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O'Sullivan A, Larsdotter C, Sawatsky R, Alvariza A, Imberg H, Cohen J, Ohlen J. Place of care and death preferences among recently bereaved family members: a cross-sectional survey. BMJ Support Palliat Care 2024:spcare-2023-004697. [PMID: 38834237 DOI: 10.1136/spcare-2023-004697] [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: 11/21/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES The aim was: (1) to investigate preferred place for end-of-life care and death for bereaved family members who had recently lost a person with advanced illness and (2) to investigate associations between bereaved family members' preferences and individual characteristics, health-related quality of life, as well as associations with their perception of the quality of care that the ill person had received, the ill person's preferred place of death and involvement in decision-making about care. METHODS A cross-sectional survey with bereaved family members, employing descriptive statistics and multinominal logistic regression analyses. RESULTS Of the 485 participants, 70.7% were women, 36.1% were ≥70 years old, 34.5% were partners and 51.8% were children of the deceased. Of the bereaved family members, 52% preferred home for place of end-of-life care and 43% for place of death. A higher likelihood of preferring inpatient palliative care was associated with being female and having higher education, whereas a lower likelihood of preferring a nursing home for the place of care and death was associated with higher secondary or higher education. Partners were more likely to prefer hospital for place of care and nursing home for place of death. CONCLUSIONS Home was the most preferred place for end-of-life care and death. Bereaved people's experiences of end-of-life care may impact their preferences, especially if they had a close relationship, such as a partner who had a higher preference for nursing home and hospital care. Conversations about preferences for the place of care and death considering previous experience are encouraged.
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Affiliation(s)
- Anna O'Sullivan
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiold Hogskola-Campus Ersta, Stockholm, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Richard Sawatsky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada
| | - Anette Alvariza
- Department of Health Care Sciences, Marie Cederschiold Hogskola-Campus Ersta, Stockholm, Sweden
- Department of Research and Development, Stockholms Sjukhem, Stockholm, Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Joachim Cohen
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Ghent University, Ghent, Belgium
| | - Joakim Ohlen
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Centre for Person-centred Care (GPCC); Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Deniau N, Shojaei T, Georges A, Danis J, Czapiuk G, Mercier S, Maari C, Pourchet S, Balladur E, Leclaire C. Home emergency response team for the seriously ill palliative care patient: feasibility and effectiveness. BMJ Support Palliat Care 2024; 14:187-190. [PMID: 37844998 PMCID: PMC11103340 DOI: 10.1136/spcare-2023-004385] [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: 05/17/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To characterise trajectories associated with a new team organisation combining critical care and palliative care approaches at home. METHODS We describe the pattern of an emergency response team 24/7 directed to patients with advanced illness presenting a distressing symptom at home, who wanted to stay at home and for whom hospitalisation was considered inappropriate by a shared medical decision-making process in an emergency situation. To assess preliminary impact of this Programme, we conducted a descriptive study on all consecutive patients receiving this intervention during the first year (between 6 September 2021 and 5 September 2022). RESULTS Among the 352 patients included, main advanced illnesses were cancer (41%), dementia (28%) or chronic organ failure (10%). They were critically ill with acute failures: respiratory (52%), neurological (48%) or circulatory (20%). Main distressing symptoms were breathlessness (43%) and pain (17%). Median response time from call to home-visit (IQR) was 140 (90-265) min. Median length of follow-up (IQR) was 4 (2-7) days. Main outcomes were death at home (72%), improvement (19%) or hospitalisation (9%) including three visits to emergency department (1%). CONCLUSIONS Our study supports that shared decision-making process and urgent care at home are feasible and might prevent undesired hospitalisations.
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Affiliation(s)
- Nicolas Deniau
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Taraneh Shojaei
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Alexandre Georges
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Jean Danis
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Georges Czapiuk
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Stephane Mercier
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Claudine Maari
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Sylvain Pourchet
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Elisabeth Balladur
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Clement Leclaire
- Paris Public Hospital at Home (HAD AP-HP), Greater Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
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Fischer C, Dirschmid K, Masel EK. Examining Variability in Intra-Hospital Patient Referrals to Specialized Palliative Care: A Comprehensive Analysis of Disciplines and Mortality. J Clin Med 2024; 13:2653. [PMID: 38731181 PMCID: PMC11084376 DOI: 10.3390/jcm13092653] [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: 03/23/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: In Austria, specialized palliative care (SPC) access is limited, with unclear referral criteria, making it challenging to identify hospitalized patients requiring SPC and determine referral timing and mortality at the palliative care unit (PCU). Methods: This retrospective cohort study analyzed patients who underwent a palliative care (PC) needs assessment between March 2016 and November 2021 and were subsequently admitted to the PCU of Austria's largest academic hospital. Demographic, clinical, and standardized referral form data were used for analysis, employing descriptive statistics and logistic regression. Results: Out of the 903 assessed patients, 19% were admitted to the PCU, primarily cancer patients (94.7%), with lung (19%) and breast cancer (13%) being most prevalent. Common referral reasons included pain (61%) and nutritional problems (46%). Despite no significant differences in referral times, most patients (78.4%) died in the PCU, with varying outcomes based on cancer type. Referral reasons like pain (OR = 2.3), nutritional problems (OR = 2.4), and end-of-life care (OR = 6.5) were significantly associated with the outcome PCU mortality. Conclusions: This study underscores Austria's SPC access imbalance and emphasizes timely PC integration across disciplines for effective advance care planning and dignified end-of-life experiences in PCUs.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Katharina Dirschmid
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Eva Katharina Masel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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Duhoux A, Allard E, Hamel D, Sasseville M, Dumaine S, Gabet M, Guertin MH. Quality of palliative and end-of-life care: a quantitative study of temporal trends and differences according to illness trajectories in Quebec (Canada). BMC Palliat Care 2024; 23:93. [PMID: 38594658 PMCID: PMC11005266 DOI: 10.1186/s12904-024-01403-9] [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] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Our aim was to assess temporal trends and compare quality indicators related to Palliative and End-of-Life Care (PEoLC) experienced by people dying of cancer (trajectory I), organ-failure (Trajectory II), and frailty/dementia (trajectory III) in Quebec (Canada) between 2002 and 2016. METHODS This descriptive population-based study focused on the last month of life of decedents who, based on the principal cause of death, would have been likely to benefit from palliative care. Five PEoLC indicators were assessed: home deaths (1), deaths in acute care beds with no PEoLC services (2), at least one Emergency Room (ER) visit in the last 14 days of life (3), ER visits on the day of death (4) and at least one Intensive Care Unit (ICU) admission in the last month of life (5). Data were obtained from Quebec's Integrated Chronic Disease Surveillance System (QICDSS). RESULTS The annual percentage of home deaths increased slightly between 2002 and 2016 in Quebec, rising from 7.7 to 9.1%, while the percentage of death during a hospitalization in acute care without palliative care decreased from 39.6% in 2002 to 21.4% in 2016. Patients with organ failure were more likely to visit the ER on the day of death (20.9%) than patients dying of cancer and dementia/frailty with percentages of 12.0% and 6.4% respectively. Similar discrepancies were observed for ICU visits in the last month and ER visits in the last 14 days. CONCLUSION PEoLC indicators showed more aggressiveness of care for patients with organ failure and highlight the need for more equitable access to quality PEoLC between malignant and non-malignant illness trajectories. These results underline the challenges of providing timely and optimal PEoLC.
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Affiliation(s)
- Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Emilie Allard
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V 5B3, Canada
| | - Martin Sasseville
- Centre de recherche Charles-Le Moyne (CRCLM), Campus de Longueuil - Université de Sherbrooke, 150 Place Charles LeMoyne - Bureau 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Dumaine
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Morgane Gabet
- School of Public Health, University of Montreal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada.
| | - Marie-Hélène Guertin
- Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V 5B3, Canada
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Pivodic L, Van den Block L, Pivodic F. Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e264-e275. [PMID: 38490235 PMCID: PMC10978496 DOI: 10.1016/s2666-7568(24)00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Social connection is a key determinant of health, but its role in shaping end-of-life outcomes is poorly understood. We examined changes in structure, function, and quality components of social connection in older people's last years of life, and the extent to which social connection predicts end-of-life outcomes (ie, symptoms, health-care utilisation, and place of death). METHODS This study used longitudinal data of representative samples from across 18 European countries and Israel in the Survey of Health, Ageing, and Retirement in Europe (SHARE), the largest European cohort study of people aged 50 years or older. We included deceased participants of waves 4 and 6 (which contained social network modules) for whom a proxy provided an end-of-life interview. We did paired sample t-tests (for continuous variables), Wilcoxon signed-rank tests (for ordinal variables), and McNemar's tests (for non-ordinal categorical variables) to assess changes in structure, function, and quality components of social connection between waves 4 and 6. To examine social connection as a predictor of end-of-life outcomes, we used social connection data from wave 6 core interviews and end-of-life interviews from wave 7, conducted with a proxy respondent covering the deceased participant's last year of life. End-of-life outcomes included symptoms (pain, breathlessness, and anxiety or sadness) in the last month of life, health-care utilisation in the last year of life, and place of death. We conducted a mixed-effects logistic regression analysis per social connection measure, for each end-of-life outcome. FINDINGS Data were collected in 2011-12 for wave 4, 2015-16 for wave 6, and 2017-18 for wave 7. We studied 3356 individuals (mean age at death was 79·7 years [SD 10·2]), with interviews conducted, on average, 4·6 (1·2) years (wave 4) and 1·1 (0·7) years (wave 6) before death. From wave 4 to wave 6, the following changes in social connection were observed: proportion of married or partnered participants (from 1406 [60·9%] of 2310 to 1438 [57·1%] of 2518; p<0·0001), receiving personal care or practical help (from 781 [37·2%] of 2099 to 1334 [53·1%] of 2512; p<0·0001), loneliness (from mean 1·4 [SD 0·5] to 1·5 [0·6]; p<0·0001; scale 1-3), satisfaction with social network (from 8·8 [1·67] to 8·7 [1·7]; p=0·037; scale 0-10), and emotional closeness to social network (eg, from 1883 [88·8%] of 2121 to 1710 [91·3%] of 1872 participants who indicated being either very close or extremely close to social network members; p<0·0001). Higher levels of loneliness at wave 6 predicted a greater likelihood of experiencing symptoms in the last month of life (odds ratio range across symptoms: 1·29 [95% CI 1·08-1·55] to 1·58 [1·32-1·89]). Being married (1·32 [1·03-1·68]) or receiving personal care or practical help (1·25 [1·04-1·49]) predicted death in hospital. INTERPRETATION Social connection undergoes multifaceted changes towards older people's end of life, countering prevalent ideas of generally declining social trajectories. Loneliness in the final months of life might be a risk factor for end-of-life symptoms. Further research is needed to substantiate a causal relationship and to identify underpinning mechanisms, which could inform screening and prevention measures. FUNDING Research Foundation-Flanders and European Union.
