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Diaz MA, Angus FC, Bickenbach JE. Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13186. [PMID: 38097500 DOI: 10.1111/jar.13186] [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: 04/17/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. METHOD This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. RESULTS Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. CONCLUSIONS The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.
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Affiliation(s)
| | | | - Jerome E Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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2
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Diaz MA, Bickenbach JE, Sabariego C, Bernard RM. Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13119. [PMID: 37315942 DOI: 10.1111/jar.13119] [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: 09/07/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying. METHOD A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed. RESULTS We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities. CONCLUSIONS The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.
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Affiliation(s)
| | | | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
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3
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Voss H, Francke AL, de Veer AJE. Improving palliative care for people with intellectual disability: a self-assessment of policies, practices and competencies in care services. BMC Palliat Care 2023; 22:103. [PMID: 37481535 PMCID: PMC10362573 DOI: 10.1186/s12904-023-01224-2] [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: 12/07/2022] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Providing care for ageing and vulnerable people with intellectual disability (ID) is challenging, and professionals working in ID care often have limited experience in palliative care. The current study provides insight into palliative care practices in ID care services and competencies of professionals and identifies ways to improve palliative care for people with ID. METHODS For this study ten services in the Netherlands were recruited that provide care for people with mild to profound ID. Professionals in each of these services conducted a self-assessment of their palliative care policies and practices based on nine core element of palliative care described in the Dutch Quality Framework for Palliative Care. The self-assessment included a medical file review of a total of 100 people with ID who died non-suddenly. In addition, 424 professionals from the services returned a digital questionnaire on palliative care competencies and training needs. RESULTS The self-assessments showed that individual care plans were recorded for people with ID and that multidisciplinary teams provided physical, psychological, social and spiritual care. However, other core elements of palliative care, such as cooperation with other organisations and expertise in palliative care, were less present in ID care services. Only half of the services collaborated with regional organisations in palliative care, and most services listed no requirements for the palliative care skills of their professionals. The questionnaire showed that almost 10% of the professionals reported that they were not at all competent in providing palliative care, and 74% felt that they needed training in palliative care. Reported areas for improvement in the provision of palliative care were increasing the quality of palliative care, improving the expertise of professionals and identifying palliative care needs earlier. CONCLUSIONS To improve palliative care in ID care services changes are required both in competencies of professionals, and organisational policies and practices. Services should enhance awareness about palliative care for people with ID, strengthen collaboration with palliative care services, and offer training or support for professionals in assessing and meeting the needs of people with ID at the end of life.
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Affiliation(s)
- Hille Voss
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, APH Amsterdam Public Health research institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Anke J E de Veer
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
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Jacobs P, Watchman K, Wilkinson H, Hoyle L, McGenily L. Experiences of people with intellectual disability and dementia: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:241-258. [PMID: 36562340 PMCID: PMC10107172 DOI: 10.1111/jar.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dementia disproportionately affects people with intellectual disability. Most qualitative studies explore their experiences by utilising proxy-reports. A smaller number of studies illustrate the possibility of exploring perspectives directly from people with intellectual disability and dementia. METHOD This systematic review synthesised findings from existing studies (n = 8) that involve people with intellectual disability and dementia as participants to understand their experiences of dementia. Searches were conducted using CINAHL, PsychInfo and Social Services Abstracts. RESULTS Findings include descriptions of changes in individual functioning, a narrowing of social worlds and of how people made sense of the changes despite often having no knowledge of their dementia diagnosis. Additionally, discussion focuses on how people's experiences are shaped by their environments. CONCLUSION The review recognises the complexities of speaking to people with intellectual disability about dementia, challenges views that people with intellectual and dementia cannot be involved in research and makes recommendations to support inclusion in future studies.
