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Donkor A, Adotey PN, Ofori EO, Ayitey JA, Ferguson C, Luckett T, Vanderpuye V, Osei-Bonsu EB, Phelan C, Hunt K. Prevalence of Preferences for End-of-Life Place of Care and Death Among Patients With Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2024; 10:e2400014. [PMID: 38815191 DOI: 10.1200/go.24.00014] [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: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE There is limited information on preferences for place of care and death among patients with cancer in low- and middle-income countries (LMICs). The aim was to report the prevalence and determinants of preferences for end-of-life place of care and death among patients with cancer in LMICs and identify concordance between the preferred and actual place of death. METHODS Systematic review and meta-analysis guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. Four electronic databases were searched to identify studies of any design that reported on the preferred and actual place of care and death of patients with cancer in LMICs. A random-effects meta-analysis estimated pooled prevalences, with 95% CI, with subgroup analyses for region and risk of bias. RESULTS Thirteen studies were included. Of 3,837 patients with cancer, 62% (95% CI, 49 to 75) preferred to die at home; however, the prevalence of actual home death was 37% (95% CI, 13 to 60). Subgroup analyses found that preferences for home as place of death varied from 55% (95% CI, 41 to 69) for Asia to 64% (95% CI, 57 to 71) for South America and 72% (95% CI, 48 to 97) for Africa. The concordance between the preferred and actual place of death was 48% (95% CI, 41 to 55) for South Africa and 92% (95% CI, 88 to 95) for Malaysia. Factors associated with an increased likelihood of preferred home death included performance status and patients with breast cancer. CONCLUSION There is very little literature from LMICs on the preferences for end-of-life place of care and death among patients with cancer. Rigorous research is needed to help understand how preferences of patients with cancer change during their journey through cancer.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Schuler T, King C, Matsveru T, Back M, Clark K, Chin D, Lilian R, Gallego B, Coiera E, Currow DC. Wearable-Triggered Ecological Momentary Assessments Are Feasible in People With Advanced Cancer and Their Family Caregivers: Feasibility Study from an Outpatient Palliative Care Clinic at a Cancer Center. J Palliat Med 2023. [PMID: 37134212 DOI: 10.1089/jpm.2022.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background: Emerging digital health approaches could play a role in better personalized palliative care. Aim: We conducted a feasibility study testing wearable sensor (WS)-triggered ecological momentary assessments (EMAs) and electronic patient-reported outcomes in community palliative care with patient-caregiver dyads. Design: All wore consumer-grade WS for five weeks. Sensor-detected "stress" (heart rate variability algorithm) that passed individualized thresholds triggered a short smartphone survey. Daily sleep surveys, weekly symptom surveys (Integrated Palliative care Outcome Scale), and a poststudy experience survey were conducted. Setting/Participants: Fifteen dyads (n = 30) were recruited from an outpatient palliative care clinic for people with cancer. Results: Daytime sensor wear-time had 73% adherence. Participants perceived value in this support. Quantity and severity of "stress" events were higher in patients. Sleep disturbance was similar but for different reasons: patients (physical symptoms) and caregivers (worrying about the patient). Conclusions: EMAs are feasible and valued in community palliative care.
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Affiliation(s)
- Thilo Schuler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire King
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Teresia Matsveru
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Clark
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dylan Chin
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ruth Lilian
- Sydney Partnership for Health, Education, Research and Enterprise, Sydney, New South Wales, Australia
| | - Blanca Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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O'Connor M. Home-based palliative care services after COVID-19. Med J Aust 2023. [PMID: 37114370 DOI: 10.5694/mja2.51939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Margaret O'Connor
- Monash University, Melbourne, VIC
- Melbourne City Mission, Melbourne, VIC
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Pepping RMC, van Aken MO, Vos RC, Numans ME, van den Berg JMW, Kroon I, van Nieuwkoop C. Using Design Thinking for Co-Creating an Integrated Care Pathway Including Hospital at Home for Older Adults with an Acute Moderate-Severe Respiratory Infection in the Netherlands. Int J Integr Care 2023; 23:30. [PMID: 37360876 PMCID: PMC10289046 DOI: 10.5334/ijic.6991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Acute respiratory infections are common in frail, community-dwelling older people and are accompanied by considerable diagnostic and prognostic uncertainties. Inadequately coordinated care is associated with unnecessary hospital referral and admission with potential iatrogenic harm. Therefore, we aimed to co-create a regional integrated care pathway (ICP), including a hospital at home journey. Developing the ICP Tasked with using design thinking methodology, stakeholders from regional healthcare facilities, together with patient representatives, were assigned to different focus groups based on their expertise. The focus of each session was to co-create ideal patient journeys suitable for embedding in the ICP. Results Based on these sessions, a regional cross-domain ICP was developed that comprises three patient journeys. The first journey included a hospital at home track, the second a tailored visit, with priority assessment, to regional emergency departments, and the third concerned referral to readily available nursing home 'recovery-beds' under the supervision of an elderly care medicine specialist. Conclusion Using design thinking and involving end-users during the whole process, we created an ICP for community-dwelling frail older people with moderate-severe acute respiratory infections. This resulted in three realistic patient journeys, including a hospital at home track, which will be implemented and evaluated in the near future.
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Affiliation(s)
- Rianne M. C. Pepping
- Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Maarten O. van Aken
- Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Rimke C. Vos
- Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
| | - Mattijs E. Numans
- Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
| | | | - Ingrid Kroon
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Elderly Care Medicine, Florence Health & Care, The Hague, The Netherlands
| | - Cees van Nieuwkoop
- Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
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Surakka LK, Hökkä M, Törrönen K, Mäntyselkä P, Lehto JT. Paramedics' experiences and educational needs when participating end-of-life care at home: A mixed method study. Palliat Med 2022; 36:1217-1227. [PMID: 35922966 DOI: 10.1177/02692163221105593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. AIM To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. DESIGN A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. SETTING/PARTICIPANTS The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. RESULTS Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. CONCLUSIONS Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future.
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Affiliation(s)
- Leena K Surakka
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Siun Sote - North Karelia Social and Health Services Joint Authority, Palliative Care Center, Joensuu, Finland
| | - Minna Hökkä
- Kajaani University of Applied Sciences, Kajaani, Finland.,Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kari Törrönen
- Fire and Rescue Department, Siun Sote - North Karelia Social and Health Services Joint Authority, Joensuu, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Oncology, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [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: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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