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Affiliation(s)
- Lara Pivodic
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium.
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium
| | - Fedja Pivodic
- World Bank, Health, Nutrition and Population Division; Washington DC, USA
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Namukwaya E, de Sousa AB, Lopes S, Touwen DP, van der Steen JT, Bélanger E, Brooks J, Yghemonos S, Sehmi K, Gomes B. EOLinPLACE: an international research project to reform the way dying places are classified and understood. Palliat Care Soc Pract 2024; 18:26323524231222498. [PMID: 38357678 PMCID: PMC10865961 DOI: 10.1177/26323524231222498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Background Whenever possible, a person should die where they feel it is the right place to be. There is substantial global variation in home death percentages but it is unclear whether these differences reflect preferences, and there are major limitations in how the place of death is classified and compared across countries. Objectives EOLinPLACE is an international interdisciplinary research project funded by the European Research Council aiming to create a solid base for a ground-breaking international classification tool that will enable the mapping of preferred and actual places towards death. Design Mixed-methods observational research. Methods and analysis We combine classic methods of developing health classifications with a bottom-up participatory research approach, working with international organizations representing patients and informal carers [International Alliance of Patients' Organizations (IAPO) and Eurocarers]. First, we will conduct an international comparative analysis of existing classification systems and routinely collected death certificate data on place of death. Secondly, we will conduct a mixed-methods study (ethnography followed by longitudinal quantitative study) in four countries (the Netherlands, Portugal, Uganda and the United States), to compare the preferences and experiences of patients with life-threatening conditions and their families. Thirdly, based on the generated evidence, we will build a contemporary classification of dying places; assess its content validity through focus groups with patients, carers and other stakeholders; and evaluate it in a psychometric study to examine construct validity, reliability, responsiveness, data quality and interpretability. Ethics Approved by the ethics committee of the University of Coimbra, Faculty of Medicine (CE-068-2022) and committees in each of the participating countries. Discussion The findings will provide a deeper understanding of the diversity in individual end-of-life pathways. They will enable key developments such as measurement of progress towards achievement of preferences when care can be planned. The project will open new directions in how to care for the dying. Trial registration Research Registry UIN 9213.
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Affiliation(s)
- Elizabeth Namukwaya
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Dorothea Petra Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny Theodora van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Joanna Brooks
- Population Health and Palliative Medicine, Master of Health Services Administration, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Kawaldip Sehmi
- International Alliance of Patients’ Organizations, London, UK
| | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Pólo III, Sub-Unidade 3, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Busquet-Duran X, Mateu-Carralero B, Bielsa-Pascual J, Milian-Adriazola L, Salamero-Tura N, Torán-Monserrat P. Systemic strengths and needs in palliative home care: exploring complexity. Rev Clin Esp 2024; 224:1-9. [PMID: 38101771 DOI: 10.1016/j.rceng.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE We aimed to investigate the relationship between systemic strengths and complexity in home care of end-of-life patients. METHODS Quantitative descriptive longitudinal study of patients cared for at home by a palliative care team. Place of death was analyzed in relation to complexity, as determined by the HexCom complexity model after the initial home assessment. We used Pearson's chi-square test to analyze the comparison of proportions. RESULTS Forty-six hundred patients (74.4% oncologic) with a mean age of 76.2 years (SD 13.2) participated. Fifty-three percent had complete or severe functional dependence, 30.8% were already bedridden in the first assessment, and 59.7% died at home. Strengths influenced place of death, specifically exosystem (team) strength (OR: 4.07 [1.92-8.63]), microsystem (both patient 0.51 [0.28-0.94]) and caregiver (OR: 3.90 [1.48-10.25]), and chronosystem, related to prediction of progressive course (OR: 2.22 [1.37-3.60]). CONCLUSIONS To improve care for end-of-life patients and their families, a systemic view of dying and death that includes both needs and strengths is necessary. In this sense, the systemic framework proposed by Bonfrenbrenner can be useful for clinical practice.
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Affiliation(s)
- X Busquet-Duran
- Programa d'Atenció Domiciliària Equip de Suport (PADES), Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord (USR-MN), Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Grupo de Investigacion Multidisciplinar en Salud y Sociedad GREMSAS, Barcelona, Spain.
| | - B Mateu-Carralero
- Programa d'Atenció Domiciliària Equip de Suport (PADES), Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Barcelona, Spain
| | - J Bielsa-Pascual
- Unitat de Suport a la Recerca Metropolitana Nord (USR-MN), Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain; Grupo de Investigacion Multidisciplinar en Salud y Sociedad GREMSAS, Barcelona, Spain
| | - L Milian-Adriazola
- Programa d'Atenció Domiciliària Equip de Suport (PADES), Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Barcelona, Spain
| | - N Salamero-Tura
- Programa d'Atenció Domiciliària Equip de Suport (PADES), Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Barcelona, Spain
| | - P Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord (USR-MN), Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Departmento de Medicina, Facultad de Medicina, Universitat de Girona, Girona, Spain; Grupo de Investigacion Multidisciplinar en Salud y Sociedad GREMSAS, Barcelona, Spain
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Quintiens B, Smets T, Chambaere K, Van den Block L, Deliens L, Sallnow L, Cohen J. Discomfort With Suffering and Dying, a Cross-Sectional Survey of the General Public. J Pain Symptom Manage 2023; 66:529-540.e6. [PMID: 37437645 DOI: 10.1016/j.jpainsymman.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT Death and the process of dying have become increasingly medicalized and professionalized. The associated cultural estrangement from death may affect how comfortable we feel about death and dying. This study examines the general public's discomfort with another person's suffering and dying, and whether these feelings are associated with specific personal characteristics or experiences. OBJECTIVES Cross-sectional survey in a random sample of people aged 16 or older in four municipalities in Flanders, Belgium (N=4400). We used the self-developed construct Discomfort with someone's suffering and dying. A directed acyclic graph guided the development of a multivariable regression model which explored the effect of different variables on the main outcome measure. RESULTS A total of 2008 completed questionnaires were returned (response rate: 45.6%). Average discomfort with someone's suffering and dying was 3.74 (SD = 0.89). Being female or currently mourning a loss were associated with more discomfort. Not being religious, having better knowledge about palliative care, having worked in healthcare, having been with someone else at the time of their death and having been culturally exposed to death and dying were associated with less discomfort. CONCLUSION A considerable level of discomfort is present within the general public about the suffering and dying of others and this may increase social stigma and a tendency to avoid seriously ill people and their social surroundings. Our findings suggest that interventions may help shift this societal discomfort if they incorporate a focus on cultural and experiential exposure and increasing knowledge about palliative care.
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Affiliation(s)
- Bert Quintiens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium.
| | - Tinne Smets
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Libby Sallnow
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; St Christopher's Hospice (L.S.), London, UK; Marie Curie Palliative Care Research Department (L.S.), Division of Psychiatry, University College London, London, UK
| | - Joachim Cohen
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
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Lundberg E, Ozanne A, Larsdotter C, Böling S, Dellenborg L, Ensted D, Öhlén J. Place of death among foreign-born individuals: a national population-based register study. Palliat Care Soc Pract 2023; 17:26323524231185157. [PMID: 37465177 PMCID: PMC10350762 DOI: 10.1177/26323524231185157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Background Relatively little is known about where foreign-born individuals die in Sweden and how birth region might influence place of death. Thus, there is a need for population-based studies investigating place of death and associated factors among foreign-born individuals. Objectives The aim of this study was to identify variations in place of death among foreign-born individuals residing in Sweden and to compare place of death between the foreign- and domestic-born population. We also examine the association between place of death, underlying cause of death and sociodemographic characteristics among the foreign-born population. Design A population-based register study. Methods All deceased individuals ⩾18 years of age in Sweden with a registered place of death between 2012 and 2019 (n = 682,697). Among these, 78,466 individuals were foreign-born. Univariable multinomial logistic regression modelling and multivariable multinomial logistic regression analyses were performed. Results Overall, hospital was the most common place of death among the foreign-born population. However, there were variations in place of death related to region of birth. Compared to domestic-born, a higher proportion of foreign-born individuals dies at home, the majority of whom were born on the African continent. Conclusion Region of birth is one of the several factors associated with place of death among foreign-born individuals. Further research is needed to explore both preferences and barriers to place of death among foreign-born individuals.
