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Iunius LA, Vilpert S, Meier C, Jox RJ, Borasio GD, Maurer J. Advance Care Planning: A Story of Trust Within the Family. J Appl Gerontol 2024; 43:349-362. [PMID: 37984553 PMCID: PMC10875907 DOI: 10.1177/07334648231214905] [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: 04/11/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023] Open
Abstract
As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues-used as a proxy measure of family relationship quality-with individuals' engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55 years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland (n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.
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Affiliation(s)
- Lory A. Iunius
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
| | - Sarah Vilpert
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
- Swiss Centre of Expertise in the Social Sciences (FORS), Lausanne, Switzerland
| | - Clément Meier
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
- Swiss Centre of Expertise in the Social Sciences (FORS), Lausanne, Switzerland
| | - Ralf J. Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jürgen Maurer
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
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Cohen-Mansfield J, Brill S. After providing end of life care to relatives, what care options do family caregivers prefer for themselves? PLoS One 2020; 15:e0239423. [PMID: 32977327 PMCID: PMC7518928 DOI: 10.1371/journal.pone.0239423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives We examined how caregivers who had cared for a relative at end of life (EoL) wished to be cared for in the event that they experienced advanced dementia or physical disability in the future, and what factors influenced their preferences for EoL care. Methods In this mixed-methods study, 83 participants, recruited from multiple sources in Israel, were interviewed concerning socio-demographic factors, health status, past experience with EoL, preference for extension of life vs. quality of life (QoL), willingness to be dependent on others, and preferences for EoL care. Results In case of advanced dementia, 58% preferred euthanasia or suicide; around a third chose those for physical disability. Care by family members was the least desired form of care in the advanced dementia scenario, although more desirable than institutional care in the physical disability scenario. QoL was rated as the highest factor impacting preferences for EoL care. Men demonstrated a higher preference than women for extension of life over QoL. Conclusion Our study points to the need for society to consider solutions to the request of participants to reject the type of EoL experienced by their relatives. Those solutions include investing in improving the quality of life at the end of life, and offering alternatives such as euthanasia, which a large proportion of our participants found ethically and medically appropriate within the current system of care in the event of severe physical disability, and more so in the event of advanced dementia.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Shai Brill
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Beit Rivka Medical Center, Petah Tikva, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Arnup K. Lessons in Death and Dying. J Palliat Care 2018. [DOI: 10.1177/082585970902500205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Katherine Arnup
- School of Canadian Studies, Carleton University, Ottawa, Ontario, Canada
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Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C. Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatr 2017; 17:222. [PMID: 28978301 PMCID: PMC5628473 DOI: 10.1186/s12877-017-0605-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for "older old" people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people's final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. METHODS Retrospective analyses linked three data sources for n = 180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and "How comfortable was he/she in his/her final illness?" RESULTS In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been "very comfortable", "comfortable", "fairly comfortable" or "uncomfortable" respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as "usual address"), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. CONCLUSIONS These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people's end-of-life care in all settings.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Rowan Calloway
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- North East Thames Foundation School, London, UK
| | - Anouk Perrels
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
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Freeman S, Bishop K, Spirgiene L, Koopmans E, Botelho FC, Fyfe T, Xiong B, Patchett S, MacLeod M. Factors affecting residents transition from long term care facilities to the community: a scoping review. BMC Health Serv Res 2017. [PMID: 28978324 DOI: 10.1186/s12913‐017‐2571‐y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community. METHODS This review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person's own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review. RESULTS The majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community. CONCLUSIONS Findings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
| | - Kristen Bishop
- Faculty of Health Sciences, Health and Rehabilitation Sciences, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Lina Spirgiene
- Department of Nursing and Care, Lithuanian University of Health Sciences, Mickevičiaus 9, -44307, Kaunas, LT, Lithuania
| | - Erica Koopmans
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Fernanda C Botelho
