.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Key points
When patients with dementia are admitted to a mental health ward it is important to undertake a thorough assessment of palliative care needs.
The Integrated Palliative care Outcome Scale for Dementia can support the assessment and management of palliative care symptoms and concerns in mental health wards.
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Affiliation(s)
- Emma Wolverson
- Dementia UK, London, UK
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Sara Appleyard
- Department of Clinical Psychology for Older People, Humber Teaching NHS Foundation Trust, Hull, UK
| | - Sarah Stirland
- Department of Clinical Psychology for Older People, Humber Teaching NHS Foundation Trust, Hull, UK
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Britt KC, Boateng ACO, Zhao H, Ezeokonkwo FC, Federwitz C, Epps F. Spiritual Needs of Older Adults Living with Dementia: An Integrative Review. Healthcare (Basel) 2023; 11:healthcare11091319. [PMID: 37174861 PMCID: PMC10178032 DOI: 10.3390/healthcare11091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Older adults living with dementia experience progressive decline, prompting reliance on others for spiritual care and support. Despite a growing interest in studying persons living with dementia (PLwDs), empirical evidence on the spiritual needs of PLwDs has not been synthesized. Using the Whittemore and Knafl method, this integrative review examined the literature from 2000 to 2022 on the spiritual care needs of PLwDs. We sought to identify characteristics of the spiritual needs of PLwDs and ways to address them. The ATLA Religion, CINAHL, PsycINFO, PubMed, and Socindex databases were used to search the literature, and 12 peer-reviewed articles met the inclusion criteria. Spiritual care needs varied across studies. Overall, findings support the importance of identifying PLwDs' religious and spiritual backgrounds to inform person-centered care. Spiritual needs were identified as verbal and non-verbal expressions related to past meaning and religious and spiritual background and were not consistently addressed in care. Providers reported observing spiritual distress in the mild stage prompting the need for spiritual care. There is a great need for dementia-specific spiritual assessment tools and spiritual care interventions to support spiritual well-being in dementia care. Spiritual care involves facilitating religious rituals and providing spiritual group therapy and religious and spiritual activities.
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Affiliation(s)
- Katherine Carroll Britt
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Augustine C O Boateng
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hui Zhao
- School of Nursing, James Madison University, Harrisonburg, VA 22807, USA
| | | | - Chad Federwitz
- Gerontology, Western Colorado Community College, Grand Junction, CO 81505, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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Yorganci E, Sleeman KE. Palliative care can benefit people with dementia. BMJ 2023; 380:754. [PMID: 37001899 DOI: 10.1136/bmj.p754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Emel Yorganci
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Gillam J, Evans C, Aworinde J, Ellis-Smith C, Ross J, Davies N. Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes. Digit Health 2023; 9:20552076231211118. [PMID: 38033518 PMCID: PMC10685752 DOI: 10.1177/20552076231211118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Background Despite positive findings around the use of eHealth in dementia care, it is rarely translated into routine practice. This can be facilitated by early involvement of end-users in the development of an implementation plan. This study aimed to co-design strategies to implement an eHealth intervention, the EMBED-Care Framework, to support assessment and decision-making for people with dementia in care homes. Methods A qualitative co-design method was applied through a series of workshops. Participants included family carers and health and social care practitioners. People with dementia were included through a series of stakeholder engagement meetings. The workshops focused on co-developing strategies in response to identified determinants of implementation. A codebook thematic analytic approach was taken, guided by the Normalisation Process Theory (NPT). Results Three workshops were conducted from July 2021 to November 2021, attended by 39 participants. Three overarching phases of implementation were identified which aligned with the constructs of the NPT: (a) incentivising adoption of the Framework, which requires promotion of its benefits and alignment with recommendations for good quality dementia care to engage stakeholders, relating to 'coherence' and 'cognitive participation' constructs; (b) enabling its operation, which requires ensuring compatibility with care home processes, provision of training and support from 'champions', relating to 'collective action'; (c) sustaining use of the Framework, which requires monitoring of implementation and appraisal of its effects, relating to 'reflexive monitoring'. Conclusions We have developed a multi-strategy, theoretically driven plan to implement eHealth to support assessment and decision-making for people with dementia in care homes. Successful implementation requires incentivisation to adopt, ability to operate and motivation to sustain use of eHealth. The plan is strengthened through collaborating with end-users to increase its value, credibility and real-world relevance. The theoretically informed strategies target mechanisms of the NPT, demonstrated to shape the implementation process and outcomes, ready for testing.