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Affiliation(s)
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanna Böling
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Ensted
- Department of Literature, History of Ideas, and Religion, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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10
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Xu X, Chau PH, Cheung DST, Ho MH, Lin CC. Preferences for end-of-life care: A cross-sectional survey of Chinese frail nursing home residents. J Clin Nurs 2023; 32:1455-1465. [PMID: 35933614 DOI: 10.1111/jocn.16483] [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: 04/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES To assess (1) the experience, knowledge and preferences of end-of-life care among frail nursing home residents and (2) the preferences of residents' family caregivers. BACKGROUND Globally, nursing homes are becoming an important place where many older people will receive their end-of-life care. Thus, assessing the end-of-life care preferences among nursing home residents is crucial. DESIGN Cross-sectional survey. METHODS Residents aged ≥65 years, with frail or pre-frail status (n = 286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist. RESULTS 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as 'not necessary'. Nursing homes were the most preferred place to receive end-of-life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes. CONCLUSIONS This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents' awareness of these topics. RELEVANCE TO CLINICAL PRACTICE To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance.
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Affiliation(s)
- Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong, Hong Kong
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11
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Yu TH, Lu FL, Wei CJ, Wu WW. The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study. BMC Palliat Care 2023; 22:29. [PMID: 36978057 PMCID: PMC10053103 DOI: 10.1186/s12904-023-01146-z] [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: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Compared to aggressive treatment for patients at the end stage of life, hospice care might be more likely to satisfy such patients' need and benefits and improve their dignity and quality of life. Whether the reimbursement policy expansion affect the use of hospice care among various demographics characteristics and health status was unknown. Therefore, the purpose of this study was to explore the impacts of reimbursement policy expansion on hospice care use, and to investigate the effects on people with various demographics characteristics and health status. METHODS We used the 2001-2017 Taiwan NHI claims data, Death Registry, and Cancer Registry in this study, and we included people who died between 2002 and 2017. The study period was divided into 4 sub-periods. hospice care use and the initiation time of 1st hospice care use were used as dependent variables; demographic characteristics and health status were also collected. RESULTS There were 2,445,781 people who died in Taiwan during the study period. The results show that the trend of hospice care use increased over time, going steeply upward after the scope of benefits expansion, but the initiation time of 1st hospice care use did not increase after the scope of benefits expansion. The results also show that the effects of expansion varied among patients by demographic characteristics. CONCLUSION The scope of benefits expansion might induce people's needs in hospice care, but the effects varied by demographic characteristics. Understanding the reasons for the variations in all populations would be the next step for Taiwan's health authorities.
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Affiliation(s)
- Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wei-Wen Wu
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan.
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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12
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Benoit DD, Vanheule S, Manesse F, Anseel F, De Soete G, Goethals K, Lievrouw A, Vansteelandt S, De Haan E, Piers R. Coaching doctors to improve ethical decision-making in adult hospitalised patients potentially receiving excessive treatment: Study protocol for a stepped wedge cluster randomised controlled trial. PLoS One 2023; 18:e0281447. [PMID: 36943825 PMCID: PMC10030010 DOI: 10.1371/journal.pone.0281447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/18/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Fast medical progress poses a significant challenge to doctors, who are asked to find the right balance between life-prolonging and palliative care. Literature indicates room for enhancing openness to discuss ethical sensitive issues within and between teams, and improving decision-making for benefit of the patient at end-of-life. METHODS Stepped wedge cluster randomized trial design, run across 10 different departments of the Ghent University Hospital between January 2022 and January 2023. Dutch speaking adult patients and one of their relatives will be included for data collection. All 10 departments were randomly assigned to start a 4-month coaching period. Junior and senior doctors will be coached through observation and debrief by a first coach of the interdisciplinary meetings and individual coaching by the second coach to enhance self-reflection and empowering leadership and managing group dynamics with regard to ethical decision-making. Nurses, junior doctors and senior doctors anonymously report perceptions of excessive treatment via the electronic patient file. Once a patient is identified by two or more different clinicians, an email is sent to the second coach and the doctor in charge of the patient. All nurses, junior and senior doctors will be invited to fill out the ethical decision making climate questionnaire at the start and end of the 12-months study period. Primary endpoints are (1) incidence of written do-not-intubate and resuscitate orders in patients potentially receiving excessive treatment and (2) quality of ethical decision-making climate. Secondary endpoints are patient and family well-being and reports on quality of care and communication; and clinician well-being. Tertiairy endpoints are quantitative and qualitative data of doctor leadership quality. DISCUSSION This is the first randomized control trial exploring the effects of coaching doctors in self-reflection and empowering leadership, and in the management of team dynamics, with regard to ethical decision-making about patients potentially receiving excessive treatment.
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Affiliation(s)
- Dominique D. Benoit
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Intensive Care Medicine, University Hospital Ghent, Gent, Belgium
| | - Stijn Vanheule
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | - Frank Manesse
- Independent, Conversio, Gent, Belgium
- Kets de Vries Institute, London, United Kingdom
| | - Frederik Anseel
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | - Geert De Soete
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | | | - An Lievrouw
- Intensive Care Medicine, University Hospital Ghent, Gent, Belgium
- Ghent University Hospital Cancer Centre, Gent, Belgium
| | - Stijn Vansteelandt
- Faculty of Applied Mathematics, Computer Sciences and Statistics, Ghent University Faculty of Sciences, Gent, Belgium
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erik De Haan
- Hult International Business School Ashridge Centre for Coaching, Berkhamsted, United Kingdom
- VU Amsterdam School of Business and Economics, Amsterdam, The Netherlands
| | - Ruth Piers
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Ghent University Hospital Geriatrics, Gent, Belgium
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End of life in patients attended by pediatric palliative care teams: what factors influence the place of death and compliance with family preferences? Eur J Pediatr 2023; 182:2369-2377. [PMID: 36890334 PMCID: PMC10175312 DOI: 10.1007/s00431-023-04870-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Abstract
Each year, more than 8 million children worldwide require specialized palliative care, yet there is little evidence available in pediatrics on the characteristics of the end of life in this context. Our aim is to analyze the characteristics of patients who die in the care of specific pediatric palliative care teams. This is ambispective, analytical observational, multicenter study conducted between 1 January and 31 December 2019. Fourteen specific pediatric palliative care teams participated. There are 164 patients, most of them suffering from oncologic, neurologic, and neuromuscular processes. The follow-up time was 2.4 months. The parents voiced preferences in respect of the place of death for 125 of the patients (76.2%). The place of death for 95 patients (57.9%) was at the hospital and 67 (40.9%) was at home. The existence of a palliative care team for over 5 years is more likely to be related to families voicing preferences and their fulfillment. Longer follow-up times by pediatric palliative care teams were observed in families with whom preferences regarding the place of death were discussed and in patients who died at home. Patients who did not receive home visits, when the pediatric palliative care team did not provide full care and when preferences regarding the place of death were not discussed with parents, were more likely to die in the hospital. Conclusions: Advance planning of end-of-life care is one of the most important aspects of pediatric palliative care. The provision of services by the teams and the follow-up time are related to parents' expressed preferences and the place of death. What is Known: • Various studies have shown how the availability of pediatric palliative care services improves the quality of life of patients and their families while reducing costs. • The place of death is an important factor influencing the quality of end-of-life care for dying people. The increase in palliative care teams increases the number of deaths in the home and having this care available 24/7 increases the probability of dying at home. What is New: • Our study identifies how a longer follow-up time of patients by palliative care teams is significantly associated with death at home and with express and comply with the preferences expressed by families. • Home visits by the palliative care team increase the likelihood that the patient will die at her home and that the preferences expressed by the palliative care team families will be cared for.
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14
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Flierman I, Gieteling E, Van Rijn M, Van Grootven B, van Doorne I, Jamaludin FS, Willems DL, Muller M, Buurman BM. Effectiveness of transmural team-based palliative care in prevention of hospitalizations in patients at the end of life: A systematic review and meta-analysis. Palliat Med 2023; 37:75-87. [PMID: 36541477 DOI: 10.1177/02692163221135616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited. AIM To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently. RESULTS About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34-0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07-0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26-3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23-18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time. CONCLUSION Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
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Affiliation(s)
- Isabelle Flierman
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam UMC Location AMC, University of Amsterdam, Department of General Practice, Section of Medical Ethics, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands
| | - Elske Gieteling
- Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands.,Amstelland Hospital, Department of Internal Medicine, Amstelveen, The Netherlands
| | - Marjon Van Rijn
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Bastiaan Van Grootven
- Research Foundation Flanders - FWO, Brussels, Belgium + KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - Iris van Doorne
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dick L Willems
- Amsterdam UMC Location AMC, University of Amsterdam, Department of General Practice, Section of Medical Ethics, Amsterdam, The Netherlands
| | - Majon Muller
- Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands
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15
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[Care complexity and place of death in palliative home care]. GACETA SANITARIA 2022; 37:102266. [PMID: 36527842 DOI: 10.1016/j.gaceta.2022.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the associations between the dimensions of the HexCom care complexity model and the place of death. METHOD Multicenter longitudinal observational study in patients with advanced illness cared for by home care support teams in Catalonia. Age, gender, type of illness, main caregiver, external support, place of death and the sub-areas of care complexity provided by HexCom were registered. A multivariate Cox regression analysis was performed. RESULTS Participation of 1527 patients (72% oncology), cared for a median of 35 days. 45% died at home. The probability of dying at home was greater when a greater functional impairment was detected in the initial assessment (hazard ratio [HR]: 7.67; 95% confidence interval [95%CI]: 4.93-11.92), when the patient was male (HR: 1.19; 95%CI: 1.02-1.39), was over 80 years old (HR: 1.41; 95%CI: 1.20-1.66) and when care complexity was detected in relation to being in a situation of last days (HR: 2.24; 95%CI: 1.69-2.97). It was more likely not to die at home in the case of cancer (HR: 0.76; 95%CI: 0.64-0.89), or if poor external support to the family group was detected in the first evaluation (HR: 0.79; 95%CI: 0.67-0.93), or that the patient did not feel at peace with others (HR: 0.56; 95%CI: 0.40-0.79), or lack of agreement on the planning of the place of death (HR: 0.57; 95%CI: 0.48-0.68). CONCLUSIONS The assessment of the complexity of care through the HexCom-Clin model can help to improve advance planning of decisions by incorporating among its dimensions the feeling of peace with others, the external support to the family nucleus and the degree of agreement on the place of death.