- School of Public Health, University of Sao Paulo, Dr. Arnaldo Street 715, Sao Paulo, SP, 01246-904, Brazil
| | - Trina Fyfe
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Beibei Xiong
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.,School of Nursing, Jilin University, 965 XinJiang Street, ChangChun, JiLin, 130012, China
| | - Stacey Patchett
- Department of Quality, Planning and Information, Northern Health, 543 Front Street, Quesnel, BC, V2J 5K7, Canada
| | - Martha MacLeod
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
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Freeman S, Bishop K, Spirgiene L, Koopmans E, Botelho FC, Fyfe T, Xiong B, Patchett S, MacLeod M. Factors affecting residents transition from long term care facilities to the community: a scoping review. BMC Health Serv Res 2017; 17:689. [PMID: 28978324 PMCID: PMC5628420 DOI: 10.1186/s12913-017-2571-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/25/2017] [Indexed: 11/23/2022] Open
Abstract
Background Long-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community. Methods This review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person’s own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review. Results The majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community. Conclusions Findings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
| | - Kristen Bishop
- Faculty of Health Sciences, Health and Rehabilitation Sciences, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Lina Spirgiene
- Department of Nursing and Care, Lithuanian University of Health Sciences, Mickevičiaus 9, -44307, Kaunas, LT, Lithuania
| | - Erica Koopmans
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Fernanda C Botelho
- School of Public Health, University of Sao Paulo, Dr. Arnaldo Street 715, Sao Paulo, SP, 01246-904, Brazil
| | - Trina Fyfe
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Beibei Xiong
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.,School of Nursing, Jilin University, 965 XinJiang Street, ChangChun, JiLin, 130012, China
| | - Stacey Patchett
- Department of Quality, Planning and Information, Northern Health, 543 Front Street, Quesnel, BC, V2J 5K7, Canada
| | - Martha MacLeod
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
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Amer MS, Khater MS, Elawam AE, Mohammed SN. Attitudes of Elderly Egyptian Nursing Homes Residents Towards Advance Directives. Lack of Knowledge but Positive Attitudes. AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-012-9156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chacko R, Anand JR, Rajan A, John S, Jeyaseelan V. End-of-life care perspectives of patients and health professionals in an Indian health-care setting. Int J Palliat Nurs 2014; 20:557-64. [DOI: 10.12968/ijpn.2014.20.11.557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ranjitha Chacko
- Junior Lecturer, College of Nursing, Medical Intensive Care Unit
| | | | - Amala Rajan
- Professor, College of Nursing, Medical Nursing Department
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Ni P, Zhou J, Wang ZX, Nie R, Phillips J, Mao J. Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study. J Am Med Dir Assoc 2014; 15:751-6. [PMID: 25066002 DOI: 10.1016/j.jamda.2014.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/23/2014] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. DESIGN Population-based cross-sectional survey. SETTINGS Nursing homes (n = 31) in Wuhan, Mainland Southern China. PARTICIPANTS Cognitively intact nursing home residents (n = 467) older than 60 years. MEASURES Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. RESULTS Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). CONCLUSIONS Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
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Affiliation(s)
- Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhou
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhao Xi Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Nie
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jane Phillips
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Chliara D, Chalkias A, Horopanitis EE, Papadimitriou L, Xanthos T. Attitude of elderly patients towards cardiopulmonary resuscitation in Greece. Geriatr Gerontol Int 2013; 14:874-9. [PMID: 24237788 DOI: 10.1111/ggi.12184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
Abstract
AIM Although researchers in several countries have investigated patients' points of view regarding cardiopulmonary resuscitation, there has been no research investigating this issue in Greece. The present study aimed at identifying the attitude of older Greek patients regarding cardiopulmonary resuscitation. METHODS One basic questionnaire consisting of 34 questions was used in order to identify patients' opinions regarding cardiopulmonary resuscitation in five different hospitals from June to November 2011. RESULTS In total, 300 questionnaires were collected. Although patients' knowledge regarding cardiopulmonary resuscitation was poor, most of them would like to be resuscitated in case they suffered an in-hospital cardiac arrest. Also, they believe that they should have the right to accept or refuse treatment. However, the legal and sociocultural norms in Greece do not support patients' choice for the decision to refuse resuscitation. The influence of several factors, such as their general health status or the underlying pathology, could lead patients to give a "do not attempt resuscitation" order. CONCLUSIONS The attitudes of older Greek patients regarding resuscitation are not different from others', whereas the legal and sociocultural norms in Greece do not support patient choice in end-of-life decisions, namely the decision to refuse resuscitation. We advocate the introduction of advanced directives, as well as the establishment and implementation of specific legislation regarding the ethics of resuscitation in Greece.
