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Breivik E, Ervik B, Kitzmüller G. Preparing for home death in rural areas - the experience of family caregivers providing palliative cancer care. Int J Circumpolar Health 2025; 84:2507443. [PMID: 40388215 PMCID: PMC12090319 DOI: 10.1080/22423982.2025.2507443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 04/24/2025] [Accepted: 05/13/2025] [Indexed: 05/20/2025] Open
Abstract
Palliative care policies worldwide support people's wishes to spend their final days at home with family caregivers playing a vital role. In Norway, 16% of the population lives in rural areas where palliative end-of-life care is especially challenging due to geographical barriers and limited access to healthcare resources. Research on rural family end-of-life care for people with cancer is sparse. Therefore, the purpose of this study was to investigate what resources are needed for rural family caregivers when providing end-of-life care and preparing for home death for a person with cancer. Thirteen semi-structured in-depth interviews with family caregivers in seven rural municipalities in Northern Norway were conducted from February to April 2023. The thematic analysis revealed three key themes supporting caregivers' resilience: end-of-life care and home death require available resources in family caregivers; the availability of reliable professional follow-up services for end-of-life care; support from family and social networks compensate for lacking healthcare resources. Holistic healthcare for rural populations should consider aspects like distance and cost while involving the entire family and their social network. Local palliative care beds and telehealth services should be available to support rural family caregivers.
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Affiliation(s)
- Elisabet Breivik
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bente Ervik
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
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Pike TD, Sargent MJ, Freeman S. Motivations for choosing "home" as one's preferred place of death: A scoping review. Palliat Support Care 2025; 23:e102. [PMID: 40270265 DOI: 10.1017/s147895152500029x] [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] [Indexed: 04/25/2025]
Abstract
OBJECTIVES While dying at home is often described as desirable, to our knowledge, no reviews have focused specifically on people's reasons for wanting to die at home. This review describes the breadth of what is known about motivations, attitudes, ideas, and reasons underlying the decision to choose "home" as one's preferred placed of death. METHODS This review was guided by a scoping review methodology following a five-stage approach including: (1) identify the research question, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize and report the results. RESULTS Seventeen articles were identified that met inclusion/exclusion criteria and discussed motivations underlying people's desires to die at home. Thirty-five percent of studies were from Canada (n = 6/17), 29% were from Europe (n = 5/17), and 29% were from Asia (n = 5/17). Most studies (n = 11/17) used methods that involved collecting and/or analyzing interview data from participants, while the remaining studies (n = 6/17) used methods that involved administering and analyzing surveys or questionnaires. Characteristics of participants varied, but most commonly, studies included people with advanced illnesses who were nearing death (35% of studies, n = 6/17). Motivations for choosing a home death included desires to preserve a sense of self, factors relating to interpersonal relationships, and topics such as culture, religion, socioeconomic status, living situation, and lived experience. SIGNIFICANCE OF RESULTS The many interconnected reasons that lead people to choose a home death vary, as individuals have a range of motivations for choosing to die at home, which are highly influenced by contextual and cultural factors. Ultimately, this review will provide a comprehensive description of factors which may inform end-of-life planning, highlighting needs to be considered when planning the preferred location of a death.
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Affiliation(s)
- Taylor D Pike
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J Sargent
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, BC, Canada
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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Zhang S, Xu L, Li Z, Wei L, Yang B, Yue P, Tang Q, Zhang X. Co-design of the Intelligent HOme-based Palliative care for End-of-life system: A development and feasibility study. J Telemed Telecare 2025:1357633X251325949. [PMID: 40151959 DOI: 10.1177/1357633x251325949] [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: 03/29/2025]
Abstract
ObjectiveThis study aimed to develop the Intelligent HOme-based Palliative care for End-of-life (I-HOPE) system, a WeChat mini-program designed to provide home-based palliative care (HBPC), including education, interaction, and social resource access for users.MethodsA mixed-method approach was employed to ensure a comprehensive exploration of user needs, system design, and evaluation. This approach integrated qualitative and quantitative methods, rapid prototyping, expert consultations, and co-design methodologies informed by social ecological theory. Four key stakeholder groups i.e. patients, caregivers, healthcare professionals, and the general public were included. Initially, field research and surveys were conducted to assess the palliative care needs of patients and caregivers. Based on these findings, the mini-program was developed in collaboration with a technical team specializing in healthcare technology. Usability, user experiences, and suggestions for improvement were then collected. This study was conducted in three tertiary hospitals and two community health service centers in Beijing, China.ResultsThe I-HOPE system achieved a System Usability Scale score of 71.89 ± 13.85. User feedback on version 1.0 led to improvements in interface design, features, information presentation, usability, and privacy protection.ConclusionThe development of the I-HOPE system represents an advancement in enhancing the accessibility and quality of HBPC. Future research should focus on identifying areas for further development and assessing its impact on palliative care outcomes.