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Haardt V, Cambriel A, Hubert S, Tran M, Bruel C, Philippart F. General practitioner residents and patients end-of life: involvement and consequences. BMC Med Ethics 2022; 23:123. [PMID: 36463158 PMCID: PMC9719227 DOI: 10.1186/s12910-022-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. METHODS We surveyed all GP trainees of "Ile de France". The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients' care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. RESULTS 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient's (210 answers, 40%) and relative's communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in "at risk" hospital settings. CONCLUSION Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.
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Affiliation(s)
- Victoire Haardt
- Marie-Thérèse Medical Center, Paris, France ,REQUIEM study group, Paris, France
| | - Amélie Cambriel
- grid.50550.350000 0001 2175 4109Anesthesiology and Intensive Care Medicine Department, APHP-Tenon University Hospital, Paris, France ,REQUIEM study group, Paris, France
| | - Sidonie Hubert
- grid.414363.70000 0001 0274 7763Internal Medicine Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
| | - Marc Tran
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Francois Philippart
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
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Rubli Truchard E, Monod S, Bula CJ, Dürst AV, Levorato A, Mazzocato C, Münzer T, Pasquier J, Quadri P, Rochat E, Spencer B, von Gunten A, Jox RJ. Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study. J Am Med Dir Assoc 2022; 23:1935-1941. [PMID: 36202218 DOI: 10.1016/j.jamda.2022.09.001] [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: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents. DESIGN Multisite cross-sectional observational study. SETTING AND PARTICIPANTS 31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment. METHODS Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed. RESULTS From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66). CONCLUSIONS AND IMPLICATIONS The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.
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Affiliation(s)
- Eve Rubli Truchard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéfanie Monod
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Véronique Dürst
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandro Levorato
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Mazzocato
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Pierluigi Quadri
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Etienne Rochat
- Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brenda Spencer
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Pilly, Switzerland
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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18
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Funk LM, Mackenzie CS, Cherba M, Del Rosario N, Krawczyk M, Rounce A, Stajduhar K, Cohen SR. Where would Canadians prefer to die? Variation by situational severity, support for family obligations, and age in a national study. Palliat Care 2022; 21:139. [PMID: 35909120 PMCID: PMC9340714 DOI: 10.1186/s12904-022-01023-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age.
Methods
Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care.
Results
Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older.
Conclusions
Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.
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19
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Bergman TD, Pasman HRW, Hendriksen JM, Onwuteaka-Philipsen BD. End of life in general practice: trends 2009-2019. BMJ Support Palliat Care 2022:bmjspcare-2022-003609. [PMID: 36288918 DOI: 10.1136/spcare-2022-003609] [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: 03/04/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess possible trends between 2009 and 2019 in the Netherlands of palliative care indicators: the provision of palliative care or treatment, hospitalisations in the last month before death, use of specialised palliative care services and place of death. METHODS The study design was a repeated retrospective cross-sectional design with questionnaires filled in by general practitioners within a clustered sample of 67 Sentinel practices. Patients whose death was non-sudden, and thus could have received palliative care, between 1 January 2009 and 31 December 2019 were included in the study, resulting in 3121 patients. RESULTS Between 2009 and 2019, there is a significant increase in the number of people who receive palliative care or treatment alongside life-prolonging or curative treatment and the number of people who die at home, while the number of hospitalisations in the last month before death and the number of people dying in hospital shows a significant decrease. However, there is no trend in the involvement of specialised palliative care services or people receiving solely palliative care or treatment. CONCLUSION This study suggests improvements in end-of-life care provided in primary care in the Netherlands. Trends coincided with increased attention to palliative care both in practice and policy. Yet, there is still considerable room for improvement as there is no significant increase in people solely receiving palliative care or treatment and the involvement of specialised palliative care services.
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Affiliation(s)
- Tessa D Bergman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - Janneke Mt Hendriksen
- Research Unit Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
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20
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Campos E, Isenberg SR, Lovblom LE, Mak S, Steinberg L, Bush SH, Goldman R, Graham C, Kavalieratos D, Stukel T, Tanuseputro P, Quinn KL. Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home-Based Palliative Care. J Am Heart Assoc 2022; 11:e026319. [PMID: 36172958 DOI: 10.1161/jaha.122.026319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We characterized the treatment preferences, care setting, and end-of-life outcomes among patients with advanced heart failure supported by a collaborative home-based model of palliative care. Methods and results This decedent cohort study included 250 patients with advanced heart failure who received collaborative home-based palliative care for a median duration of 1.9 months of follow-up in Ontario, Canada, from April 2013 to July 2019. Patients were categorized into 1 of 4 groups according to their initial treatment preferences. Outcomes included location of death (out of hospital versus in hospital), changes in treatment preferences, and health service use. Among patients who initially prioritized quantity of life, 21 of 43 (48.8%) changed their treatment preferences during follow-up (mean 0.28 changes per month). The majority of these patients changed their preferences to avoid hospitalization and focus on comfort at home (19 of 24 changes, 79%). A total of 207 of 250 (82.8%) patients experienced an out-of-hospital death. Patients who initially prioritized quantity of life had decreased odds of out-of-hospital death (versus in-hospital death; adjusted odds ratio, 0.259 [95% CI, 0.097-0.693]) and more frequent hospitalizations (mean 0.45 hospitalizations per person-month) compared with patients who initially prioritized quality of life at home. Conclusions Our results yield a more detailed understanding of the interaction of advanced care planning and patient preferences. Shared decision making for personalized treatment is dynamic and can be enacted earlier than at the very end of life.
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Affiliation(s)
- Erin Campos
- Department of Medicine University of Toronto Toronto Ontario
| | - Sarina R Isenberg
- Bruyère Research Institute Ottawa Ontario.,Department of Medicine University of Ottawa Ottawa Ontario.,Department of Family and Community Medicine University of Toronto Toronto Ontario
| | | | - Susanna Mak
- Department of Medicine University of Toronto Toronto Ontario.,Department of Medicine Sinai Health System Toronto Ontario.,Division of Cardiology Sinai Health System Toronto Ontario
| | - Leah Steinberg
- Department of Family and Community Medicine University of Toronto Toronto Ontario.,Department of Medicine Sinai Health System Toronto Ontario.,Interdepartmental Division of Palliative Care Sinai Health System Toronto Ontario
| | - Shirley H Bush
- Bruyère Research Institute Ottawa Ontario.,Department of Medicine University of Ottawa Ottawa Ontario.,Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario
| | - Russell Goldman
- Interdepartmental Division of Palliative Care Sinai Health System Toronto Ontario.,Temmy Latner Centre for Palliative Care Toronto Ontario
| | | | - Dio Kavalieratos
- Division of Palliative Medicine Emory University School of Medicine Atlanta Georgia
| | | | - Peter Tanuseputro
- Bruyère Research Institute Ottawa Ontario.,Department of Medicine University of Ottawa Ottawa Ontario.,Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario.,ICES Toronto Ontario.,ICES Ottawa Ontario
| | - Kieran L Quinn
- Department of Medicine University of Toronto Toronto Ontario.,Department of Medicine Sinai Health System Toronto Ontario.,Interdepartmental Division of Palliative Care Sinai Health System Toronto Ontario.,Temmy Latner Centre for Palliative Care Toronto Ontario.,ICES Toronto Ontario.,ICES Ottawa Ontario
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21
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Zhang J, Cao Y, Su M, Cheng J, Yao N. The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study. BMC Palliat Care 2022; 21:163. [PMID: 36138401 PMCID: PMC9494800 DOI: 10.1186/s12904-022-01054-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chinese clinical nurses are increasingly confronting patient death, as the proportion of hospital deaths is growing. Witnessing patient suffering and death is stressful, and failure to cope with this challenge may result in decreased well-being of nurses and impediment of the provision of “good death” care for patients and their families. To our knowledge, few studies have specifically explored clinical nurses’ experiences coping with patient death in mainland China. Objective We aimed to explore nurses’ experiences coping with patient death in China in order to support frontline clinical nurses effectively and guide the government in improving hospice care policy. Methods Clinical nurses were recruited using purposive and snowball sampling between June 2020 and August 2020. We gathered experiences of clinical nurses who have coped with patient death using face-to-face, semi-structured, in-depth interviews. Audio recordings were transcribed verbatim and analyzed using thematic analysis. Results Three thematic categories were generated from data analysis. The first was “negative emotions from contextual challenges.” This category involved grief over deaths of younger persons, pity for deaths without family, and dread related to coping with patient death on night duty. The second category was “awareness of mortality on its own.” Subthemes included the ideas that death means that everything stops being and good living is important because we all die and disappear. The third category was “coping style.” This category included focusing on treating dying patients, recording the signs and symptoms, and responding to changes in the patient’s condition. It also involved subthemes such as avoiding talk about death due to the grief associated with dying and death, and seeking help from colleagues. Conclusions Clinical nurses’ emotional experiences are shaped by intense Chinese filial love, charity, and cultural attitudes towards death. Reasonable nurse scheduling to ensure patient and staff safety is a major priority. “Good death” decisions based on Chinese ethical and moral beliefs must be embedded throughout hospital care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01054-8.
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Affiliation(s)
- Jinxin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.,School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Joyce Cheng
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
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22
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Pivodic L, Wendrich-van Dael A, Gilissen J, De Buyser S, Deliens L, Gastmans C, Vander Stichele R, Van den Block L. Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial. Palliat Med 2022; 36:1059-1071. [PMID: 35769038 DOI: 10.1177/02692163221102000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention. AIMS To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning. DESIGN Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models. SETTING/PARTICIPANTS Nursing homes in Flanders (Belgium). RESULTS 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups. CONCLUSIONS The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.
