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Christ SM, Hünerwadel E, Hut B, Ahmadsei M, Matthes O, Seiler A, Schettle M, Blum D, Hertler C. Socio-economic determinants for the place of last care: results from the acute palliative care unit of a large comprehensive cancer center in a high-income country in Europe. BMC Palliat Care 2023; 22:114. [PMID: 37550688 PMCID: PMC10408184 DOI: 10.1186/s12904-023-01240-2] [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: 01/05/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND INTRODUCTION The place of last care carries importance for patients at the end of life. It is influenced by the realities of the social welfare and healthcare systems, cultural aspects, and symptom burden. This study aims to investigate the place of care trajectories of patients admitted to an acute palliative care unit. MATERIALS AND METHODS The medical records of all patients hospitalized on our acute palliative care unit in 2019 were assessed. Demographic, socio-economic and disease characteristics were recorded. Descriptive and inferential statistics were used to identify determinants for place of last care. RESULTS A total of 377 patients were included in this study. Median age was 71 (IQR, 59-81) years. Of these patients, 56% (n = 210) were male. The majority of patients was Swiss (80%; n = 300); about 60% (n = 226) reported a Christian confession; and 77% had completed high school or tertiary education. Most patients (80%, n = 300) had a cancer diagnosis. The acute palliative care unit was the place of last care for 54% of patients. Gender, nationality, religion, health insurance, and highest level of completed education were no predictors for place of last care, yet previous outpatient palliative care involvement decreased the odds of dying in a hospital (OR, 0.301; 95% CI, 0.180-0.505; p-value < 0.001). CONCLUSION More than half of patients admitted for end-of-life care died on the acute palliative care unit. While socio-economic factors did not determine place of last care, previous involvement of outpatient palliative care is a lever to facilitate dying at home.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | | | - Bigna Hut
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Matthes
- Department of Consultant Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annina Seiler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Yamout R, Hanna J, El Asmar R, Beydoun H, Rahm M, Osman H. Preferred place of death for patients with terminal illness: A literature review. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1961985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rana Yamout
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Janane Hanna
- Department of Anesthesia and Pain Management, AUBMC, Beirut, Lebanon
| | | | - Hanadi Beydoun
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Mira Rahm
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Hibah Osman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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Beng TS, Ying YK, Xin CA, Jane LE, Lin DC, Khuen LP, Capelle DP, Zainuddin SI, Chin LE, Loong LC. The experiences of well-being of family caregivers in palliative care: A qualitative study using thematic analysis. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1872135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yeoh Kee Ying
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheah Ai Xin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Dong Chooi Lin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Poh Khuen
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Gerber K, Maharaj E, Brijnath B, Antoniades J. End-of-life care for older first-generation migrants: a scoping review. BMJ Support Palliat Care 2020:bmjspcare-2020-002617. [PMID: 33298550 DOI: 10.1136/bmjspcare-2020-002617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The unprecedented scale of contemporary migration across countries over the last decade means that ageing and dying occur in a more globalised, multicultural context. It is therefore essential to explore the end-of-life experiences of older people from migrant backgrounds. METHODS A scoping review of peer-reviewed articles published in English from 2008 to 2018. Included studies addressed end-of-life preferences, attitudes, values and beliefs of first-generation international migrants who were at least 50 years of age. RESULTS Fifteen studies met the inclusion criteria for this review, which addressed six key themes: (1) the reluctance among older migrants and their families to talk about death and dying; (2) difficult communication in patient-clinician relationships; (3) the contrast between collectivistic and individualistic norms and its associated end-of-life preferences; (4) limited health literacy in older adults from migrant backgrounds; (5) experiences with systemic barriers like time pressure, inflexibility of service provision and lack of cultural sensitivity and (6) the need for care providers to appreciate migrants' 'double home experience' and what this means for end-of-life decision-making regarding place of care and place of death. DISCUSSION To respond effectively to an increasingly culturally diverse population, healthcare staff, researchers and policymakers need to invest in the provision of culturally sensitive end-of-life care. Areas for improvement include: (a) increased awareness of cultural needs and the role of family members; (b) cultural training for healthcare staff; (c) access to interpreters and translated information and (d) involvement of older migrants in end-of-life discussions, research and policymaking.
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Affiliation(s)
- Katrin Gerber
- Melbourne Ageing Research Collaboration, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Emma Maharaj
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- Department of General Practice, Monash University, Clayton, Victoria, Australia
- School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
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5
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Supportive and palliative care for people with respiratory problems and preexisting serious mental illness. Curr Opin Support Palliat Care 2020; 14:190-196. [PMID: 32701857 DOI: 10.1097/spc.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW People living with serious mental illness are at a higher risk of developing respiratory problems that can lead to increased morbidity and early mortality. This review aimed to identify recent advances in care provision for people with respiratory problems and preexisting serious mental illness to ease symptom burden and reduce the risk of premature mortality. RECENT FINDINGS Intervention-based studies in this area are scarce. The evidence reviewed originated from observational studies. Concluding comments from the synthesis suggest there are specific needs for proactive screening of respiratory function as part of routine physical health checks across care settings for people living with serious mental illness, more stringent monitoring of comorbid chronic lung conditions and increased attention in reducing the frequency respiratory infections. Integrated services across care settings are needed to support people with serious mental illness to limit the impact of modifiable lifestyle factors known to be detrimental to respiratory health, such as smoking. SUMMARY Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.
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Gerber K, Lemmon C, Williams S, Watt J, Panayiotou A, Batchelor F, Hayes B, Brijnath B. ‘There for me’: A qualitative study of family communication and decision-making in end-of-life care for older people. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1767437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katrin Gerber
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Christel Lemmon
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Sue Williams
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | | | - Anita Panayiotou
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Frances Batchelor
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | | | - Bianca Brijnath
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
- Department of General Practice, Monash University, Melbourne, Australia
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7
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Gerber K, Craanen R, James N, Savvas S, Hayes B, Brijnath B. A New Plea to Focus on the End-of-Life Needs of People with Severe Mental Illnesses. Issues Ment Health Nurs 2019; 40:827-828. [PMID: 31322981 DOI: 10.1080/01612840.2019.1630536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Katrin Gerber
- National Ageing Research Institute , Melbourne , Australia
| | | | - Natalie James
- National Ageing Research Institute , Melbourne , Australia
| | - Steven Savvas
- National Ageing Research Institute , Melbourne , Australia
| | | | - Bianca Brijnath
- National Ageing Research Institute , Melbourne , Australia.,School of Occupational Therapy and Social Work, Curtin University , Perth , Australia.,Department of General Practice, Monash University , Notting Hill , Australia
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