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Affiliation(s)
- Daphne Chliara
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation, Athens, Greece
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Wilson DM, Cohen J, Deliens L, Hewitt JA, Houttekier D. The preferred place of last days: results of a representative population-based public survey. J Palliat Med 2013; 16:502-8. [PMID: 23421538 DOI: 10.1089/jpm.2012.0262] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The place of death is of considerable interest now, yet few studies have determined public preferences for place of end-of-life (EOL) care or final days of life. OBJECTIVE A survey was designed to answer three questions: (1) What are public preferences for the place of last days? (2) Is this place preference related to socio-demographic and other background characteristics? and (3) Is this place preference associated with specified previous death and dying experiences, the preparation of a living will or advance directive, or a viewpoint supportive of death hastening? DESIGN An experienced telephone survey company was commissioned to gain a representative population-based sample and survey participants. In mid-2010, 1203 adults were surveyed in Alberta. Descriptive statistics and multinomial logistic regression were conducted. RESULTS This survey revealed 70.8% preferred to be at home near death; while 14.7% preferred a hospice/palliative care facility, 7.0% a hospital, and 1.7% a nursing home; 5.7% had no stated preference. Marital status was the only predictor of place preference, with widowed persons more often indicating a preference for a hospital or hospice/palliative care facility. CONCLUSIONS These findings suggest homes are the preferred EOL place now for the majority of Albertans, if not other citizens, while at the same time suggesting that marital and living arrangement realities temper EOL place choices and possibilities, with widows best realizing the need for assistance from others when dying. The widespread preference for home-based EOL care indicates public health interventions are needed to promote good home deaths.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 2013; 12:7. [PMID: 23414145 PMCID: PMC3623898 DOI: 10.1186/1472-684x-12-7] [Citation(s) in RCA: 607] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home-based models of hospice and palliative care are promoted with the argument that most people prefer to die at home. We examined the heterogeneity in preferences for home death and explored, for the first time, changes of preference with illness progression. METHODS We searched for studies on adult preferences for place of care at the end of life or place of death in MEDLINE (1966-2011), EMBASE (1980-2011), psycINFO (1967-2011), CINAHL (1982-2011), six palliative care journals (2006-11) and reference lists. Standard criteria were used to grade study quality and evidence strength. Scatter plots showed the percentage preferring home death amongst patients, lay caregivers and general public, by study quality, year, weighted by sample size. RESULTS 210 studies reported preferences of just over 100,000 people from 33 countries, including 34,021 patients, 19,514 caregivers and 29,926 general public members. 68% of studies with quantitative data were of low quality; only 76 provided the question used to elicit preferences. There was moderate evidence that most people prefer a home death-this was found in 75% of studies, 9/14 of those of high quality. Amongst the latter and excluding outliers, home preference estimates ranged 31% to 87% for patients (9 studies), 25% to 64% for caregivers (5 studies), 49% to 70% for the public (4 studies). 20% of 1395 patients in 10 studies (2 of high quality) changed their preference, but statistical significance was untested. CONCLUSIONS Controlling for methodological weaknesses, we found evidence that most people prefer to die at home. Around four fifths of patients did not change preference as their illness progressed. This supports focusing on home-based care for patients with advanced illness yet urges policy-makers to secure hospice and palliative care elsewhere for those who think differently or change their mind. Research must be clear on how preferences are elicited. There is an urgent need for studies examining change of preferences towards death.
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Affiliation(s)
- Barbara Gomes
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Natalia Calanzani
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Marjolein Gysels
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Sue Hall
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Irene J Higginson
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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Taitel M, Meaux N, Pegus C, Valerian C, Kirkham H. Place of death among patients with terminal heart failure in a continuous inotropic infusion program. Am J Hosp Palliat Care 2011; 29:249-53. [PMID: 21840872 DOI: 10.1177/1049909111418638] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although most patients with terminal heart failure (HF) prefer to die at home, the majority die in hospitals. To determine the impact of home inotropic support in the place of death among patients with terminal HF, this retrospective study compared the place of death in patients with terminal HF enrolled in an inotropic infusion program to place of death in a national sample of patients with HF. The rate of home death among program participants (64.5%; n = 217) was significantly higher (P < .001) than an age- and sex-adjusted rate of home death in a national sample (35.9%; n = 56 596). Patients with HF participating in home inotropic support can remain at home during the final stage of life and are less likely to die in hospitals.
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Affiliation(s)
- Michael Taitel
- Clinical Outcomes & Analytic Services, Walgreens Co., 1415 Lake Cook Road, Deerfield, IL 60015, USA.