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Affiliation(s)
- Lara Pivodic
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
| | - Annelien Wendrich-van Dael
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
| | - Joni Gilissen
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Atlantic Fellows for Equity in Brain Health, Global Brain Health Institute, University California San Francisco, San Francisco, CA, USA
| | - Stefanie De Buyser
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | | | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
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23
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Higashitsuji A, Majima T. Factors Associated with Japanese Nurses' Support on End-of-life Decision-making: A Cross-sectional Study. J Community Health Nurs 2022; 39:139-149. [PMID: 35653795 DOI: 10.1080/07370016.2022.2073790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to clarify the factors associated with Japanese nurses' end-of-life decision-making support. DESIGN Cross-sectional study. METHODS An online survey was conducted among 278 nurses. FINDINGS Significantly associated factors included visiting nursing, nursing experience duration, female sex, workshop participation, and time spent on end-of-life care. CONCLUSION Visiting nursing was the most significant factor associated with nurses' end-of-lifedecision-making support. CLINICAL EVIDENCE Consideration should be given to the curriculum in basic nursing education related to visiting nursing. It shouldinclude end-of-life care as well as resources for end-of-life decision-making to increase the number of patients who die in their preferred setting.
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Affiliation(s)
| | - Tomoko Majima
- Graduate School of Nursing, Chiba University, Chiba, Japan
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24
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Tobin J, Rogers A, Winterburn I, Tullie S, Kalyanasundaram A, Kuhn I, Barclay S. Hospice care access inequalities: a systematic review and narrative synthesis. BMJ Support Palliat Care 2022; 12:142-151. [PMID: 33608254 PMCID: PMC9125370 DOI: 10.1136/bmjspcare-2020-002719] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/09/2021] [Accepted: 01/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations. OBJECTIVE To identify from the literature the demographic characteristics of those who access hospice care more often, focusing on: diagnosis, age, gender, marital status, ethnicity, geography and socioeconomic status. DESIGN Systematic literature review and narrative synthesis. METHOD Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to end September 2019 were conducted. Inclusion criteria were peer-reviewed studies of adult patients in the UK, Australia, New Zealand and Canada, receiving inpatient, day, outpatient and community hospice care. Of the 45 937 titles retrieved, 130 met the inclusion criteria. Narrative synthesis of extracted data was conducted. RESULTS An extensive literature search demonstrates persistent inequalities in hospice care provision: patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas are under-represented in hospice populations. The effect of gender and marital status is inconsistent. There is a limited literature concerning hospice service access for the LGBTQ+ community, homeless people and those living with HIV/AIDS, diabetes and cystic fibrosis. CONCLUSION Barriers of prognostic uncertainty, institutional cultures, particular needs of certain groups and lack of public awareness of hospice services remain substantial challenges to the hospice movement in ensuring equitable access for all.
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Affiliation(s)
- Jake Tobin
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alice Rogers
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isaac Winterburn
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sebastian Tullie
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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25
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Gurney JK, Stanley J, Koea J, Adler J, Atkinson J, Sarfati D. Where Are We Dying? Ethnic Differences in Place of Death Among New Zealanders Dying of Cancer. JCO Glob Oncol 2022; 8:e2200024. [PMID: 35623019 PMCID: PMC9225597 DOI: 10.1200/go.22.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Around a third of people with cancer will die outside of their preferred place of death, with substantial variation occurring between and within countries in terms of place of death. Here, we examine place of death within the New Zealand cancer context, with specific focus on differences between Indigenous Māori and other ethnic groups. National study reveals substantial differences in place of cancer death between ethnic groups in NZ.![]()
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Affiliation(s)
- Jason Kevin Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
| | - Jonathan Adler
- Capital and Coast District Health Board, Wellington, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu-Cancer Control Agency, Wellington, New Zealand
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26
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What does it mean to be the main caregiver to a terminally ill family member in Lithuania?: A qualitative study. PLoS One 2022; 17:e0265165. [PMID: 35551302 PMCID: PMC9098011 DOI: 10.1371/journal.pone.0265165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Family caregivers are a great resource for providing dignified end-of-life care for terminally ill patients. Framed from the perspective of role theory and the relational nature of providing and receiving care, study objectives were as follows: (1) to capture caregivers’ understanding of the process of taking on the role of main caregiver, (2) to conceptualize their understanding of the functions that they assume while being the main caregivers, and (3) to understand how they experienced the consequences they confronted.
Methods
The research team employed the methodological strategy of descriptive thematic analysis using a semi-structured interview guide. The sample consisting of 33 family caregivers was recruited using purposeful and snowball sampling strategies in 2020. Interview data was analyzed using content-driven inductive thematic analysis.
Results
The data analysis revealed four main themes that structure the process of becoming the main care giver of a terminally ill family member and the meaning of the caregiver role: (1) inaccessibility and mistrust of public care services for persons with terminal illness, (2) moral obligations and responsibilities of immediate family and friends, (3) cultural traditions, (4) the caregiver feels responsible for everything. The themes describe the social role of family caregiver in social context, address the process of taking on the role of caregiver and living with systemic corruption.
Conclusions
Recognition of caregiving experiences is essential in planning better systems, in direct practice and in confronting corruption. The study suggests the need for open communication, accessibility of quality services, and the recognition of caregivers as care-team members. The larger implication is that the increasing numbers of distressed caregivers and aging populations can be considered as public health populations, and thus addressable through public health methods.
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Hentschel L, Wellesen A, Krause LC, von Havranek M, Kramer M, Hornemann B, Bornhäuser M, Schuler U, Schütte K. Predicting unplanned hospital readmission in palliative outpatients (PRePP) – study protocol of a longitudinal, prospective study to identify informal caregiver-related and structural predictors. BMC Palliat Care 2022; 21:62. [PMID: 35501763 PMCID: PMC9059677 DOI: 10.1186/s12904-022-00955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although the majority of German patients in a palliative state prefer to die at home, the actual place of death is most often a hospital. Unplanned hospital readmissions (UHA) not only contradict most patients’ preferences but also increase the probability of an aggressive end-of-life treatment. As limited knowledge is available which factors contribute to an UHA, the PRePP-project aims to explore predictors related to informal caregivers (IC) as well as medical and structural factors. Methods This prospective, observational, mono-centric study will assess structural and medical factors as well as ICs’ psychological burden throughout seven study visits. Starting in April 2021 it will consecutively include 240 patients and their respective IC if available. Standardized measures concerning ICs’ Quality of Life (WHOQOL-BREF), psychological distress (NCCN-Distress Thermometer), anxiety (GAD-7) and depressiveness (PHQ-9) will be assessed. If participants prefer, assessment via phone, browser-based or paper-based will be conducted. Medical records will provide routinely assessed information concerning patient-related characteristics such as gender, age, duration of hospital stay and medical condition. Nurse-reported data will give information on whether hospitalization and death occurred unexpectedly. Data will be progressed pseudonymized. Multivariable regression models will help to identify predictors of the primary endpoint “unplanned hospital admissions”. Discussion The PRePP-project is an important prerequisite for a clinical risk assessment of UHAs. Nevertheless, it faces several methodological challenges: as it is a single center study, representativity of results is limited while social desirability might be increased as the study is partly conducted by the treatment team. Furthermore, we anticipated an underrepresentation of highly burdened participants as they might refrain from participation. Trial registration This study was retrospectively registered 19 October 2021 at clinicaltrials.gov (NCT05082389). https://clinicaltrials.gov/ct2/show/NCT05082389
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Seitz K, Cohen J, Deliens L, Cartin A, Castañeda de la Lanza C, Cardozo EA, Marcucci FCI, Viana L, Rodrigues LF, Colorado M, Samayoa VR, Tripodoro VA, Pozo X, Pastrana T. Place of death and associated factors in 12 Latin American countries: A total population study using death certificate data. J Glob Health 2022; 12:04031. [PMID: 35486804 PMCID: PMC9078151 DOI: 10.7189/jogh.12.04031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Katja Seitz
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | | | - Celina Castañeda de la Lanza
- Coordination for Advance Directives and Palliative Care Program, Institute of Health of the State of Mexico, Ministry of Health of Mexico, Toluca, Mexico
| | - Emanuel A Cardozo
- Dirección de Estadísticas en Información de Salud, National Ministry of Health, Buenos Aires, Argentina
| | - Fernando CI Marcucci
- Hospital Dr. Anísio Figueiredo, State Health Secretariat of Paraná, Londrina, Brazil
| | - Leticia Viana
- Department of Palliative Care and Pain, National Cancer Institute, Capiata, Paraguay
| | - Luís F Rodrigues
- Palliative Care Unit, Barreto’s Cancer Hospital, Barretos, Brazil
| | | | - Victor R Samayoa
- Palliative Care Unit, Institute of Cancerology, Guatemala City, Guatemala
| | - Vilma A Tripodoro
- Department of Palliative Care, Institute of Medical Research A. Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Ximena Pozo
- Palliative Care Unit, Hospital Comprehensive Care for the Elderly, Ministry of Public Health, Quito, Ecuador
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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29
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Fortuna D, Caselli L, Banchelli F, Moro ML, Costantini M. How Many Cancer Patients Need Palliative Care? A Population-Based Study. J Pain Symptom Manage 2022; 63:468-475. [PMID: 34995682 DOI: 10.1016/j.jpainsymman.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of cancer patients potentially amenable to palliative care is conventionally estimated from cancer deaths, as reported in the death certificates. However, a more representative population should also include cancer patients who die from causes other than cancer, as they may develop other life-limiting chronic conditions leading to terminal prognosis. AIM This study aimed at refining the assessment of the number of cancer patients potentially in need of palliative care, by linked hospital and death data. DESIGN Retrospective study. SETTING/PARTICIPANTS Residents in the Emilia Romagna Region in Italy, who died between 2009 and 2017. RESULTS We identified a potential palliative care population of 157,547 cancer patients. The use of different administrative data sources enhanced the sensitivity of our selection. Starting from a standard estimate of 129,212 patients based on cancer as the primary cause of death, we showed that the additional use of hospital records identified a further 11.4% of possible palliative care patients 14,687. Also considering cancer as secondary cause of death, the estimate further increased by 10.6% (13,648 new cases). Notably, the proportion of cancer patients selected by the additional data sources were characterized by more advanced age and higher prevalence of comorbidity. CONCLUSION Healthcare services addressing the issue of estimating palliative care needs of cancer patients at a population level should consider that relying on the death certificate alone may lead to underestimating these needs of about 22%.
