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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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Drummond DK, Kaur-Gill S, Murray GF, Schifferdecker KE, Butcher R, Perry AN, Brooks GA, Kapadia NS, Barnato AE. Problematic Integration: Racial Discordance in End-of-Life Decision Making. HEALTH COMMUNICATION 2023; 38:2730-2741. [PMID: 35981599 DOI: 10.1080/10410236.2022.2111631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients' religion and support systems; (3) epistemological uncertainty as ambivalence in which providers' feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.
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Affiliation(s)
| | | | | | - Karen E Schifferdecker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Center for Program Design & Evaluation, Dartmouth College
| | - Rebecca Butcher
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Center for Program Design & Evaluation, Dartmouth College
| | - Amanda N Perry
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
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Mehdizadeh-Maraghi R, Nemati-Anaraki L. Application of Problematic Integration Theory in Health Communication: A Scoping Review. HEALTH COMMUNICATION 2023:1-27. [PMID: 37981577 DOI: 10.1080/10410236.2023.2281078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Problematic integration theory is a theory in communication that deals with the processing of messages by humans. It is helpful to study challenges and their solutions in the health communication context to develop effective relationships, treat patients, and, ultimately, ensure the well-being of society. A scoping review was conducted. Three databases were searched following the PRISMA-ScR statement without a time frame. Independent screening of titles, abstracts, and full texts was performed, and the studies selected based on the inclusion and exclusion criteria were assessed. The required information was then extracted from the studies and entered into Excel software. A total of 43 studies related to PI theory were identified in the databases. The results indicated that PI theory is used to interpret feelings, beliefs, challenges, concerns, and problematic dilemmas in five thematic categories: elderly care, cancer care, infertility, pregnancy, and childbirth care, illness care, and sexual care. Each of the papers also offers distinctive and valuable considerations for interventions such as communication strategies, coping mechanisms, uncertainty and certainty management, information management, education, training, support groups, and campaigns to improve decision-making and meet the challenges of health communication.
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Affiliation(s)
- Razieh Mehdizadeh-Maraghi
- Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences
| | - Leila Nemati-Anaraki
- Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences
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Nagelschmidt K, Leppin N, Seifart C, Rief W, von Blanckenburg P. Systematic mixed-method review of barriers to end-of-life communication in the family context. BMJ Support Palliat Care 2020; 11:253-263. [DOI: 10.1136/bmjspcare-2020-002219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/03/2022]
Abstract
BackgroundCommunication about the end of life is especially important in the family context, as patients and their families are considered as the care unit in palliative care. Open end-of-life communication can positively affect medical, psychological and relational outcomes during the dying process for patient and family. Regardless of the benefits of end-of-life conversations, many patients and their family caregivers speak little about relevant end-of-life issues.AimTo identify barriers that hinder or influence the discussion of end-of-life issues in the family context.DesignA systematic mixed-method review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Data sourcesA systematic search of PsycInfo, CINAHL, PubMed and Web of Science was conducted and extended with a hand search. Peer-reviewed primary studies reporting on the barriers to or difficulties in end-of-life conversations experienced by terminally ill patients and/or family caregivers were included in this review.Results18 qualitative and two quantitative studies met the inclusion criteria. The experiences of n=205 patients and n=738 family caregivers were analysed qualitatively; n=293 patients and n=236 caregivers were surveyed in the questionnaire studies. Five overarching categories emerged from the extracted data: emotional, cognitive, communicative, relational and external processes can hinder end-of-life communication within the family. The most frequently reported barriers are emotional and cognitive processes such as protective buffering or belief in positive thinking.ConclusionsResearch on end-of-life communication barriers in the family context is scarce. Further research should enhance the development of appropriate assessment tools and interventions to support families with the challenges experienced regarding end-of-life conversations.