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Lawrence JF. The advance directive prevalence in long-term care: a comparison of relationships between a nurse practitioner healthcare model and a traditional healthcare model. ACTA ACUST UNITED AC 2009; 21:179-85. [PMID: 19302695 DOI: 10.1111/j.1745-7599.2008.00381.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to examine rates of completion of advance directives (ADs) among institutionalized older adults in three geographically diverse areas of the country--Arizona, Georgia, and Massachusetts. Comparisons among four variables--gender, race, education, and type of healthcare model (Evercare vs. non-Evercare), related to AD completion rates were examined. DATA SOURCES This study was a secondary data analysis using deidentified data from 11,775 older adults enrolled in the Evercare healthcare model to 91,443 non-Evercare older adults (Minimum Data Set) during the last quarter of 2004. Chi-square analysis was used to examine any differences in gender, race, education, and healthcare model associated with the completion rates of ADs. CONCLUSIONS The Evercare healthcare model that used nurse practitioners (NPs) consistently had significantly higher (p < .001) completion rates of ADs compared to the non-Evercare healthcare model that did not use NPs. Black people and white people in the Evercare healthcare model had similar rates of AD completion (p > .001), which is contrary to previous findings where black people had a lower completion rate. Males and females in the Evercare healthcare model had similar rates of AD completion (p > .001), which is also contrary to previous findings where females had a higher completion rate. Finally, older adults with a high school education or less and older adults with greater than a high school education in the Evercare healthcare model had similar rates of AD completion (p > .001), which is contrary to previous findings where individuals with increased education had a higher completion rate. IMPLICATIONS FOR PRACTICE With the increasing number of older adults in the general and the long-term care population, older adults should be encouraged to complete their ADs when discussing their medical decisions with their healthcare providers. Through the use of the Evercare healthcare model, NPs are well prepared to assist their clients and families in identifying these decisions. As a result, a significantly greater proportion of ADs have been completed by individuals enrolled in the Evercare healthcare model when compared to non-Evercare individuals living in long-term care settings. By using this model, Evercare NPs ensure that the specific medical choices of their patients are carried out.
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Affiliation(s)
- James F Lawrence
- B.F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia 30319, USA.
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Wilson DM, Truman CD, Thomas R, Fainsinger R, Kovacs-Burns K, Froggatt K, Justice C. The rapidly changing location of death in Canada, 1994-2004. Soc Sci Med 2009; 68:1752-8. [PMID: 19342137 DOI: 10.1016/j.socscimed.2009.03.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Indexed: 10/21/2022]
Abstract
This 2008 study assessed location-of-death changes in Canada during 1994-2004, after previous research had identified a continuing increase to 1994 in hospital deaths. The most recent (1994-2004) complete population and individual-level Statistics Canada mortality data were analyzed, involving 1,806,318 decedents of all Canadian provinces and territories except Quebec. A substantial and continuing decline in hospitalized deaths was found (77.7%-60.6%). This decline was universal among decedents regardless of age, gender, marital status, whether they were born in Canada or not, across urban and rural provinces, and for all but two (infrequent) causes of death. This shift occurred in the absence of policy or purposive healthcare planning to shift death or dying out of hospital. In the developed world, recent changing patterns in the place of death, as well as the location and type of care provided near death appear to be occurring, making location-of-death trends an important topic of investigation. Canada is an important case study for highlighting the significance of location-of-death trends, and suggesting important underlying causal relationships and implications for end-of-life policies and practices.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, Third Floor Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6T 1E8.
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Motiwala SS, Croxford R, Guerriere DN, Coyte PC. Predictors of place of death for seniors in Ontario: a population-based cohort analysis. Can J Aging 2008; 25:363-71. [PMID: 17310457 DOI: 10.1353/cja.2007.0019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Place of death was determined for all 58,689 seniors (age > or = 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2 %) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.
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Affiliation(s)
- Sanober S Motiwala
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Jakobsson E, Gaston-Johansson F, Öhlén J, Bergh I. Clinical problems at the end of life in a Swedish population, including the role of advancing age and physical and cognitive function. Scand J Public Health 2008; 36:177-82. [DOI: 10.1177/1403494807085375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: To improve the understanding of specific clinical problems at the end of life, including the role of advancing age, physical function and cognitive function. Methods: The study is part of an explorative survey of data relevant to end-of-life healthcare services during the last 3 months of life of a randomly selected sample of the population of a Swedish county. Data were selected through retrospective reviews of death certificates and medical records, and comprise information from 12 municipalities and 229 individuals. Results: A range of prevalent concerns was found. Overall deterioration, urinary incontinence, constipation, impaired skin integrity, anxiety and sleep disturbances were significantly associated with dependency on others for activities of daily living; pulmonary rattles and swallowing disturbances were associated with cognitive disorientation; excepting cough, advancing age did not have significant impacts on these prevalent clinical concerns. Conclusions: A range of distressing conditions constitute a common pathway for many individuals at or near the end of life. The incorporation of health promotion as a principle of palliative care will probably benefit individuals at the end of life, and includes a proactive focus and emphasis on enhanced well-being at the time of diagnosis of a life-threatening illness. For individuals with physical and cognitive limitations imparting a state of dependency, it is reasonable to provide assurance of care for individuals' specific needs by professionals with both training for and competence in this special and sometimes unique clinical environment.