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Affiliation(s)
- Juliet Gillam
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Catherine Evans
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
- Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Jesutofunmi Aworinde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Clare Ellis-Smith
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Jamie Ross
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
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Vardy E. Patterns of unplanned hospital admissions in people with dementia. Age Ageing 2022; 51:6588718. [PMID: 35588064 DOI: 10.1093/ageing/afac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emma Vardy
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust , Stott Lane, Salford M6 8HD , UK
- School of Health Sciences , University of Manchester, Oxford Road, Manchester M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester , University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Yorganci E, Stewart R, Sampson EL, Sleeman KE. Patterns of unplanned hospital admissions among people with dementia: from diagnosis to the end of life. Age Ageing 2022; 51:afac098. [PMID: 35581158 PMCID: PMC9113942 DOI: 10.1093/ageing/afac098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND hospitalisations are sentinel events for people with dementia. How patterns of unplanned hospital admissions change among people with dementia after diagnosis is relatively unknown. OBJECTIVE to describe patterns of unplanned hospital admissions of people with dementia from diagnosis until death/study end. METHODS retrospective cohort study using mental healthcare provider data of people diagnosed with dementia in London, UK (1995-2017), linked to mortality and hospital data. The primary outcome was the rate of unplanned hospital admissions after diagnosis until death/study end. We calculated the cumulative incidence of unplanned hospital admissions. The rates of unplanned hospital admissions and the percentage of time spent as an inpatient were stratified by time from first dementia diagnosis. RESULTS for 19,221 people with dementia (61.4% female, mean age at diagnosis 81.0 years (standard deviation, SD 8.5)), the cumulative incidence of unplanned hospital admissions (n = 14,759) was 76.8% (95% CI 76.3%-77.3%). Individuals remained in the study for mean 3.0 (SD 2.6) years, and 12,667 (65.9%) died. Rates and lengths of unplanned hospital admissions remained relatively low and short in the months after the dementia diagnosis, increasing only as people approached the end of life. Percentage of time spent as an inpatient was <3% for people who were alive at the study end but was on average 19.6 and 13.3% for the decedents in the last 6 and 12 months of life, respectively. CONCLUSIONS the steep rise in hospitalisations before death highlights the need for improved community care and services for people with dementia who are approaching the end of life.