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Affiliation(s)
- Shan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Lijie Xu
- School of Nursing, Capital Medical University, Beijing, China
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, Beijing, China
| | - Ling Wei
- Institute for Internet Behavior, Tsinghua University, Beijing, P. R. China
| | - Bin Yang
- Institute for Internet Behavior, Tsinghua University, Beijing, P. R. China
| | - Peng Yue
- School of Nursing, Capital Medical University, Beijing, China
| | - Qianqian Tang
- Department of Nursing, Peking University First Hospital, Beijing, China
| | - Xiaotian Zhang
- Department of Nursing, Peking University Third Hospital, Beijing, China
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Viitala A, Palonen M, Lehto JT, Åstedt-Kurki P. Coping with the unthinkable: A qualitative metasynthesis of patients' experiences with incurable cancer. Eur J Oncol Nurs 2025; 76:102876. [PMID: 40199169 DOI: 10.1016/j.ejon.2025.102876] [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: 09/30/2024] [Revised: 03/15/2025] [Accepted: 03/20/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE This study aimed to address the coping experiences of adult patients with incurable cancer palliative and hospice care. The objective of the study was to provide information that can help improve their support. METHODS The study used a qualitative research design, including a literature review and semi-structured interviews with 56 adult patients. Data were analyzed using inductive content analysis and metasynthesis. RESULTS Key coping factors identified were managing everyday life, maintaining the best possible health, utilizing support options, and accepting the incurable nature of their disease. Emotional coping and inconsistencies in the healthcare support network also played significant roles. CONCLUSIONS The study highlighted the coping experiences, expectations, and problems faced by patients with incurable cancer, aiming to make their needs more visible in public healthcare. The findings can help healthcare sectors design better services and support for these patients and their families.
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Affiliation(s)
- Anu Viitala
- Medicine and Health Technology, Tampere University, Tampere, Finland; Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland.
| | - Mira Palonen
- Social Sciences, Nursing Science, Tampere University, Tampere, Finland; Nursing Research Foundation, Helsinki, Finland
| | - Juho T Lehto
- Medicine and Health Technology, Tampere University, Tampere, Finland; Palliative Care Centre, Tampere University Hospital, Tampere, Finland
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Storm E, Bergdahl E, Tranvåg O, Korzhina Y, Linnanen C, Blomqvist H, Hemberg J. Palliative nurses' experiences of alleviating suffering and preserving dignity. Nurs Ethics 2025:9697330251326235. [PMID: 40112145 DOI: 10.1177/09697330251326235] [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: 03/22/2025]
Abstract
BackgroundMost patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one's death can contribute to the loss of one's sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide.AimThe aim of the study was to explore and describe nurses' experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare.Research designA qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson's caritative caring theory.Participants and research contextA total of nine nurses with extensive work experience from a palliative homecare context participated in the study.Ethical considerationsThe study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study.FindingsOne main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge.ConclusionsCertain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses' ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.
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Affiliation(s)
| | | | - Oscar Tranvåg
- Western Norway University of Applied Sciences; Oslo University Hospital
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Staats K, Svendsen SJ, Lockertsen V. Navigating toward acceptance of death: Home-dwelling patients in the palliative phase. BMC Palliat Care 2025; 24:71. [PMID: 40087610 PMCID: PMC11908046 DOI: 10.1186/s12904-025-01707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 03/03/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND As global life expectancy increases, the need for palliative care grows. Recognizing the deeply personal and diverse nature of individuals' end-of-life experiences, palliative care for home-dwelling patients requires a flexible and person-centered approach. This study explores the complex process of death acceptance as experienced by patients receiving palliative care at home. METHODS Utilizing a qualitative, explorative, and descriptive design grounded in hermeneutic methodology, this study incorporates a secondary analysis of data derived from 13 in-depth interviews with home-dwelling patients in the palliative phase. RESULTS The findings reveal that patients consider relationships with family and healthcare professionals crucial in their journey toward accepting death. While strong, supportive relationships provided peace and meaningfulness, they could also introduce emotional complexity. Trust, honesty, and supportive care were fundamental for patients to find meaning and maintain quality of life during this challenging process. Staying in familiar environments, particularly at home, increased patients' likelihood of accepting their mortality. Participants noted that achieving peace and reconciling with death required balancing hope for life with acceptance of death. CONCLUSION This study highlights the complex process of death acceptance as experienced by patients receiving palliative care at home. Healthcare professionals can provide vital support by facilitating open conversations about fears and preferences related to death. Further research is needed to explore how end-of-life care can best support this intricate process.
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Affiliation(s)
- Katrine Staats
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Head of Studies - Area of responsibility 2, OsloMet- Oslo Metropolitan University, Kunnskapsveien 55, 2007, Kjeller, Norway.