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Affiliation(s)
- Eva Jakobsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden, School of Life Sciences, University of Skövde, Skövde, Sweden,
| | - Fannie Gaston-Johansson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Joakim Öhlén
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden
| | - Ingrid Bergh
- School of Life Sciences, University of Skövde, Skövde, Sweden
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Seymour J, Payne S, Chapman A, Holloway M. Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2007; 29:872-890. [PMID: 17986020 DOI: 10.1111/j.1467-9566.2007.01045.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper presents findings from two linked studies of white (n = 77) and Chinese (n = 92) older adults living in the UK, which sought their views about end-of-life care. We focus particularly on experiences and expectations in relation to the provision of end-of-life care at home and in hospices. White elders perceived hospices in idealised terms which resonate with a 'revivalist' discourse of the 'good death'. In marked comparison, for those Chinese elders who had heard of them, hospices were regarded as repositories of 'inauspicious' care in which opportunities for achieving an appropriate or good death were limited. They instead expressed preference for the medicalised environment of the hospital. Among both groups these different preferences for instututional death seemed to be related to shared concerns about the demands on the family that may flow from having to manage pain, suffering and the dying body within the domestic space. These concerns, which appeared to be based on largely practical considerations among the white elders, were expressed by Chinese elders as beliefs about 'contamination' of the domestic home (and, by implication, of the family) by the dying and dead body.
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Affiliation(s)
- Jane Seymour
- School of Nursing, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, UK.
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Morin D, Saint-Laurent L, Bresse MP, Dallaire C, Fillion L. The benefits of a palliative care network: a case study in Quebec, Canada. Int J Palliat Nurs 2007; 13:190-6. [PMID: 17551423 DOI: 10.12968/ijpn.2007.13.4.23488] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article aims to present the beneficial effects associated with the local implementation of an integrated network in palliative care, as perceived by diverse constituency groups. A case study was conducted in the province of Quebec, Canada, using individual (n=16) and group (n=16) interviews, with a total of 106 participants (i.e. managers and formal and informal caregivers). From a content analysis, two categories of beneficial effects emerged: those associated with professional practice and those with patient services. The most important effects of this organisational initiative were found to be the recognition of the palliative care domain necessitating specialized competencies, an improved interdisciplinary collaboration, and more efficient circulation of information between care settings, as well as improved accessibility, continuity and quality of care and services to patients at the end of life.
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Affiliation(s)
- Diane Morin
- Faculty of Nursing Sciences, Universite Laval, Quebec, Canada.
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20
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Duke G, Thompson S, Hastie M. Factors influencing completion of advanced directives in hospitalized patients. Int J Palliat Nurs 2007; 13:39-43. [PMID: 17353849 DOI: 10.12968/ijpn.2007.13.1.22779] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM A cross-sectional, descriptive study to describe characteristics and other factors that influenced the decision by hospitalized patients in the East Texas area to formulate an advanced directive (AD). FINDINGS Spouses, family members and sense of spirituality were the strongest influential factors for completion of an AD. Most learned about ADs from family, friends, personal attorneys, and others, while less than a quarter of the sample learned about ADs from health care providers. Not wanting to be a burden on their family was the major reason cited for completing an AD. CONCLUSIONS Health care provider roles are vague in terms of responsibility for AD discussion and education. Further exploration of the attitudes, knowledge and practices concerning ADs of nurses and primary health care providers is recommended to provide focal points for future research in order to facilitate peace of mind for patients and families at end-of-life.
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Affiliation(s)
- Gloria Duke
- Office of Nursing Research and Scholarship, The University of Texas at Tyler, College of Nursing and Health Sciences, 3900 University Blvd, Tyler, Texas, USA.
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21
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Dumont S, Turgeon J, Allard P, Gagnon P, Charbonneau C, Vézina L. Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers. J Palliat Med 2006; 9:912-21. [PMID: 16910806 DOI: 10.1089/jpm.2006.9.912] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Family caregivers caring for a patient with terminal cancer may experience significant psychological distress. OBJECTIVE The purpose of this study was to determine the extent to which the family caregivers' psychological distress is influenced by the patients' performance status while taking into account individual characteristics of caregivers and their unmet needs. METHODS Two hundred twelve family caregivers were assigned to three cohorts according to the patient's performance status, as measured by the Eastern Collaborative Oncology Group Functional Scale (ECOGS). Interview information was collected on the services and care provided, as well as on the caregivers' characteristics and level of psychological distress. RESULTS Family caregivers' psychosocial distress is strongly associated with the patients' terminal disease progress and declined functioning. The level of psychological distress varies from 25.2 to 33.5 (p = 0.0008) between the groups. Moreover, the percentage of caregivers with a high level of psychological distress varies from 41% to 62%, while this percentage is estimated at 19.2% in general population. A high distress index was significantly associated with the caregiver's burden, the patient's young age, the patient's symptoms, the caregiver's young age and gender, a poor perception of his/her health and dissatisfaction with emotional and tangible support. CONCLUSIONS Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.