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Affiliation(s)
- Daniela Fortuna
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Luana Caselli
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Federico Banchelli
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Massimo Costantini
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
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30
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Kim SH. Illnesses and Symptoms in Older Adults at the End of Life at Different Places of Death in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073924. [PMID: 35409606 PMCID: PMC8998111 DOI: 10.3390/ijerph19073924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022]
Abstract
Context: A comprehensive plan has been launched by the Korean government to expand hospice and palliative care from hospital-based inpatient units to other services, such as palliative care at home, palliative consultation, and palliative care at a nursing home. Objective: To examine the illnesses and symptoms at the end of life associated with the place of death among older Korean adults. Methods: This secondary data analysis included a stratified random sample of 281 adults identified from the exit survey of the Korean Longitudinal Study of Aging aged ≥65 years and who died in 2017–2018. Results: Overall, 69% of the patients died at hospitals, 13% died at long-term care facilities (LTCF), and 18% died at home. In the multinomial logistic regression analysis adjusting for age, sex, and marital status, older adults who died in the hospital had higher odds (2.02–4.43 times) of having limitations in activities of daily living (ADL) as well as symptoms of anorexia, depression, weakness, dyspnea, and periodic confusion 1 month before death than those who died at home. Older adults who died in an LTCF were more likely to have limitations in ADL and instrumental ADL as well as a higher likelihood (2–5 times) of experiencing pain, anorexia, fatigue, depression, weakness, dyspnea, incontinence, periodic confusion, and loss of consciousness than those who died at home. Conclusion: Since the majority of subjects died either in a hospital or an LCTF, and this proportion is expected to increase, policy planning should focus on improving the palliative case in these settings. Future policies and clinical practices should consider the illness and symptoms of older patients at the end of life across different care settings.
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Affiliation(s)
- Su Hyun Kim
- Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea
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Huang X, Zhao X, Ou X, Qin Y, Wan Q. Title of the article: Adaptation and Validation of the Chinese Version of Palliative Care Difficulties Scale. Asia Pac J Oncol Nurs 2022; 9:100051. [PMID: 35647222 PMCID: PMC9130522 DOI: 10.1016/j.apjon.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The Palliative Care Difficulties Scale (PCDS) is the most popular tool in developed countries for the assessment of difficulties perceived by clinical professionals in palliative care practice. This study aimed to culturally adapt the PCDS into a Chinese version and validate the psychometric properties of the adapted Chinese version of the PCDS. Methods The study was carried out in two major phases: (1) translation and cultural adaption of the PCDS into a Chinese version according to the corresponding guidelines, and (2) evaluation of the psychometric properties of the adapted Chinese version of the PCDS by consulting experts and performing a cross-sectional survey among 284 nurses and physicians. Floor and ceiling effects were estimated by the percentage of participants obtaining the lowest or highest possible scores. Internal consistency reliability was assessed using the Cronbach's α coefficient. Test–retest reliability was evaluated by the intra-class correlation coefficient (ICC). Content validity was evaluated by the content validity index (CVI). Construct validity was calculated by applying the confirmatory factor analysis (CFA). Results The PCDS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level Cronbach's α coefficient was 0.94 with each dimension ranging from 0.84 to 0.92. The scale-level ICC was 0.66 with each dimension ranging from 0.41 to 0.65. Both the item-level and scale-level CVIs were equal to 1. The CFA verified the five-factor structure of the original PCDS with factor loadings for each item ranging from 0.62 to 0.96. Conclusions The Chinese version of the PCDS showed satisfactory psychometric properties. It is a valid and reliable tool for the assessment of difficulties perceived by clinical staff in palliative care practice.
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Affiliation(s)
- Xiuxiu Huang
- School of Nursing, Peking University, Beijing, China
| | - Xiaoyan Zhao
- School of Nursing, Peking University, Beijing, China
| | - Xiaohong Ou
- Palliative Care Unit, Beijing Haidian Hospital, Beijing, China
| | - Yuan Qin
- Palliative Care Unit, Beijing Haidian Hospital, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
- Corresponding author.
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Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, Doble B, Dullie L, Durie R, Finkelstein EA, Guglani S, Hodson M, Husebø BS, Kellehear A, Kitzinger C, Knaul FM, Murray SA, Neuberger J, O'Mahony S, Rajagopal MR, Russell S, Sase E, Sleeman KE, Solomon S, Taylor R, Tutu van Furth M, Wyatt K. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet 2022; 399:837-884. [PMID: 35114146 PMCID: PMC8803389 DOI: 10.1016/s0140-6736(21)02314-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Afsan Bhadelia
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Yali Cong
- Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | - Julia Neuberger
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Sarah Russell
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eriko Sase
- Georgetown University, Washington, DC, USA
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Weng L, Hu Y, Sun Z, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Pang Y, Lu Y, Chen J, Chen Z, Du B, Lv J, Li L. Place of death and phenomenon of going home to die in Chinese adults: A prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100301. [PMID: 35024647 PMCID: PMC8671632 DOI: 10.1016/j.lanwpc.2021.100301] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND China is embracing an ageing population without sustainable end-of-life care services. However, changes in place of death and trends of going home to die (GHTD) from the hospital remains unknown. METHODS A total of 42,956 participants from the China Kadoorie Biobank, a large Chinese cohort, who died between 2009 and 2017 was included into analysis. GHTD was defined as death at home within 7 days after discharge from the hospital. A modified Poisson regression was used to investigate temporal trends of the place of death and GHTD, and estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association of GHTD with health insurance (HI) schemes. FINDINGS From 2009 to 2017, home remained the most common place of death (71·5%), followed by the hospital (21·6%). The proportion of GHTD for Urban and Rural Residents' Basic Medical Insurance (URRBMI) beneficiaries was around six times higher than that for Urban Employee Basic Medical Insurance (UEBMI) beneficiaries (66·0% vs 11·6%). Besides, a substantial increase in the proportion of GHTD throughout the study period was observed regardless of HI schemes (4·4% annually for URRBMI, and 5·4% for UEBMI). Compared with UEBMI beneficiaries, URRBMI beneficiaries were more likely to experience GHTD, with an adjusted PR (95% CI) of 1·19 (95% CI: 1·12, 1·27) (P<0·001). INTERPRETATION In China, most of deaths occurred at home, with a large proportion of decedents GHTD from the hospital, especially for URRBMI beneficiaries. Substantial variation in the phenomenon of GHTD across HI schemes indicates inequalities in end-of-life care utilization. FUNDING The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology.
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Affiliation(s)
- Li Weng
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yizhen Hu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Zhijia Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Yu Guo
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Yuanjie Pang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yan Lu
- Suzhou Center for Disease Control and Prevention, Jiangsu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Bin Du
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Quintiens B, Smets T, Chambaere K, Van Den Block L, Deliens L, Cohen J. Researching two Compassionate Cities: study protocol for a mixed-methods process and outcome evaluation. Palliat Care Soc Pract 2022; 16:26323524221137601. [DOI: 10.1177/26323524221137601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background/Objectives: Compassionate Cities are social ecology approaches that apply a set of actions, targeting a broad range of stakeholders, with the intention of renormalising caring, dying, loss and grieving in everyday life. While several initiatives have been described in the literature, a rigorous evaluation of their processes and outcomes is lacking. This article describes the protocol for a mixed-methods study to evaluate the development process and the outcomes of two Compassionate Cities in Flanders, Belgium. Methods and Analysis: We will use a convergent multiphase mixed-methods design, in which a combination of qualitative and quantitative data collection methods will be triangulated in the data analysis stage to capture both development processes and outcomes. Our design includes a quasi-experimental component of a quantitative outcome evaluation in both Compassionate Cities and two comparable control cities with no formal Compassionate City programme. Both Compassionate Cities will be co-created in collaboration with local stakeholders. A critical realism lens will be applied to understand how and why certain processes manifest themselves. Discussion: The creation of Compassionate Cities implies high levels of complexity, adaptivity, unpredictability and uncertainty. This requires various data collection methods that can be applied flexibly. A researcher taking on the role of active participant in the project’s development has several advantages, such as access to scholarly information. Reflexivity in this role is paramount to questioning where the ownership of the project lies. By applying a critical realism lens, we remain cautious about our interpretations, and we test the homogeneity of our findings through other forms of data collection. Conclusion: This is the first published study protocol to describe both a process and outcome evaluation of a Compassionate City project. By transparently describing our aims and data collection methods, we try to maximise information exchange among researchers and to inform others who desire to implement and evaluate their own initiatives.