| | - Sandra Jahr Svendsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Head of Studies - Area of responsibility 2, OsloMet- Oslo Metropolitan University, Kunnskapsveien 55, 2007, Kjeller, Norway
- Lillestrøm Municipality, Jonas Lies gate 18, 2000, Lillestrøm, Norway
| | - Veronica Lockertsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Head of Studies - Area of responsibility 2, OsloMet- Oslo Metropolitan University, Kunnskapsveien 55, 2007, Kjeller, Norway
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Kochems K, de Graaf E, Hesselmann GM, Teunissen SCCM. Being Seen as a Unique Person is Essential in Palliative Care at Home and Nursing Homes: A Qualitative Study With Patients and Relatives. Am J Hosp Palliat Care 2025; 42:207-216. [PMID: 38581256 PMCID: PMC11636018 DOI: 10.1177/10499091241242810] [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] [Indexed: 04/08/2024] Open
Abstract
CONTEXT Incorporation of a palliative care approach is increasingly needed in primary care and nursing home care because most people with a life-limiting illness or frailty live there. OBJECTIVES To explore patients' and relatives' experiences of palliative care at home and in nursing homes. METHODS Generic qualitative research in a purposive sample of patients with an estimated life expectancy of <1 year, receiving care at home or in a nursing home, and their relatives. Data is collected through semi-structured interviews and thematically analyzed by a multidisciplinary research team. RESULTS Seven patients and five relatives participated. Three essential elements of palliative care and their contributing factors emerged: 1) be seen (personal attention, alignment to who the patient is as a person, and feeling connected) 2) information needs (illness trajectory and multidimensional symptoms and concerns, and 3) ensuring continuity (single point of contact, availability of HCPs, and coordination of care). Patients and relatives experienced loss of control and safety if these essentials were not met, which depended largely on the practices of the individual health care professional. CONCLUSION In both primary care and nursing home care, patients and relatives expressed the same essential elements of palliative care. They emphasized the importance of being recognized as a unique person beyond their patient status, receiving honest and clear information aligned with their preferences, and having care organized to ensure continuity. Adequate competence and skills are needed, together with a care organization that enables continuity to provide safe and person-centered care.
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Affiliation(s)
- Katrin Kochems
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Saskia C. C. M. Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Lee H, Kim A, Lee H, Woo K. Contributing factors to the length of stay and discharge destination of home health care patients: 10-year electronic health record analysis using the Donabedian model. Jpn J Nurs Sci 2025; 22:e12647. [PMID: 39838704 DOI: 10.1111/jjns.12647] [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: 09/08/2024] [Revised: 11/15/2024] [Accepted: 12/16/2024] [Indexed: 01/23/2025]
Abstract
AIM To identify the factors affecting the length of stay (LOS) and discharge destination (DD) of home health care (HHC) patients in South Korea. METHODS A retrospective cross-sectional study was conducted using the electronic health records of 1769 patients from a hospital in South Korea. Data were collected from January 2013 to December 2022. We categorized the independent variables into patient context, structure, and process factors following a modification of Donabedian's model. Hierarchical and multinomial logistic regression analyses were used. RESULTS The mean length of stay was 26.41 days. Patients were discharged to the following locations: 35.0% continued HHC, 21.0% died, 19% were discharged to their homes, 17.0% were admitted, and 8.0% were sent to other locations. Patients' sex, type of insurance coverage, and primary caregiver as well as the number of nurse visits, HHC admission route, and type of nursing service were predictors of their LOS. Operation history, a high Charlson comorbidity index, the type of insurance coverage, HHC admission route, and certain nursing care services were associated with admission and death as the DD. CONCLUSIONS Process variables (e.g., number of nurse visits, HHC admission route, type of nursing services) have a considerable influence on determining the LOS and DD of HHC patients. This result provides new insights into the use of HHC services and care transitions out of the hospital for patients living in their home, offering evidence to reduce unnecessary readmissions and ensure more effective and efficient HHC.
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Affiliation(s)
- Hana Lee
- Center for World-leading Human-care Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Aeri Kim
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hyeyoun Lee
- Public Home Health Care Team, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungmi Woo
- Center for World-leading Human-care Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
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Ng HL, Wu XV, Yap SY, Yeo SNB, Dino MJ, Jiang Y. Exploring the Experiences of Older Adults and Their Caregivers in Home-Based Palliative Care Setting: A Systematic Review and Meta-Synthesis. Semin Oncol Nurs 2024; 40:151753. [PMID: 39550249 DOI: 10.1016/j.soncn.2024.151753] [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: 04/10/2024] [Revised: 10/10/2024] [Accepted: 10/12/2024] [Indexed: 11/18/2024]
Abstract
OBJECTIVES While Home-based palliative care might be the preferred choice of many, there has been little research exploring the experiences of older adults and caregivers in this setting. This systematic review aims to explore and synthesize the experiences of home-dwelling older adults (aged 60 and above) and their caregivers with Home-based palliative care. METHODS A Systematic Review and Meta-Synthesis of qualitative and mixed-methods studies was conducted and reported in accordance with PRISMA guidelines. A systematic search across nine electronic databases, as well as grey literature, reference lists and citation lists were conducted. Studies were included with the following criteria: older adult palliative patients and/or their informal caregivers with the primary setting of palliative care delivery at home. Quality appraisal was conducted by two researchers independently using the Critical Appraisal Skills Programme Qualitative Research Checklist and Mixed Methods Appraisal Tool. Data analysis was facilitated by Braun and Clark's thematic analysis, and meta-synthesis was underpinned by Sandelowski and Barroso's guidelines. RESULTS A total of 4,931 records were yielded through the electronic database search. After duplicate removal and screening of titles/abstracts and full-texts, a total of 25 studies were included. Five main themes and 11 sub-themes emerged: 1) Living in a diminishing world due to immobility, 2) Bittersweet caregiving process, 3) Navigating a fragmented healthcare system, 4) Maintaining normalcy amongst disruption, 5) Indispensable aspects of Home-based palliative care needed by families. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE This meta-synthesis highlights the fundamental significance of embracing a dyadic approach to fully comprehend the intricate dynamics of Home-based palliative care. By recognising the older adult-caregiver dyad as an interconnected unit, future research, therapeutic interventions, and policy initiatives can integrate this dyadic perspective, resulting in more holistic and inclusive Home-based palliative care programs. REGISTRATION The protocol was registered on PROSPERO (Registration No. CRD42022376864).
