Facilitating family needs and support at the end of life in hospital: A descriptive study

A Mixed Methods Analysis of Standardized Documentation of Serious Illness Conversations Within an Electronic Health Record Module During Hospitalization

BACKGROUND

Analysis of documented Serious Illness Conversations (SICs) in the inpatient setting can help clinicians align management to address patient and caregiver needs.

METHODS

We conducted a mixed methods analysis of the first instance of standardized documentation of a SIC within a structured module among hospitalized general medicine patients from 2018 to 2019. Percentage of documentations that included a description of patient or family understanding of the patient's medical condition and use of radio buttons to answer the "prognostic information shared," "hopes," and "worries" modules are reported. Using grounded theory approach, physicians analyzed free text entries to: "What is important to the patient/family?" and "Recommendations or next steps planned."

RESULTS

Out of 5142 patients, 59 patients had a documented SIC. Patient or family understanding of the medical condition(s) was reported in 56 (95%). For "prognostic information shared," the most frequently selected radio buttons were: 49 (83%) incurable disease and 28 (48%) prognosis of weeks to months while those for "hopes" were: 52 (88%) be comfortable and 27 (46%) be at home and for "worries" were: 49 (83%) other physical suffering and 36 (61%) pain. Themes generated from entries to "What's important to patient/family?" included being with loved ones; comfort; mentally and physically present; and reliable care while those for "Recommendations" were coordinating support services; symptom management; and support and communication.

CONCLUSIONS

SIC content indicated concern about pain and reliable care suggesting the complex, intensive nature of caring for seriously ill patients and the need to consider SICs earlier in the life course of patients.

What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China

OBJECTIVES

This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China.

METHODS

A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants.

RESULTS

A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI.

SIGNIFICANCE OF RESULTS

This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.

Family's experience of memory making in adult intensive care and its use in early bereavement: A descriptive qualitative study

AIM AND OBJECTIVES

To explore the family's experience being offered memory making during end-of-life care in the adult intensive care unit and its use in early bereavement.

BACKGROUND

Family members of individuals who develop a critical illness requiring emergency hospitalisation are unlikely to be prepared for a possible death. This places them at increased risk of poorer bereavement experiences. One potential intervention is memory making, which is an act that provides tangible objects such as a handprint, footprint, lock of hair, or teddy bear, that allows connections with and provides meaningful memories about a person. Families in the adult acute population reportedly have positive reactions regarding the objects, but it is unknown the object's effects on early bereavement experiences.

DESIGN

Descriptive qualitative study utilising inductive reflexive thematic analysis. Reporting adheres to the COREQ checklist.

METHODS

Between May 2019-December 2020, a purposeful, convenience sample of 21 participants from a tertiary referral, adult intensive care unit in Australia were recruited to explore their experiences being offered memory making during end-of-life care and the objects use in early bereavement. Interviews were conducted using a semi-structured format and occurred at the participants' location of choice.

RESULTS

Data analysis generated three themes: guidance during end of life by healthcare professionals that recognises the autonomy of the family; object used as a trigger to access memories; and storage and preservation of the object as an indication of its sentimental value and use in early bereavement CONCLUSION: Memory making objects such as handprints, locks of hair, or teddy bears received in the adult intensive care unit were valued and utilised during early bereavement by most recipients.

RELEVANCE TO CLINICAL PRACTICE

Findings inform practice evidence gaps regarding the family's experiences of memory making received as a bereavement intervention in the adult acute population.

PATIENT OR PUBLIC CONTRIBUTION

Participants contributed through sharing their first-hand experiences of receiving memory making in the adult intensive care unit.

Spirituality in Australian Health Professional Practice: A Scoping Review and Qualitative Synthesis of Findings

This study explores how spirituality is integrated into practice across the different Australian health professions. Utilising the Joanna Briggs Institute's (JBI) protocol, six databases were searched, and sixty-seven articles were finally included. To present the findings, a qualitative synthesis was used. 'Meaning' and 'purpose in life' were found to be key to many spirituality definitions. The most frequently reported approach for Australian health professionals (HPs) in asking about client spirituality was using one or two questions within a comprehensive assessment. Major facilitators included a holistic care approach and prior training, whereas a key barrier was a lack of time.

Deathbed Etiquette - The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings

Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a 'Deathbed Etiquette' guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words 'death' and 'dying' were identified. Most participants also expressed reservations about the title, with the word 'deathbed' found to be old-fashioned and the word 'etiquette' not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for 'mythbusting' death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The 'Deathbed Etiquette' guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.

How do intensive care clinicians ensure culturally sensitive care for family members at the end of life? A retrospective descriptive study

INTRODUCTION

Patients and their family members have diverse needs at the end of life, influenced by culture.

OBJECTIVE

To examine whether clinicians (doctors and nurses), provided culturally sensitive care for family members of patients from culturally diverse backgrounds who died in an intensive care unit.

METHODS

A retrospective medical record audit was undertaken in four metropolitan intensive care units in Melbourne, Australia. Quantitative data are reported using descriptive statistics. Qualitative progress note entries are presented using themes.

RESULTS

In all, 430 patients died in 2018 and were included in the audit. Almost half of patients (47.9%, n = 206) were born in Australia, with the remaining 52.1% (n = 224) representing 41 other countries of birth. Languages other than English were spoken by 14.9% (n = 64) of patients. Christian religions were most common (50.2%, n = 216), followed by Buddhism 3.0% (n = 13), and Hindu and Islam respectively (1.9%, n = 8). A cultural assessment was undertaken in 10.5% (n = 45) of cases, mostly by social workers, to ascertain family members' wishes and preferences for the dying patient's end-of-life care. Religious leaders (eg. priests) (25.1%, n = 108) and interpreters (4.9%, n = 21) contributed to ensuring family members could participate as desired, in accordance with cultural wishes and preferences.

CONCLUSIONS

Despite the culturally-diverse patient population, findings show that details about culturally sensitive end-of-life care are rarely documented. Comprehensive documentation is required of how clinicians assess patient and family member cultural wishes and preferences, in conjunction with how clinicians attempt to address these cultural needs.