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Affiliation(s)
- Bert Quintiens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Compassionate Communities Center of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Center of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Center of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Center of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Center of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Blankart CR, van Gool K, Papanicolas I, Bernal‐Delgado E, Bowden N, Estupiñán‐Romero F, Gauld R, Knight H, Abiona O, Riley K, Schoenfeld AJ, Shatrov K, Wodchis WP, Figueroa JF. International comparison of spending and utilization at the end of life for hip fracture patients. Health Serv Res 2021; 56 Suppl 3:1370-1382. [PMID: 34490633 PMCID: PMC8579204 DOI: 10.1111/1475-6773.13734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. DATA SOURCES Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). STUDY DESIGN We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. DATA COLLECTION/EXTRACTION METHODS We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. PRINCIPAL FINDINGS Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. CONCLUSIONS Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
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Affiliation(s)
- Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Irene Papanicolas
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Health PolicyLondon School of EconomicsLondonUK
| | | | - Nicholas Bowden
- Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | | | - Robin Gauld
- Otago Business School and Centre for Health Systems and TechnologyUniversity of OtagoDunedinNew Zealand
| | | | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Andrew J. Schoenfeld
- Division of Orthopedic SurgeryBrigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
| | - Walter P. Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Gustafsson A, Skogsberg J, Rejnö Å. Oral health plays second fiddle in palliative care: an interview study with registered nurses in home healthcare. BMC Palliat Care 2021; 20:173. [PMID: 34753462 PMCID: PMC8579523 DOI: 10.1186/s12904-021-00859-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Oral health is crucial to the experience of well-being, and symptoms from the mouth are common at the end of life. Palliative care aims to identify and treat symptoms early to avoid unnecessary suffering and is thus an important part of nursing in home healthcare. The aim of this study was to illustrate the professional reflections of registered nurses about oral health amongst patients in palliative care, who are being cared for in a home healthcare setting. Results The results showed oral health in end-of-life care, to be an area marked by responsibility and ethical considerations. This was seen in all four partly overlapping themes that emerged through the analysis: Oral health is easily overlooked in palliative care, Oral health is everybody’s but in reality nobody’s responsibility, Patient integrity can be an obstacle for oral health, and Focus on oral health is urgently needed. The mouth is often not included as part of the daily basic care routine, by the registered nurses and the home healthcare staff, until the patient is near end of life. Moreover, neither does the patient tell about symptoms from the mouth. The interpreted whole indicates that the registered nurses had a bad conscience about not doing what they are actually responsible for and ought to do. Conclusion The oral health of patients at the end of life risks being forgotten or falling between the cracks, due to the nurses’ scattered tasks and unclear delimitations between their, and other professionals’ responsibilities. The responsibilities of registered nurses are also ethically demanding, since their intent to respect the patient’s integrity could mean that in some cases the patients does not allow them to help with oral health. To reduce the risk that oral health is overlooked, clearer demarcation and guidelines on the division of responsibilities are required. Routines that clearly implement early and recurring oral health assessments in home healthcare as well as continuing education updates on oral health and oral care are also needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00859-3.
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Affiliation(s)
| | - Johanna Skogsberg
- MedPro Clinic Stavre Primary Health Care Centre, Trollhättan, Sweden
| | - Åsa Rejnö
- Department of Health Sciences, University West, Trollhättan, Sweden. .,Skaraborg institute of Research and Development, Skövde, Sweden. .,Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden.
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Pautex S, Schneider M, Charmillot PA, Bassal C, Morgan de Paula E, Herrmann F, Gamondi C, Fusi-Schmidhauser T. Providing Medical Care at the End of Life - A Cross-Sectional Study of Long-Term Care Facilities in Switzerland. PRAXIS 2021; 110:831-838. [PMID: 34814719 DOI: 10.1024/1661-8157/a003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The provision of high-quality palliative care in nursing homes (NHs) requires specific knowledge and skills among health professionals. The aims of the study were to assess quality of care during the dying process and quality of end-of-life of NH residents in the French and Italian parts of Switzerland. 90 residents died during the study period (mean age 88.7 years). Mean of the "End-of-Life in Dementia Scales - Comfort Assessment while Dying" score was 35.7 (theoretical range 14-42). Mean of the "Quality of Dying in LongTerm Care" score was 38.3 (theoretical range 11-55). In conclusion, the quality of dying and quality of end-of-life care in NH studied can be improved improved, in particular on the anticipation level. Die Bereitstellung einer qualitativ hochwertigen Palliativversorgung in Pflegeheimen erfordert spezifische Fähigkeiten. Ziel der Studie war es, die Qualität der Sterbebegleitung von Bewohnern, die in der französisch- und italienischsprachigen Schweiz in Pflegeheimen sterben, zu bewerten. 90 Bewohner starben während der Studiendauer (Durchschnittsalter 88,7 Jahre). Der mittlere Wert der «End-of-Life in Dementia Scales - Comfort Assessment while Dying» lag bei 35,7 (theoretischer Bereich 14-42). Der Mittelwert der Skala «the Quality of Dying in LongTerm Care» lag bei 38,3 (theoretischer Bereich 11-55). Zusammenfassend lässt sich sagen, dass die Qualität der Versorgung am Lebensende in den untersuchten Pflegeheimen verbessert werden kann, insbesondere im Hinblick auf die Antizipation.
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Affiliation(s)
- Sophie Pautex
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals; University of Geneva, Geneva
| | - Martin Schneider
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals; University of Geneva, Geneva
| | | | - Catherine Bassal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Geneva
| | | | - François Herrmann
- Geriatric division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals; University of Geneva, Geneva
| | - Claudia Gamondi
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona
| | - Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona
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Wilson DM, Anafi F, Roh SJ, Errasti-Ibarrondo B. A Scoping Research Literature Review to Identify Contemporary Evidence on the Incidence, Causes, and Impacts of End-of-Life Intra-Family Conflict. HEALTH COMMUNICATION 2021; 36:1616-1622. [PMID: 32519565 DOI: 10.1080/10410236.2020.1775448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
When someone is terminally ill, it is often a very stressful time for the dying person and their family. It would not be unusual for intra-family conflict, involving one or more family members and even the dying person, to occur. However, this type of conflict has not been identified as an end-of-life issue needing to be noticed and addressed or prevented when possible. This lack of attention could be because it is not known how common or how impactful this type of conflict is. A scoping research literature review was conducted for available 2004-2019 evidence on the incidence or prevalence of intra-family conflict, factors contributing to it or causing it, and the outcomes or impact of it. A search for published peer-review articles identified 18 research reports for a scoping review. The 18 studies, all conducted in developed countries, revealed intra-family conflict is often present; and with a range of harmful effects for the dying person, the family as a whole or individual family members, and other persons and organizations. The identified factors contributing to or predisposing intra-family conflict were grouped into three categories: (a) family disagreements over curative treatment and/or end-of-life care and decisions, (b) previous family conflict and other family dynamic matters, and (c) the dying process itself. The evidence identified through this scoping review, although relatively minimal, should be useful for planning future research and for raising awareness of end-of-life intra-family conflict to improve social services and palliative programs or services.
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Agar MR. In-Home Care at the End of Life-How Much Is Needed? JAMA Netw Open 2021; 4:e2133019. [PMID: 34748011 DOI: 10.1001/jamanetworkopen.2021.33019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute of Applied Medical Research, Sydney, Australia
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Virdun C, Luckett T, Davidson PM, Lorenz K, Phillips J. Generating key practice points that enable optimal palliative care in acute hospitals: Results from the OPAL project's mid-point meta-inference. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Binda F, Clari M, Nicolò G, Gambazza S, Sappa B, Bosco P, Laquintana D. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care. BMC Palliat Care 2021; 20:153. [PMID: 34641824 PMCID: PMC8507336 DOI: 10.1186/s12904-021-00862-8] [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: 03/19/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P < 0.001). The palliative care consultant was requested for only two patients. Conclusion Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life.
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Affiliation(s)
- Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Marco Clari
- Department of Public Health and Paediatrics - University of Torino, Via Santena, 5, 10126, Torino, Italy
| | - Gabriella Nicolò
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Simone Gambazza
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Barbara Sappa
- Department of Healthcare Professions (General Internal Medicine Unit), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Paola Bosco
- Department of Healthcare Professions (High-dependency Unit), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
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Ernecoff NC, Wessell KL, Bennett AV, Hanson LC. Measuring Goal-Concordant Care in Palliative Care Research. J Pain Symptom Manage 2021; 62:e305-e314. [PMID: 33675919 PMCID: PMC9082654 DOI: 10.1016/j.jpainsymman.2021.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
>Goal-concordant care is a priority outcome for palliative care research, yet the field lacks consensus on optimal methods for measurement. We sought to 1) categorize methods used to measure goal-concordant care, and 2) discuss strengths and limitations of each method using empirical examples from palliative care research. We categorized measurement methods for goal-concordant care. We identified empirical examples of each method to illustrate the strengths, limitations, and applicability of each method to relevant study designs. We defined four methods used to measure goal-concordant care: 1) Patient- or Caregiver-Reported, 2) Caregiver-Reported After Death, 3) Concordance in Longitudinal Data, and 4) Population-Level Indicators. Patient or caregiver-reported goal-concordant care draws on strengths of patient-reported outcomes, and can be captured for multiple aspects of treatment; these methods are subject to recall bias or family-proxy bias. Concordance in longitudinal data is optimal when a treatment preference can be specifically and temporally linked to actual treatment; the method is limited to common life-sustaining treatment choices and validity may be affected by temporal variation between preference and treatment. Population-level indicators allow pragmatic research to include large populations; its primary limitation is the assumption that preferences held by a majority of persons should correspond to patterns of actual treatment in similar populations. Methods used to measure goal-concordant care have distinct strengths and limitations, and methods should be selected based on research question and study design. Existing methods could be improved, yet a future gold standard is unlikely to suit all research designs.