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Affiliation(s)
- Hua Lin Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
| | - Siat Yee Yap
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seo Ngee Brian Yeo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Joseph Dino
- Research Development and Innovation Center, Our Lady of Fatima University, Philippines; School of Nursing, Johns Hopkins University, Baltimore, Maryland; College of Nursing, University of Central Florida, FL, USA
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Pedersen T, Raunkiær M, Graven V. Barriers and facilitators for place of death: A scoping review. Palliat Support Care 2024:1-14. [PMID: 39390769 DOI: 10.1017/s1478951524001500] [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: 10/12/2024]
Abstract
OBJECTIVES Many factors influence where people die, but most people prefer to die at home. Investigating the factors affecting death at different locations can enhance end-of-life care and enable more people to die at their preferred place. The aim was to investigate barriers and facilitators affecting place of death and compare facilitators and barriers across different places of death. METHODS A scoping review registered on Open Science Framework was conducted in accordance with the guidelines for Scoping Reviews (PRISMA-ScR). An electronic search of literature was undertaken in MEDLINE, EMBASE, PUBMED, PsycINFO, and CINAHL covering the years January 2013-December 2023. Studies were included if they described barriers and/or facilitators for place of death among adults. RESULTS This review identified 517 studies, and 95 of these were included in the review. The review identified the following themes. Illness factors: disease type, dying trajectory, treatment, symptoms, and safe environment. Individual factors: sex, age, ethnicity, preferences, and for environmental factors the following were identified: healthcare inputs, education and employment, social support, economy, and place of residence. SIGNIFICANCE OF RESULTS The factors influencing place of death are complex and some have a cumulative impact affecting where people die. These factors are mostly rooted in structural aspects and make hospital death more likely for vulnerable groups, who are also less likely to receive palliative care and advanced care planning. Disease type and social support further impact the location of death. Future research is needed regarding vulnerable groups and their preferences for place of death.
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Affiliation(s)
- Tina Pedersen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Raunkiær
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Mushtaq NS. Exploring the patients' and family members' perspectives on home-based palliative care. Int J Palliat Nurs 2024; 30:548-555. [PMID: 39422923 DOI: 10.12968/ijpn.2024.30.10.548] [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] [Indexed: 10/19/2024]
Abstract
BACKGROUND Healthcare at home is considered a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and are unable to pay for hospital care at the end of life in some countries. PURPOSE To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services. METHOD This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data collection was done via interviews, and simultaneously, the interviewer recorded field notes, which were all carried out within the confines of the participants' homes. Moreover, the subjects were recruited through purposive sampling, resulting in a total of six patients and six family members. The final number of participants was determined based on data saturation. The inclusion criteria encompassed individuals of all genders, aged 18 and above, and residents of Karachi, Pakistan. Those who were not able to provide information, due to any reason, were excluded from the study. The study adhered strictly to ethical considerations. FINDINGS The study uncovered several significant themes that provide valuable insights, including caregivers' availability, patients' inclusiveness, improved dietary pattern, psychological wellbeing, and rapid recovery in home-based care. Furthermore, the study identified themes on providing home-based palliative care, like family members' education and keeping back-ups for unforeseen situations. In contrast, the themes identified as home-based care preference over hospital care were: experienced compromised care, hospital anxiety, restricted to the available resources and higher hospital living expenses for patients and family members. CONCLUSION The study underscored the importance of adopting a patient-centric approach. It has become evident that the comfort and familiarity of one's home environment provide a conducive backdrop for holistic healing and wellbeing.
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Wang SY, Lee PY, Sun YJE, Liu JF. The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study. Int J Nurs Pract 2024; 30:e13280. [PMID: 38932439 DOI: 10.1111/ijn.13280] [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: 11/09/2023] [Revised: 03/07/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. AIM The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. METHODS This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. FINDINGS Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. CONCLUSION We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.