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Affiliation(s)
- Paula Jacobs
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Heather Wilkinson
- Edinburgh Centre for Research on the Experience of Dementia, University of Edinburgh, Edinburgh, Scotland, UK
| | - Louise Hoyle
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Laura McGenily
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK.,Clinical Research Nurse, NHS Forth Valley, Larbert/Postgraduate Research Student, University of Stirling, Stirling, Scotland, UK
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Viola M, Braun RT, Luth EA, Pan CX, Lief L, Gang J, Adamou Z, Dodd P, Prigerson HG. Associations of Intellectual Disability with Cardiopulmonary Resuscitation and Endotracheal Intubation at End of Life. J Palliat Med 2022; 25:1268-1272. [PMID: 35442779 PMCID: PMC9347372 DOI: 10.1089/jpm.2021.0584] [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] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). Objectives: To identify differences in receipt of end-of-life cardiopulmonary resuscitation (CPR) and endotracheal intubation among adult patients with and without ID and examine whether do-not-resuscitate orders (DNRs) mediate associations between ID and CPR. Design: Exploratory matched cohort study using medical records of inpatient decedents treated between 2012 and 2018. Results: Patients with ID (n = 37) more frequently received CPR (37.8% vs. 21.6%) and intubation (78.4% vs. 47.8%) than patients without ID (n = 74). In multivariable models, ID was associated with receiving CPR (relative risk [RR] = 2.92, 95% confidence interval = 1.26-6.78, p = 0.012), but not intubation. Patients with ID less frequently had a DNR placed (67.6% vs. 91.9%), mediating associations between ID and CPR. Conclusions: In this pilot study, ID was associated with increased likelihood of receiving end-of-life CPR, likely due to lower utilization of DNRs among patients with ID. Further research is needed to confirm these results.
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Affiliation(s)
- Martin Viola
- Center for Research on End-of-Life Care and Weill Cornell Medicine, New York, New York, USA
| | - Robert Tyler Braun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth A. Luth
- Department of Family Medicine and Community Health, Institute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Cynthia X. Pan
- Division of Palliative Medicine and Geriatrics, New York Presbyterian Queens Hospital, Flushing, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lindsay Lief
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - James Gang
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Zara Adamou
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Philip Dodd
- University of Dublin, Trinity College, Dublin, Ireland
- Department of Psychiatry, St Michael's House Intellectual Disability Services
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care and Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Lam CKK, Bernal J, Finlayson J, Todd S, Taggart L, Boaz A, Tuffrey-Wijne I. Maximising engagement and participation of intellectual disability staff in research: Insights from conducting a UK-wide survey. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:554-566. [PMID: 32394781 PMCID: PMC8649423 DOI: 10.1177/1744629520924141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
AIM This article explores ways of maximising engagement of intellectual disability staff as research participants, research advisers and research implementers. METHOD The authors describe and reflect on a three-phased strategy in recruiting front-line staff (n = 690) working for intellectual disability service providers (n = 25) to participate in a UK-wide anonymous online survey about death, dying and bereavement. RESULTS Important elements in engaging participants were: involving stakeholders at all stages of the research process, which includes: building relationships with participating organisations; enlisting organisational management support at all levels; an attractive and well laid-out collection tool; a well-structured recruitment strategy; time and flexibility; and a varied and targeted dissemination strategy. However, the recruitment method had limitations, in particular around representativeness, bias and generalisability. CONCLUSIONS Staff in intellectual disability services can be enthusiastic and invaluable research participants. Active engagement between researchers, participating organisations and stakeholder groups is key to ensuring involvement of intellectual disability staff with research.
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Affiliation(s)
| | | | | | | | | | - Annette Boaz
- Kingston University and St George’s, University of London,
UK
| | - Irene Tuffrey-Wijne
- Irene Tuffrey-Wijne, Faculty of Health, Social Care
and Education, Kingston University and St George’s, University of London, 6th Floor Hunter
Wing, Cranmer Terrace, London SW17 0RE, UK.
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Voss H, Loxton A, Anderson J, Watson J. "It was one of those complicated cases": health practitioners' perspectives and practices of providing end-of-life care for people with profound intellectual and multiple disability. BMC Palliat Care 2021; 20:177. [PMID: 34772382 PMCID: PMC8586595 DOI: 10.1186/s12904-021-00873-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Due to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD. Methods Seven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data. Results Four main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments. Conclusions Due to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00873-5.