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Affiliation(s)
- Emel Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Mental Health of Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elizabeth L Sampson
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
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Chen PJ, Smits L, Miranda R, Liao JY, Petersen I, Van den Block L, Sampson EL. Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review. BMC Geriatr 2022; 22:80. [PMID: 35081914 PMCID: PMC8793202 DOI: 10.1186/s12877-022-02768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home healthcare (HHC) comprises clinical services provided by medical professionals for people living at home with various levels of care needs and health conditions. HHC may reduce care transitions from home to acute hospitals, but its long-term impact on homebound people living with dementia (PLWD) towards end-of-life remains unclear. We aim to describe the impact of HHC on acute healthcare utilization and end-of-life outcomes in PLWD. METHODS Design: Systematic review of quantitative and qualitative original studies which examine the association between HHC and targeted outcomes. INTERVENTIONS HHC. PARTICIPANTS At least 80% of study participants had dementia and lived at home. MEASUREMENTS Primary outcome was acute healthcare utilization in the last year of life. Secondary outcomes included hospice palliative care, advance care planning, continuity of care, and place of death. We briefly reviewed selected national policy to provide contextual information regarding these outcomes. RESULTS From 6831 articles initially identified, we included five studies comprising data on 4493 participants from USA, Japan, and Italy. No included studies received a "high" quality rating. We synthesised core properties related to HHC at three implementational levels. Micro-level: HHC may be associated with a lower risk of acute healthcare utilization in the early period (e.g., last 90 days before death) and a higher risk in the late period (e.g. last 15 days) of the disease trajectory toward end-of-life in PLWD. HHC may increase palliative care referrals. Advance care planning was an important factor influencing end-of-life outcomes. Meso-level: challenges for HHC providers in medical decision-making and initiating palliative care for PLWD at the end-of-life may require further training and external support. Coordination between HHC and social care is highlighted but not well examined. Macro-level: reforms of national policy or financial schemes are found in some countries but the effects are not clearly understood. CONCLUSIONS This review highlights the dearth of dementia-specific research regarding the impact of HHC on end-of-life outcomes. Effects of advance care planning during HHC, the integration between health and social care, and coordination between primary HHC and specialist geriatric/ palliative care services require further investigation.
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Affiliation(s)
- Ping-Jen Chen
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.412027.20000 0004 0620 9374Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lisanne Smits
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.7177.60000000084992262Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Rose Miranda
- grid.8767.e0000 0001 2290 8069End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jung-Yu Liao
- grid.412019.f0000 0000 9476 5696Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Irene Petersen
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - Lieve Van den Block
- grid.8767.e0000 0001 2290 8069End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.439355.d0000 0000 8813 6797Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Gilissen J, Hunt L, Van den Block L, van der Steen J, Tahir P, Ritchie C. Earlier initiation of palliative care in the disease trajectory of people living with dementia: a scoping review protocol. BMJ Open 2021; 11:e044502. [PMID: 34155071 PMCID: PMC8217927 DOI: 10.1136/bmjopen-2020-044502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION While the need for palliative care for people living with dementia has widely been recognised, they continue to be a disadvantaged group when it comes to timely initiation, and controversies remain regarding appropriate timing, or what elements constitute high quality palliative care early in the disease trajectory. To date, no literature review has summarised this debate or offered insights. The aim of this scoping review is to provide a general overview of research regarding palliative care in mild or moderate dementia, to identify existing controversies, and to examine what are key components of palliative care in dementia, specifically when initiated earlier in the disease trajectory. METHODS AND ANALYSIS Consistent with recent guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we carried out a search for academic literature in PubMed, CINAHL, EMBASE, Cochrane Library, PsycINFO, Web of Science; on 5 November 2019 and an updated search on 2 February 2021. We will include studies with different study designs published in English over the last decade that focused on palliative care in early stages of dementia. We will include models targeting at least one outcome domain of palliative care (physical, psychological, social or spiritual) and advance care planning, and will exclude hospice models with limited prognosis similar to the requirements in the USA. We will report study characteristics and quality. We aim to apply narrative synthesis techniques to develop a theoretical model of how, for whom and why palliative care can be relevant in early stages of dementia, and what are facilitators and barriers. We anticipate to also describe if and how the concept of (early) palliative care in dementia changed across time and studies. ETHICS AND DISSEMINATION No ethical review required. Results will identify research gaps and lay out basic principles for conceptualising palliative care in early stages of dementia.
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Affiliation(s)
- Joni Gilissen
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco, California, USA
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Hunt
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco, California, USA
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jenny van der Steen
- Department of Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, Gelderland, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Peggy Tahir
- UCSF Library, University of California, San Francisco, California, USA
| | - Christine Ritchie
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco, California, USA
- Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
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Burns A. Editorial: A celebration of dementia care implementation research. Int J Geriatr Psychiatry 2020; 35:809-810. [PMID: 32017262 DOI: 10.1002/gps.5275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/05/2022]
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