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Affiliation(s)
- Serge Dumont
- Ecole de service social, Université Laval, Centre de recherche en cancérologie, Université Laval, Québec, Canada.
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22
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Hwang SS, Chang VT, Cogswell J, Srinivas S, Kasimis B. Knowledge and attitudes toward end-of-life care in veterans with symptomatic metastatic cancer. Palliat Support Care 2006; 1:221-30. [PMID: 16594422 DOI: 10.1017/s1478951503030396] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purposes of this study were to study symptomatic metastatic cancer patients' knowledge and attitudes toward end-of-life (EOL) care and to examine how patient-perceived health status affects attitudes toward EOL care and survival. METHODS From 1999 to 2002, 254 symptomatic metastatic cancer patients at the VA New Jersey Health Care System completed the Vermont Voices on Care of the Dying Questionnaire. Survival status and location of death were obtained. Descriptive statistics and the chi square method were used to assess the differences between African Americans (N=109) and Caucasians (N=135), and between different patient-perceived health status groups. A log-rank test was performed to assess for differences in median survival length between different patient-perceived health-status groups. RESULTS Veterans' responses to the Vermont questionnaire showed knowledge deficits regarding EOL care. There was wide variation in self-rankings of health status: 45.6% of patients rated their illness as serious and life threatening, 18.9% considered their health problem significant but not life threatening, 2.8% thought they were in good health, and one-third of patients were unsure about their health status. Most patients (86.2%) preferred physician frankness when communicating bad news and 61.8% preferred family involvement in EOL discussions. African American patients were less likely to have completed advance directives (p < 0.0001), to have knowledge about hospice programs (p < 0.00001), and to feel capable of assessing their health situation (p = 0.04). Patient-rated health status affected completion rates of advance directives and survival. SIGNIFICANCE OF THE RESEARCH These findings demonstrate knowledge deficits and racial differences in attitudes and values toward EOL care in veterans with cancer. The Vermont questionnaire enables patients to state their EOL preferences but may not be detailed enough for clinical applications. Patient-rated health status may be an important explanatory variable for EOL preferences and length of survival.
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Affiliation(s)
- Shirley S Hwang
- Section of Hematology/Oncology (111), VA New Jersey Health Care System at East Orange, East Orange 07018, New Jersey, USA.
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23
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Vandrevala T, Hampson SE, Daly T, Arber S, Thomas H. Dilemmas in decision-making about resuscitation—a focus group study of older people. Soc Sci Med 2006; 62:1579-93. [PMID: 16182420 DOI: 10.1016/j.socscimed.2005.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary resuscitation (CPR) may be used by default on patients suffering a cardiac arrest in hospital in the UK unless there is an order that specifies otherwise in the patient's notes. Guidelines recommend that the decision involves competent and willing patients or, in the case of incapacitation, their families. In practice, patient autonomy is often compromised. Ideally, discussion of preferences for end-of-life care should take place prior to hospitalisation. The majority of research on this topic has been conducted on hospitalised patients, so little is known about the views of older, but healthy, people about resuscitation decision-making. The present study was designed to address this gap. A series of eight focus groups involving a total of 48 participants over the age of 65 was conducted to explore people's views about the factors guiding resuscitation decision-making. A qualitative analysis, which emphasised the dilemmatic nature of resuscitation decision-making, identified two broad thematic dilemmas that subsumed six specific themes which contribute to resolving the dilemmas: quality of life (medical condition, mental versus physical incapacity, age and ageing, and burden), and the involvement of others (doctors and families) versus loss of autonomy. The dilemma underlying quality of life is that an acceptable quality of life after CPR cannot be assured. The dilemma underlying the involvement of others is that individual autonomy may be lost. The themes and subthemes provide the basis for guiding these difficult discussions in advance of serious illness.
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Gruenewald DA, White EJ. The Illness Experience of Older Adults near the End of Life: a Systematic Review. ACTA ACUST UNITED AC 2006; 24:163-80, ix. [PMID: 16487901 DOI: 10.1016/j.atc.2005.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A systematic literature review identified qualitative studies of issues important to older people near the end of their lives, to develop a model of the illness experience near the end of life based on the views of older people. Six elements were identified from 40 studies that comprise a core domain of the experience of illness while dying: burden, suffering, hope, dignity, decision making, and control and autonomy. These elements were interwoven with three main themes: contextual factors, perceptions and concerns, and response to illness. Collectively, the core domain and the three themes comprise a model of the experience of illness near the end of life.
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Affiliation(s)
- David A Gruenewald
- Palliative Care and Hospice Service, Geriatrics and Extended Care Service, Veterans Affairs Puget Sound Health Care System, S-182-GEC, 1660 South Columbian Way, Seattle, WA 98108, USA.