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Affiliation(s)
- Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kathryn L Wessell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA
| | - Antonia V Bennett
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Laura C Hanson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, USA; Division of Geriatric Medicine and Palliative Care Program, University of North Carolina at Chapel Hill, NC, USA
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Norinder M, Årestedt K, Lind S, Axelsson L, Grande G, Ewing G, Holm M, Öhlén J, Benkel I, Alvariza A. Higher levels of unmet support needs in spouses are associated with poorer quality of life - a descriptive cross-sectional study in the context of palliative home care. BMC Palliat Care 2021; 20:132. [PMID: 34454454 PMCID: PMC8403446 DOI: 10.1186/s12904-021-00829-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Family caregivers often report having unmet support needs when caring for someone with life-threatening illness. They are at risk for psychological distress, adverse physical symptoms and negatively affected quality of life. This study aims to explore associations between family caregivers’ support needs and quality of life when caring for a spouse receiving specialized palliative home care. Methods A descriptive cross-sectional design was used: 114 family caregivers completed the Carer Support Needs Assessment Tool (CSNAT) and the Quality of Life in Life-Threatening Illness – Family caregiver version (QOLLTI-F) and 43 of them also answered one open-ended question on thoughts about their situation. Descriptive statistics, multiple linear regression analyses, and qualitative content analysis, were used for analyses. Results Higher levels of unmet support needs were significantly associated with poorer quality of life. All CSNAT support domains were significantly associated with one or more quality of life domains in QOLLTI-F, with the exception of the QoL domain related to distress about the patient condition. However, family caregivers described in the open-ended question that their life was disrupted by the patient’s life-threatening illness and its consequences. Family caregivers reported most the need of more support concerning knowing what to expect in the future, which they also described as worries and concerns about what the illness would mean for them and the patient further on. Lowest QoL was reported in relation to the patient’s condition, and the family caregiver’s own physical and emotional health. Conclusion With a deeper understanding of the complexities of supporting family caregivers in palliative care, healthcare professionals might help to increase family caregivers’ QoL by revealing their problems and concerns. Thus, tailored support is needed.
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Affiliation(s)
- Maria Norinder
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, 121 87, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden. .,The Research Section, Region Kalmar County, Kalmar, Sweden.
| | - Susanne Lind
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden
| | - Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Gunn Grande
- Division of Nursing, Midwifery & Social Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Maja Holm
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and the Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,The Palliative Care Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Benkel
- The Palliative Care Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Geriatric Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, 121 87, Stockholm, Sweden
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Chung JH, Kim SH, Suh SY, Cheng SY, Mori M, Yamaguchi T, Chen PJ, Morita T, Tsuneto S. Differences between dedicated and not dedicated hospice physicians in symptoms and signs improvement among advanced cancer patients. Medicine (Baltimore) 2021; 100:e26915. [PMID: 34397931 PMCID: PMC8360492 DOI: 10.1097/md.0000000000026915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
The hospice and palliative care can improve the symptoms and signs of terminal cancer patients. The purposes of this study are how to improve terminally ill cancer patients' symptoms and signs and how the dedicated palliative care service effects on these improvements.From January 2017 to March 2019, among 919 terminally ill cancer patients admitted to the palliative care units in 11 hospitals of South Korea, we analyzed 334 patients with prospective cohort method and categorized them into non-dedicated hospice care group of 234 and dedicated hospice care group of 100.Symptoms improvement of dyspnea, fatigue, drowsiness, and dry mouth during the first week of admission were respectively 298 (89.2%), 25 (7.5%), 204 (61.1%), 76 (22.8%). Signs improvement of myoclonus, respiratory secretion, leg edema, and ascites between admission and a week after were 5 (1.5%), 41 (12.3%), 47 (14.1%), 12 (3.6%). Significant differences between dedicated hospice care physician group and non-dedicated hospice care physician group were shown in drowsiness (67.5% vs 46%, P < .001) and respiratory secretion (15% vs 6%, P < .028). Compared to non-dedicated care group, the odds ratio for more than 2 symptoms or signs was 1.78 (95% confidence interval, 1.05-3.02) in the dedicated care group after adjusting confounding variables.In conclusion, terminally ill cancer patients who received palliative or hospice service showed significant improvement in symptoms and signs. And, family doctors (dedicated hospice physician group) performed better than oncologists (non-dedicated physician group).
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Affiliation(s)
- Jae Ho Chung
- Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Sun Hyun Kim
- Department of Family Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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O'Sullivan A, Alvariza A, Öhlén J, Larsdotter C. Support received by family members before, at and after an ill person's death. BMC Palliat Care 2021; 20:92. [PMID: 34167530 PMCID: PMC8228910 DOI: 10.1186/s12904-021-00800-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background It is widely recognised, that family members are central to care of people with advanced illness, and that support should be provided to all family members in need thereof. The aim of this study was to investigate family members’ experiences of support received during the last three months of life, at the time of death and after the death of a person with advanced illness. Methods A retrospective cross-sectional survey design was employed, using the VOICES(SF) questionnaire and multiple methods for data analyses. The sample consisted of 485 bereaved family members (aged: 20–90 years old, 70% women) of people who died in hospital between August 2016-April 2017. Results Of the family members, 58,8% reported they had received enough help and support during the illness, whereas 30,2% had not. Family members’ comments about support during the illness were mainly related to care the ill person had or had not received, rather than about support they themselves received. Of all family members, 52,8% reported having had enough support at the time of the ill person’s death. Related to support at death, 14,6% reported that the imminence of death was not clear, which was described as having affected their opportunity to be with the dying person at the time of death. Of all, 25,2% had a follow-up conversation after the death, 48% did not and did not want to, and 21% had no follow-up conversation, but would have liked one. A follow-up conversation was described as helpful for the bereavement process, and disappointment was expressed when not receiving support after the death. Conclusions Family members’ experiences of support were partly related to whether the ill person’s care needs were fulfilled. Healthcare staff expressing empathy and respect in the care of dying people and their family members were important for family members’ experiences of support. Family members’ difficulty recognising that death was imminent and the importance of healthcare staff providing them with clear information were expressed in connection with support at death. Follow-up conversations were valued by family members, especially if with a healthcare professional who was present at the time of death.
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Affiliation(s)
- Anna O'Sullivan
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Joakim Öhlén
- Centre for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy At the University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
| | - Cecilia Larsdotter
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden. .,Department of Nursing Science, Sophiahemmet University, P.O. Box 5605, 114 86, Stockholm, Sweden.
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47
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Lau C, Meaney C, Morgan M, Cook R, Zimmermann C, Wentlandt K. Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review. Palliat Med 2021; 35:1191-1201. [PMID: 33855886 PMCID: PMC8189004 DOI: 10.1177/02692163211007387] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. AIM To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. DESIGN A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. SETTING/PARTICIPANTS Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. RESULTS A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015-2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%-20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%-40% were associated with decreased rates and/or likelihood of admission. CONCLUSION Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are "sicker" with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.
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Affiliation(s)
- Christine Lau
- Division of Palliative Care, Sunnybrook Health Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Morgan
- Division of General Internal Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Ontario Health - Toronto Region, Toronto, ON, Canada
| | - Rose Cook
- Ontario Health - Toronto Region, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Ontario Health - Toronto Region, Toronto, ON, Canada.,Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Tjernberg J, Bökberg C. Older persons' thoughts about death and dying and their experiences of care in end-of-life: a qualitative study. BMC Nurs 2020; 19:123. [PMID: 33327960 PMCID: PMC7739469 DOI: 10.1186/s12912-020-00514-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023] Open
Abstract
Background Few studies have focused on how older persons living in nursing homes perceive their last period of life. Furthermore, previous research on older persons’ perceptions of death and dying is limited. Hence, there is an urgent need to explore their experiences during their final period in life. Aim To explore thoughts about death and dying and experiences of care in end-of-life among older persons living in nursing homes. Methods This study employed a qualitative approach including individual interviews with 36 older persons living in Swedish nursing homes. Questions related to quality of life; physical health; thoughts about death, dying, and the future; and experiences related to the living condition and environment were asked. The interview transcripts were analysed through content analysis. The study was approved by the Regional Ethics Review Board (reference number: 2015/4). Results The analysis resulted in the identification of three main thematic categories: The unavoidable and unknown end of life, Thoughts on control and Living your last period of life at a nursing home. The older persons did not fear death itself but had some worries about dying. Spending the last stage of life at a nursing home contributed to different thoughts and feelings among the older persons. With a few exceptions, older persons characterized life at the nursing home as boring and felt they were surrounded by people who did not belong there. Conclusions This study indicates a need for older persons to talk about death, dying and end-life issues. Furthermore, this study highlighted that the co-residence of cognitively healthy persons and persons with dementia in the same ward adversely affected cognitively healthy persons. This situation resulted in there being not enough time to both handle the care needs of persons with dementia and have the conversations that cognitively healthy persons desired, such as conversations about thoughts about existence, that could have improved their quality of life. Trial registration NCT02708498 Date of registration 16 February 2016.
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Affiliation(s)
- Johanna Tjernberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
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Nolasco A, Fernández-Alcántara M, Pereyra-Zamora P, Cabañero-Martínez MJ, Copete JM, Oliva-Arocas A, Cabrero-García J. Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities. Int J Equity Health 2020; 19:214. [PMID: 33272290 PMCID: PMC7713024 DOI: 10.1186/s12939-020-01324-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010-2015, and to assess if such inequalities are related to palliative or non-palliative conditions. METHODS This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables. RESULTS We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected. CONCLUSIONS The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.
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Affiliation(s)
- Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain.
| | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, Alicante, Spain.,Institute for Health and Biomedical Research of Alicante (ISABIAL- FISABIO Foundation), Alicante, Spain
| | - José M Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
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Honinx E, Smets T, Piers R, Pasman HRW, Payne SA, Szczerbińska K, Gambassi G, Kylänen M, Pautex S, Deliens L, Van den Block L. Lack of Effect of a Multicomponent Palliative Care Program for Nursing Home Residents on Hospital Use in the Last Month of Life and on Place of Death: A Secondary Analysis of a Multicountry Cluster Randomized Control Trial. J Am Med Dir Assoc 2020; 21:1973-1978.e2. [DOI: 10.1016/j.jamda.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 10/23/2022]
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