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Affiliation(s)
- Hille Voss
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, Utrecht, 3513 CR, The Netherlands.
| | - April Loxton
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Julie Anderson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Joanne Watson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
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Todd S, Bernal J, Worth R, Shearn J, Brearley S, McCarron M, Hunt K. Hidden lives and deaths: the last months of life of people with intellectual disabilities living in long-term, generic care settings in the UK. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1489-1498. [PMID: 34031949 DOI: 10.1111/jar.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE This paper concerns mortality and needs for end-of-life care in a population of adults with ID living in generic care homes. METHODS Various sampling strategies were used to identify a difficult to find a population of people with ID in generic care homes. Demographic and health data were obtained for 132 people with ID. This included the Surprise Question. At T2, 12 months later, data were obtained on the survival of this sample. FINDINGS The average age was 68.6 years, and the majority were women (55.3%). Their health was typically rated as good or better. Responses to the Surprise Question indicated that 23.3% respondents might need EoLC. At T2, 18.0% of this population had died. The average of death was 72.2 years. The majority died within the care setting (62.9%). IMPLICATIONS The implications for end-of-life care and mortality research are discussed.
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Hedayioglu J, Marsden S, Sackree A, Oliver D. Paid carers' understanding and experiences of meaningful involvement in bereavement for people with intellectual disability when a significant other is dying. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:143-149. [PMID: 34240511 DOI: 10.1111/jar.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Wider communication about death and dying for those with intellectual disabilities has been highlighted as being of key importance. OBJECTIVE To gain the perspective of paid carers based in residential homes about meaningfully supporting individuals with intellectual disabilities in the bereavement process. METHODS Semi-structured interviews were conducted with paid carers working across two residential homes. RESULTS Four themes were identified: (a) challenges in having conversations about death and dying; (b) meaningful involvement of residents in the bereavement process; (c) the relationship between paid carers and residents (including the impact of a resident's death on paid carers); and (d) the support needs of paid carers. CONCLUSIONS The recommendations from previous research of meaningfully involving people with intellectual disabilities in the bereavement process have not filtered fully into practice. Paid carers still highlight the need for specialist support and advice to help them discuss and increase involvement in death and dying.
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Affiliation(s)
- Julie Hedayioglu
- Clinical Audit & Research, Kent Community NHS Foundation Trust, Kent, UK.,Centre for Health Services Studies, University of Kent, Kent, UK
| | - Sue Marsden
- Specialist Community Matron, Kent Community NHS Foundation Trust, West Malling, UK
| | | | - David Oliver
- Tizard Centre, University of Kent, Canterbury, UK
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Kim MA, Yi J, Bradbury L, Han KM, Yang J, Lee J. A Photovoice Study: The life experiences of middle-aged adults with intellectual disabilities in Korea. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:852-865. [PMID: 33686721 DOI: 10.1111/jar.12870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As adults with intellectual disabilities approach older adulthood, they face unique physical and psychosocial challenges. This study explored the lived experiences of middle-aged adults with intellectual disabilities living in their community. METHOD Six sessions of Photovoice were conducted with a purposeful sample of six middle-aged adults with intellectual disabilities in South Korea. Participants were involved with the theme selection, taking photographs related to the themes, group discussion of photo stories and sharing Photovoice outcomes. RESULTS Thematic analysis yielded 11 subthemes under the five major themes selected by the participants: health, free time, time in the centre, family and my future in old age. CONCLUSIONS The study findings showed complex issues middle-aged adults with intellectual disabilities may face in later life, including bereavement and healthy lifestyle concerns. It is important to create a space for meaningful social support and social interactions without stigma.
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Affiliation(s)
- Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Laura Bradbury
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Ki-Myung Han
- Department of Gerontology, Graduate School of East-West Medical Science, Kyung Hee University, Gyeonggi, Republic of Korea
| | - Jieun Yang
- Therapy Center for Children with Emotional and Behavioral Issues, I-Zone in Seodaemun, Seoul, Republic of Korea
| | - Jinseung Lee
- Woori Daycare Center, Gyeonggi, Republic of Korea
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Bernal J, Hunt K, Worth R, Shearn J, Jones E, Lowe K, Todd S. Expecting the unexpected: measures, outcomes and dying trajectories for expected and unexpected death in adults with intellectual disabilities in social care settings in the UK. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:594-605. [DOI: 10.1111/jar.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/09/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Katherine Hunt
- School of Health Sciences University of Southampton Southampton UK
| | | | | | | | - Kathy Lowe
- University of South Wales Pontypridd UK
- Abertawe Bro Morgannwg University Health Board Wales UK
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