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25
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Abstract
The purpose of this paper is to describe the variations in and factors influencing family members' decisions to provide home-based palliative care. Findings were part of a larger ethnographic study examining the social context of home-based palliative caregiving. Data from participant observations and in-depth interviews with family members (n=13) providing care to a palliative patient at home, interviews with bereaved family members (n=47) and interviews with health care providers (n=25) were subjected to constant comparative analysis. Findings indicate decisions were characterized by three types. Some caregivers made uninformed decisions, giving little consideration to the implications of their decisions. Others made indifferent decisions, whereby they reluctantly agreed to provide care at home, and still others negotiated decisions for home care with the dying person. Decisions were influenced by three factors: fulfilling a promise to the patient to be cared for at home, desiring to maintain a 'normal family life' and having previous negative encounters with institutional care. Findings suggest interventions are needed to better prepare caregivers for their role, enhance caregivers' choice in the decision-making process, improve care for the dying in hospital, and consider the development of alternate options for care.
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Affiliation(s)
- Kelli I Stajduhar
- Centre on Aging, University of Victoria and Vancouver Island Health Authority, Victoria, BC, Canada.
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Olthuis G, Dekkers W. Quality of life considered as well-being: views from philosophy and palliative care practice. THEORETICAL MEDICINE AND BIOETHICS 2005; 26:307-37. [PMID: 16180112 DOI: 10.1007/s11017-005-4487-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The main measure of quality of life is well-being. The aim of this article is to compare insights about well-being from contemporary philosophy with the practice-related opinions of palliative care professionals. In the first part of the paper two philosophical theories on well-being are introduced: Sumner's theory of authentic happiness and Griffin's theory of prudential perfectionism. The second part presents opinions derived from interviews with 19 professional palliative caregivers. Both the well-being of patients and the well-being of the carers themselves are considered in this empirical exploration. In the third part the attention shifts from the description of "well-being" to prescriptions for the promotion of well-being. Our interview data are analysed in light of the theories of Sumner and Griffin for clues to the promotion of "well-being." The analysis (1) underscores the subject-relativity of well-being, (2) points out that values that are considered important in every life still seem to be relevant (at least in palliative care practice), and (3) shows the importance of living a certain sort of life when aiming to enhance dying patients' well-being.
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Affiliation(s)
- Gert Olthuis
- Department of Ethics, Philosophy and History of Medicine, Radboud University, Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, The Netherlands.
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Abstract
Advance statements about medical care have been heralded by some as a solution to the problem of end of life decision making for people not able to participate in discussions about their care. Since death is now most likely to occur at the end of a long life, it is important to understand the views and values which older people express in relation to these. This paper reports on a study which used focus groups to explore older people's views about advance statements and the role these might play in end of life care decisions. Participants were 32 older people or their representatives who belonged to six diverse community groups in Sheffield, UK. Advance statements were understood primarily in terms of their potential to aid personal integrity and to help the families of older people by reducing the perceived 'burden' of their decision making. However, concerns were expressed about the perceived link between advance care statements and euthanasia, their future applicability, and the possibility that preferences for care may change. Participants also reported worries and difficulties related to thinking about and discussing death and dying. Trust between doctor and patient, built up over time, was perceived to be important in creating an environment in which the communication necessary to underpin advance care planning could take place. Lastly, participants did not perceive that during dying they would be ready necessarily to adhere to an advance statement and 'disengage' from their lives. We conclude that, rather than emphasising the completion of advance statements, it may be preferable to conceptualise advance care planning as a process of discussion and review between clinicians, patients and families.
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Affiliation(s)
- Jane Seymour
- The School of Nursing and Midwifery, The University of Sheffield, Palliative and End of Life Care Research Group, Winter St, Sheffield, Bartolmé House, S3 7ND, UK.
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Abstract
Providing high-quality end-of-life care to older people is a requirement especially for countries with a high proportion of old and very old people. This calls for an understanding of older people's view of death and dying, and one way forward is to investigate the current knowledge base. This study aimed at reviewing the literature of empirical studies about older people's view of death and dying, whether in a terminal phase of life or not. A total of 33 publications were included, identified in a stepwise literature search done in Medline, CINAHL and PsychInfo, using the terms "death", "attitude to death", "death" and "dying" in combination with "aged". Very few studies focused solely on the oldest old. The designs were mainly cross-sectional, quantitative or qualitative, using personal interviews. Some common themes of importance for further research were revealed, such as older people's readiness to talk about death and dying, conceptions of death, after-death and dying, and were seemingly related to anxiety about death, the impact on and of those close by, having both negative and positive connotations, especially related to balancing closeness, being a burden and dependency, death anxiety and its possible antecedents, the fine line between natural sadness and suffering from depression, and worry about the end-of-life phase. The lack of studies dealing with older people's view of death and dying, and the heterogeneity with regard to research questions and samples implies that findings may serve mainly as inspiration for further research.