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Affiliation(s)
- Shou-Yu Wang
- Discipline of Nursing, School of Health, University of New England, Armidale, New South Wales, Australia
| | - Pei-Yu Lee
- Department of Long-term Care and Health Management, Cheng Shiu University, Kaohsiung City, Taiwan
| | - Yong-Jhu Emily Sun
- Nursing Service and Residential Aged Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ju-Fen Liu
- Department of Nursing, Kuang Tien General Hospital, Taichung City, Taiwan
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Wall C, Blomberg K, Bergdahl E, Sjölin H, Alm F. Patients near death receiving specialized palliative home care being transferred to inpatient care - a registry study. BMC Palliat Care 2024; 23:215. [PMID: 39182053 PMCID: PMC11344375 DOI: 10.1186/s12904-024-01549-6] [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: 05/13/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The majority of palliative care patients express a preference for remaining at home for as long as possible. Despite progression of disease there is a strong desire to die at home. Nonetheless, there are transfers between care settings, demonstrating a discrepancy between desired and actual place of death. AIM To map the prevalence of patients near death undergoing specialized palliative home care and being transferred to inpatient care in Sweden. METHODS A national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥ 18 years of age enrolled in specialized palliative home care with dates of death between 1 November 2015 and 31 October 2022 were included (n = 39,698). Descriptive statistics were used. RESULTS Seven thousand three hundred eighty-three patients (18.6%), approximately 1,000 per year, were transferred to inpatient care and died within seven days of arrival. A considerable proportion of these patients died within two days after admission. The majority (73.6%) were admitted to specialized palliative inpatient care units, 22.9% to non-specialized palliative inpatient care units and 3.5% to additional care units. Transferred patients had more frequent dyspnoea (30.9% vs. 23.2%, p < 0.001), anxiety (60.2% vs. 56.5%, p < 0.001) and presence of several simultaneous symptoms was significantly more common (27.0% vs. 24.8%, p 0.001). CONCLUSION The results show that patients admitted to specialized palliative home care in Sweden are being transferred to inpatient care near death. A notable proportion of these patients dies within two days of admission. Common features, such as symptoms and symptom burden, can be observed in the patients transferred. The study highlights a phenomenon that may be experienced by patients, relatives and healthcare personnel as a significant event in a vulnerable situation. A deeper understanding of the underlying causes of these transfers is required to ascertain whether they are compatible with good palliative care and a dignified death.
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Affiliation(s)
- Camilla Wall
- Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.
- School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Karin Blomberg
- School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
| | - Elisabeth Bergdahl
- School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
| | - Helena Sjölin
- School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
| | - Fredrik Alm
- School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
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Aurén-Møkleby M, Aasbø G, Fredheim OMS, Mengshoel AM, Solbrække KN, Thoresen L. "It turned out right for both of us": A qualitative study about a preference for home death and actual place of death. DEATH STUDIES 2024:1-10. [PMID: 38916193 DOI: 10.1080/07481187.2024.2369847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
This qualitative study was conducted in Norway to explore couples' preference for home death when one of the partners was dying from cancer, and what made home death possible or not. We conducted dyad interviews with five couples. After the patients' death, the spouses participated in individual interviews. The data were interpreted using thematic narrative analysis. One patient died at home, and three died in a healthcare institution. The narratives show how interdependency and mutual care were important when dealing with home death. When care needs were manageable at home, home was perceived a safe place and the preferred place for death. When care needs were experienced to become unmanageable at home, the sense of safety changed and admission to a health care institution was considered the best option. Regardless of place of death, the spouses experienced the end to have turned out right for their partner and themselves.
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Affiliation(s)
| | - Gunvor Aasbø
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olav Magnus S Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Kari N Solbrække
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lisbeth Thoresen
- Institute of Health and Society, University of Oslo, Oslo, Norway
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15
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Brenne AT, Løhre ET, Knudsen AK, Lund JÅ, Thronæs M, Driller B, Brunelli C, Kaasa S. Standardizing Integrated Oncology and Palliative Care Across Service Levels: Challenges in Demonstrating Effects in a Prospective Controlled Intervention Trial. Oncol Ther 2024; 12:345-362. [PMID: 38744750 PMCID: PMC11187047 DOI: 10.1007/s40487-024-00278-3] [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: 02/26/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of oncology and palliative care services would result in more time spent at home during end-of-life. METHODS A prospective non-randomized intervention trial was conducted in two rural regions of Mid-Norway. The hospitals' oncology and palliative care outpatient clinics and surrounding communities participated. An intervention including information, education, and a standardized care pathway was developed and implemented. Adult non-curative patients with cancer were eligible. Proportion of last 90 days of life spent at home was the primary outcome. RESULTS We included 129 patients in the intervention group (I) and 76 patients in the comparison group (C), of whom 82% of patients in I and 78% of patients in C died during follow-up. The mean proportion of last 90 days of life spent at home was 0.62 in I and 0.72 in C (p = 0.044), with 23% and 36% (p = 0.073), respectively, dying at home. A higher proportion died at home in both groups compared to pre-study level (12%). During the observation period the comparison region developed and implemented an alternative intervention to the study intervention, with the former more focused on end-of-life care. CONCLUSION A higher proportion of patients with cancer died at home in both groups compared to pre-study level. Patients with cancer in I did not spend more time at home during end-of-life compared to those in C. The study intervention focused on the whole disease trajectory, while the alternative intervention was more directed towards end-of-life care. "Simpler" and more focused interventions on end-of-life care may be relevant for future studies on integration of palliative care into oncology. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02170168.