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Chuang IF, Shyu YIL, Weng LC, Huang HL. Consistency in End-of-Life Care Preferences Between Hospitalized Elderly Patients and Their Primary Family Caregivers. Patient Prefer Adherence 2020; 14:2377-2387. [PMID: 33299304 PMCID: PMC7721293 DOI: 10.2147/ppa.s283923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study explored the consistency between preferences for end-of-life care for elderly hospitalized patients and their primary caregivers and predictors of consistency. PATIENTS AND METHODS This cross-sectional correlational study recruited 100 dyads of elderly hospitalized patients and their primary caregivers from a medical center in Central Taiwan. A structural questionnaire about preferences for seven end-of-life medical treatment options involved cardiopulmonary resuscitation, intravenous therapy, nasogastric tube feeding, intensive care unit, blood transfusion, tracheotomy, and hemodialysis. RESULTS The consistency was 42.28% for preferences of end-of-life medical care between patients and caregivers. The Kappa values for seven life-sustaining medical treatments ranged from 0.001 to 0.155. Logistic regression showed that the predictors of consistency for preferences of treatment were: a patient with a signed living will (odds ratio [OR] = 6.20, p<0.01) and a male family caregiver (OR= 0.23, p<0.01) for cardiopulmonary resuscitation; a patient who visited relatives in the intensive care unit (OR= 2.94, p< 0.05) and a spouse caregiver (OR= 3.07, p< 0.05) for nasogastric tube feeding; a spouse caregiver (OR=3.12, p<0.05) and a caregiver who visited the intensive care unit (OR= 5.50, p<0.01) for tracheotomy; and a spouse caregiver (OR= 2.76, p<0.05) and a caregiver who visited the intensive care unit (OR= 4.42, p<0.05) for hemodialysis. CONCLUSION End-of-life medical treatment preferences were inconsistent between patients and family caregivers, which might be influenced by Asian culture, the nature of the relationship and individual experiences. Implementation of advance care planning that respects the patient's autonomy and preferences about end-of-life care is recommended.
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Affiliation(s)
- I-Fei Chuang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yea-Ing Lotus Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Healthy Aging Research Center, Chang Gung University, TaoyuanCity, Taiwan
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsiu-Li Huang
- Department of Long-TermCare, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Correspondence: Hsiu-Li Huang No. 83-1, Nei-Chiang St, Wan-Hwa Dist, Taipei10845, TaiwanTel +886-2-28227101 Ext. 6134Fax +886-2-23891464 Email
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Hidaka T, Endo S, Kasuga H, Masuishi Y, Kakamu T, Kumagai T, Saito K, Abe K, Fukushima T. Disparity in pre-emptive end-of-life conversation experience caused by subjective economic status among general Japanese elderly people: a cross-sectional study with stratified random sampling. BMJ Open 2019; 9:e031681. [PMID: 31594894 PMCID: PMC6797420 DOI: 10.1136/bmjopen-2019-031681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pre-emptive conversations (PCs) about end-of-life (EOL) preferences are beneficial for both elderly people and their families to understand and share the preferences. However, the factors which promote/inhibit PCs have yet to be clarified. We therefore aimed to determine the factors related to having PCs with hypothesis that age, subjective economic status and subjective health status are associated with having PC experience. DESIGN A cross-sectional study administering a questionnaire and using stratified random sampling by gender and region. SETTING Residents aged 65 years or older who were not receiving nursing care as of 1 November 2016, were extracted from the Japanese long-term care insurance system registry in Koriyama City, Fukushima Prefecture, Japan. PARTICIPANTS 1575 participants (717 males and 858 females). OUTCOME Presence or absence of PC experience with family or friends (yes/no). RESULTS The mean age of the participants was 74.0 years. A multivariable logistic-regression analysis revealed that having PC experience was significantly associated with gender (OR=1.907; 95% CI=1.556 to 2.337; p<0.001), subjective economic status (OR=0.832; 95% CI=0.716 to 0.966; p=0.016) and subjective happiness (OR=0.926; 95% CI=0.880 to 0.973; p=0.003). CONCLUSIONS Poor subjective economic status of elderly people may result in the absence of EOL conversation experience with their families and friends, hindering the elderly from sharing and understanding the EOL preferences. To promote PCs about EOL, gerontology and public health professionals should give special consideration to the subjective economic status of elderly people.
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Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Kumagai
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Keiko Saito
- Division of Children, Hoshi General Hospital Foundation, Fukushima, Japan
| | - Kouichi Abe
- Director, Koriyama City Public Health Center, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
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Odachi R, Tamaki T, Ito M, Okita T, Kitamura Y, Sobue T. Nurses' Experiences of End-of-life Care in Long-term Care Hospitals in Japan: Balancing Improving the Quality of Life and Sustaining the Lives of Patients Dying at Hospitals. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:207-215. [DOI: 10.1016/j.anr.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022] Open
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