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Resnick B, Andrews C. End-of-life treatment preferences among older adults: a nurse practitioner initiated intervention. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2002; 14:517-22. [PMID: 12479154 DOI: 10.1111/j.1745-7599.2002.tb00084.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore end-of-life treatment preferences (ELTP) among older adults and to test the impact of a nurse practitioner (NP) initiated intervention to facilitate the completion of ELTPs. DATA SOURCES A descriptive study including 135 older adults living in a continuing care retirement community. CONCLUSIONS The findings in this study suggest that the majority of older adults do not want life sustaining interventions at the end of life, but are willing to accept interventions that will keep them comfortable. ELTP can, however, change over time. An NP-initiated teaching intervention about advance directives and ELTP significantly increased the number of individuals who completed advance directive forms. IMPLICATIONS FOR PRACTICE With the advancement of medical technology, various life-sustaining treatments are available at the end of life. Older adults should be encouraged to establish their ELTPs while they are physically and mentally able to do so. Health care providers should initiate discussions about ELTP at regular intervals (yearly) to assist older adults in participating in decisions about their end-of-life care.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA.
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Abstract
PURPOSE This article reviews the literature on "The Experience of Dying" and presents data from a larger, ongoing study of an ethnography of dying in nursing homes. The purpose of the ethnographic study was to investigate the process of providing end-of-life care to residents who were dying in nursing homes. DESIGN AND METHODS Participant observation, in-depth interviews, and event analysis were used to obtain data in three nursing facilities. RESULTS The review of the literature disclosed that research on the experience of dying is limited; most of the studies have been conducted in acute care hospitals among people who were dying of cancer. The ethnographic study found that lack of attention to cultural needs, cognitive status, inadequate staffing, and inappropriate and inadequate communication between health care providers and nursing home residents and their families were the predominant factors that influenced the experience of dying. IMPLICATIONS Future research is needed on: The experience of dying for patients with dementia, for people in a comatose state, and for non-English speaking patients; symptom management; health care provider/patient-family interaction; the burden of caregiving for families; and the consequences of the constraints within our health care system for people who are dying in various settings.
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Affiliation(s)
- Jeanie Kayser-Jones
- Department of Physiological Nursing, University of California, San Francisco, CA 94143-0610, USA.
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31
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Wilson DM. The duration and degree of end-of-life dependency of home care clients and hospital inpatients. Appl Nurs Res 2002; 15:81-6. [PMID: 11994824 DOI: 10.1053/apnr.2002.29526] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This investigation sought to describe and compare dependency among dying persons. To accomplish this, healthcare records of all deceased persons who received care over a 6-month period in one Canadian hospital (n = 150) and one home care department (n = 59) were reviewed. Only 36% of the home care clients died at home; all others (n = 38) were hospitalized. Almost all subjects had dependency needs on admission to care, with dependency increasing until all were completely dependent near death. Hospitalized home care clients had the longest documented average duration of total (partial and complete) dependency (81.3 days). Types of dependency (partial and complete) and progression in dependency were similar among subject groups, with the exception of 26% of hospital inpatients, who suddenly developed complete dependency until death. The duration of complete dependency varied between and among subject groups, which explains why a significant difference in lengths of complete dependency between hospital inpatients (M = 8.3 days) and home care clients who died at home (M = 4.1 days) was not found. In light of a dearth of research-based knowledge, this information should facilitate an improved understanding of the dependency needs of dying persons. Ultimately, it should assist end-of-life care planning and policy making.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Wilson DM, Northcott HC, Truman CD, Smith SL, Anderson MC, Fainsinger RL, Stingl MJ. Location of death in Canada. A comparison of 20th-century hospital and nonhospital locations of death and corresponding population trends. Eval Health Prof 2001; 24:385-403. [PMID: 11817198 DOI: 10.1177/01632780122034975] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report compares 20th-century Canadian hospital and nonhospital location-of-death trends and corresponding population mortality trends. One of the chief findings is a hospitalization-of-death trend, with deaths in hospital peaking in 1994 at 80.5% of all deaths. The rise in hospitalization was more pronounced in the years prior to the development of a national health care program (1966). Another key finding is a gradual reduction since 1994 in hospital deaths, with this reduction occurring across all sociodemographic variables. This suggests nonhospital care options are needed to support what may be an ongoing shift away from hospitalized death and dying.
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