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Affiliation(s)
- Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jo-Åsmund Lund
- Department of Oncology, Møre Og Romsdal Hospital Trust, Ålesund, Norway
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bardo Driller
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, Møre Og Romsdal Hospital Trust, Ålesund, Norway
- Department for Research and Innovation, Møre Og Romsdal Hospital Trust, Ålesund, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Sullivan DR, Jones KF, Wachterman MW, Griffin HL, Kinder D, Smith D, Thorpe J, Feder SL, Ersek M, Kutney-Lee A. Opportunities to Improve End-of-Life Care Quality among Patients with Short Terminal Admissions. J Pain Symptom Manage 2024:S0885-3924(24)00789-9. [PMID: 38810950 DOI: 10.1016/j.jpainsymman.2024.05.020] [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] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
CONTEXT Little is known about Veterans who die during a short terminal admission, which renders them ineligible for the Department of Veterans Affairs (VA) Bereaved Family Survey. OBJECTIVES We sought to describe this population and identify opportunities to improve end-of-life (EOL) care quality. METHODS Retrospective, cohort analysis of Veteran decedents who died in a VA inpatient setting between October 2018-September 2019. Veterans were dichotomized by short (<24 hours) and long (≥24 hours) terminal admissions; sociodemographics, clinical characteristics, VA and non-VA healthcare use, and EOL care quality indicators were compared. RESULTS Among 17,033 inpatient decedents, 723 (4%) had short terminal admissions. Patients with short compared to long terminal admissions were less likely to have a VA hospitalization (38% vs. 54%) in the last 90 days of life and were more likely to die in an intensive care (49% vs 21%) or acute care (27% vs 18%) unit. Patients with a short compared to long admission were about half as likely to receive hospice (33% vs 64%) or palliative care (33% vs 69%). Most patients with short admissions (76%) had a life-limiting condition (e.g., cancer, chronic obstructive pulmonary disease) and those with cancer were more likely to receive palliative care compared to those with non-cancer conditions. CONCLUSION Veterans with short terminal admissions are less likely to receive hospice or palliative care compared to patients with long terminal admissions. Many patients with short terminal admissions, such as those with life-limiting conditions (especially cancer), receive aspects of high-quality EOL care, however, opportunities for improvement exist.
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Affiliation(s)
- Donald R Sullivan
- Department of Medicine (D.R.S.), Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland Oregon, USA; Center to Improve Veteran Involvement in Care (D.R.S.), Portland Veteran Affairs Healthcare System, Portland Oregon, USA.
| | - Katie F Jones
- New England Geriatric Research Education and Clinical Center (K.F.J.), Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA; Department of Medicine (K.F.J.), Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa W Wachterman
- Section of General Internal Medicine (M.W.), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA; Division of General Internal Medicine (M.W.), Brigham and Women's Hospital, Boston MA, USA; Department of Psychosocial Oncology and Palliative Care (M.W.), Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hilary L Griffin
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kinder
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Dawn Smith
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Thorpe
- Center for Health Equity Research and Promotion (J.M.T.), Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA; University of North Carolina School of Pharmacy (J.M.T.), Chapel Hill, North Carolina, USA
| | - Shelli L Feder
- Yale University School of Nursing (S.L.F.), Orange, Connecticut, USA; West Haven Department of Veterans Affairs (S.L.F.), West Haven, Connecticut, USA
| | - Mary Ersek
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Leonard Davis Institute (M.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Veteran Experience Center (H.G., D.K., D.G., M.E., A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Center for Health Equity and Research Promotion (A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania (A.K.L.), School of Nursing, Philadelphia, Pennsylvania, USA
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17
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Kasdorf A, Voltz R, Strupp J. Dying at home: What is needed? Findings from a nationwide retrospective cross-sectional online survey of bereaved people in Germany. Palliat Support Care 2024:1-9. [PMID: 38533612 DOI: 10.1017/s1478951524000440] [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: 03/28/2024]
Abstract
OBJECTIVES According to the "Last Year of Life in Cologne" study, 68% of patients with a serious and terminal illness wanted to die at home, but 42% died in hospital. Only 1 in 5 died at home. Most people want to spend their last days and hours at home, but the reality is that this is not always possible. Recommendations are needed on how best to support families to enable people to die at home - if this is their preferred place of death. Our aim was to identify the factors that make it possible for people to die at home and to analyze factors of dying at home. METHODS Germany-wide quantitative cross-sectional online survey of bereaved adult relatives. RESULTS The needs of 320 relatives of patients who wished to die at home were explored. Of these, 198 patients died at home and 122 did not. In the last 3 months of life, caregivers needed support in managing out-of-hours care (p < 0.001), financing (p = 0.012), preparing and organizing home care (both p < 0.001), communicating with the patient and medical staff (p = 0.012 and p = 0.009, respectively), and pain management (p < 0.001). Relatives whose next of kin did not die at home had higher needs, suggesting that these factors are key to home care of the dying. SIGNIFICANCE OF RESULTS The process of dying at home begins long before the actual dying phase. To minimize caregiver burden and improve symptom management, advanced home care plans are needed, with ongoing reassessment of family preferences and abilities.
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Affiliation(s)
- Alina Kasdorf
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Health Services Research, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Julia Strupp
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
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18
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Goodrich J, Watson C, Gaczkowska I, Harding R, Evans C, Firth A, Murtagh FE. Understanding patient and family utilisation of community-based palliative care services out-of-hours: Additional analysis of systematic review evidence using narrative synthesis. PLoS One 2024; 19:e0296405. [PMID: 38381768 PMCID: PMC10880966 DOI: 10.1371/journal.pone.0296405] [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: 05/04/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Community-based out-of-hours services are an integral component of end-of-life care. However, there is little understanding of how patients and families utilise these services. This additional analysis of a systematic review aims to understand and identify patterns of out-of-hours service use and produce recommendations for future service design. METHOD Data on service use was extracted and secondary analysis undertaken, from a systematic review of models of community out-of-hours services. Narrative synthesis was completed, addressing four specific aspects of service use: 1.Times when patients/families/healthcare professionals need to contact out-of-hours services; 2. Who contacts out-of-hours services; 3. Whether a telephone call, centre visit or home visit is provided; 4. Who responds to out-of-hours calls. RESULTS Community-based out-of-hours palliative care services were most often accessed between 5pm and midnight, especially on weekdays (with reports of 69% of all calls being made out-of-hours). Family members and carers were the most frequent callers to of the services (making between 60% and 80% of all calls). The type of contact (telephone, centre visit or home visit) varied based on what was offered and on patient need. Over half of services were led by a single discipline (nurse). CONCLUSIONS Out-of-hours services are highly used up to midnight, and particularly by patients' family and carers. Recommendations to commissioners and service providers are to: • Increase provision of out-of-hours services between 5pm and midnight to reflect the increased use at these times. • Ensure that family and carers are provided with clear contact details for out-of-hours support. • Ensure patient records can be easily accessed by health professionals responding to calls, making the triage process easier. • Listen to patients, family and carers in the design of out-of-hours services, including telephone services. • Collect data systematically on out-of-hours-service use and on outcomes for patients who use the service.
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Affiliation(s)
- Joanna Goodrich
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Caleb Watson
- King’s College London Medical School, London, United Kingdom
| | - Inez Gaczkowska
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Richard Harding
- King’s College London Medical School, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Angelo M, Souder A, Poole A, Mirsch T, Souder E. Cost Reduction and Utilization Patterns in a Medicare Accountable Care Organization Using Home-Based Palliative Care Services. Popul Health Manag 2024; 27:55-59. [PMID: 38011716 DOI: 10.1089/pop.2023.0224] [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] [Indexed: 11/29/2023] Open
Abstract
Accountable care organizations (ACOs) are often tasked with helping providers to deliver care efficiently and with higher quality outcomes. For an ACO to succeed in delivering efficient care, it is important to direct resources toward patients who exhibit the greatest levels of opportunity while focusing attention toward mitigating their needs. Home-based palliative care (HBPC) services are known to address patient needs for those with serious illness while decreasing the total cost of care (TCC). In this retrospective review, ACO researchers reviewed cost, quality, and utilization patterns for 3418 beneficiaries within a Medicare Shared Saving Program approaching the end of life comparing decedents who received HBPC versus those who did not receive the service. Those individuals who received HBPC services were significantly less likely to be hospitalized (51% reduction in the HBPC group), more likely to use hospice (70% vs. 43%; P = 0.001), and their TCC was less than that of those who did not receive the service ($27,203 vs. $36,089: P = 0.0163). Although more research needs to be done to understand the specific components of care delivery that are helpful in decreasing unnecessary utilization, in this retrospective review in an accountable care population, HBPC is associated with a significant decrease in cost and utilization in a population approaching end of life.
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Affiliation(s)
- Mark Angelo
- Supportive Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Delaware Valley ACO, Humana Inc., Louisville, Kentucky, USA
| | | | - Angela Poole
- Delaware Valley ACO, Humana Inc., Louisville, Kentucky, USA
| | - Terre Mirsch
- Main Line Health System, HomeCare and Hospice, Radnor, Pennsylvania, USA
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20
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Nysaeter TM, Olsson C, Sandsdalen T, Hov R, Larsson M. Family caregivers' preferences for support when caring for a family member with cancer in late palliative phase who wish to die at home - a grounded theory study. BMC Palliat Care 2024; 23:15. [PMID: 38212707 PMCID: PMC10782637 DOI: 10.1186/s12904-024-01350-5] [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: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Family caregivers are essential in end-of-life care for cancer patients who wish to die at home. The knowledge is still limited regarding family caregivers needs and preferences for support and whether the preferences change during the patient's illness trajectory. Therefore, the aim was to explore family caregivers' preferences for support from home care services over time when caring for a family member with cancer at the end of life who wished to die at home. METHODS A qualitative method was applied according to Grounded Theory. Data was collected longitudinally over the illness trajectory by means of repeated individual interviews (n = 22) with adult family caregivers (n = 11). Sampling, data collection and data analysis were undertaken simultaneously in line with the constant comparative method. RESULTS The findings are captured in the core category "hold out in duty and love". The categories "having control and readiness for action" and "being involved in care" describe the family caregivers' preferences for being prepared and able to handle procedures, medical treatment and care, and to be involved by the healthcare personnel in the patient's care and decision making. The categories "being seen and confirmed" and "having a respite" describe family caregivers' preferences for support according to their own needs to be able to persevere in the situation. CONCLUSION Despite deterioration in the patient's illness and the increasing responsibility family caregiver struggle to hold out and focus on being in the present. Over time together with deterioration in the patient's illness and changes in the situation, they expressed a need for more intense and extensive support from the home care services. To meet the family caregivers' preferences for support a systematic implementation of a person-centred care model and multicomponent psycho- educational interventions performed by nurses can be proposed. Moreover, we suggest developing a tool based on the conceptual model generated in this study to identify and map family caregivers' needs and preferences for support. Such a tool can facilitate communication and ensure person-centred interventions.
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Affiliation(s)
- Toril Merete Nysaeter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
- Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
- Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Hamar, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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21
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Agar M, Xuan W, Lee J, Barclay G, Oloffs A, Jobburn K, Harlum J, Maurya N, Chow JSF. Longitudinal symptom profile of palliative care patients receiving a nurse-led end-of-life (PEACH) programme to support preference to die at home. BMJ Open 2024; 14:e058448. [PMID: 38167283 PMCID: PMC10773358 DOI: 10.1136/bmjopen-2021-058448] [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: 11/05/2022] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Tailored models of home-based palliative care aimed to support death at home, should also ensure optimal symptom control. This study aimed to explore symptom occurrence and distress over time in Palliative Extended And Care at Home (PEACH) model of care recipients. DESIGN This was a prospective cohort study. SETTING AND PARTICIPANTS Participants were consecutive recipients of the PEACH rapid response nurse-led model of care in metropolitan Sydney (December 2013-January 2017) who were in the last weeks of life with a terminal or deteriorating phase of illness and had a preference to be cared or die at home. OUTCOME MEASURES Deidentified data including sociodemographic and clinical characteristics, and symptom distress scores (Symptom Assessment Score) were collected at each clinical visit. Descriptive statistics and forward selection logistic regression analysis were used to explore influence of symptom distress levels on mode of separation ((1) died at home while still receiving a PEACH package, (2) admitted to a hospital or an inpatient palliative care unit or (3) discharged from the package (alive and no longer requiring PEACH)) across four symptom distress level categories. RESULTS 1754 consecutive clients received a PEACH package (mean age 70 years, 55% male). 75.7% (n=1327) had a home death, 13.5% (n=237) were admitted and 10.8% (n=190) were still alive and residing at home when the package ceased. Mean symptom distress scores improved from baseline to final scores in the three groups (p<0.0001). The frequency of no symptom distress score (0) category was higher in the home death group. Higher scores for nausea, fatigue, insomnia and bowel problems were independent predictors of who was admitted. CONCLUSION Tailored home-based palliative care models to meet preference to die at home, achieve this while maintaining symptom control. A focus on particular symptoms may further optimise these models of care.
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Affiliation(s)
- Meera Agar
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Wei Xuan
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Jessica Lee
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Gregory Barclay
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Alan Oloffs
- Nepean Blue Mountains Local Health District, Nepean, New South Wales, Australia
| | - Kim Jobburn
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Janeane Harlum
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Nutan Maurya
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Josephine Sau Fan Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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22
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Miles A, Brady A, Friary P, Sekula J, Wallis C, Jackson B. Implementing an interprofessional palliative care education program to speech-language therapy and dietetic students. J Interprof Care 2023; 37:964-973. [PMID: 37161383 DOI: 10.1080/13561820.2023.2203731] [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: 10/13/2022] [Revised: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Palliative care education for allied health professionals has received minimal research attention. This longitudinal study followed the development of an education program for speech-language therapy (SLT) and dietetic (DT) students. The project comprised three stages. In Stage I, consenting SLT and DT graduates (n = 9) were interviewed 6 months after graduation exploring preparedness for working in palliative care. Interviews were transcribed, and topics were extracted through content analysis. In Stage II, a new palliative care curriculum was developed using the extant literature and gaps reported in Stage I. In Stage III, we implemented and evaluated the new curriculum. Students were surveyed before (n = 68) and after (n = 42) the new program and at 6-month post-graduation (n = 15) to capture student-reported changes in knowledge and confidence in palliative care. In Stage I, 10 topics were developed covering knowledge, roles, team, family-focused care, and feelings. In Stage II, a hybrid program was developed including e-learning modules, didactic lectures, and a simulated learning experience. In Stage III, student feedback demonstrated positive shifts in knowledge and confidence ratings from medians 3-6 to 5-8 (1 = none; 10 = excellent) across all domains. Gains in knowledge and confidence were consistently higher at 6-month post-graduation for final survey respondents. Mixed modality interprofessional palliative care education for allied health professionals has merit in improving knowledge, confidence, and perceived preparedness for practice.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Alana Brady
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Philippa Friary
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Julia Sekula
- Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Clare Wallis
- Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Bianca Jackson
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
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23
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Liu JH, Shih CY, Huang HL, Peng JK, Cheng SY, Tsai JS, Lai F. Evaluating the Potential of Machine Learning and Wearable Devices in End-of-Life Care in Predicting 7-Day Death Events Among Patients With Terminal Cancer: Cohort Study. J Med Internet Res 2023; 25:e47366. [PMID: 37594793 PMCID: PMC10474512 DOI: 10.2196/47366] [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: 03/17/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND An accurate prediction of mortality in end-of-life care is crucial but presents challenges. Existing prognostic tools demonstrate moderate performance in predicting survival across various time frames, primarily in in-hospital settings and single-time evaluations. However, these tools may fail to capture the individualized and diverse trajectories of patients. Limited evidence exists regarding the use of artificial intelligence (AI) and wearable devices, specifically among patients with cancer at the end of life. OBJECTIVE This study aimed to investigate the potential of using wearable devices and AI to predict death events among patients with cancer at the end of life. Our hypothesis was that continuous monitoring through smartwatches can offer valuable insights into the progression of patients at the end of life and enable the prediction of changes in their condition, which could ultimately enhance personalized care, particularly in outpatient or home care settings. METHODS This prospective study was conducted at the National Taiwan University Hospital. Patients diagnosed with cancer and receiving end-of-life care were invited to enroll in wards, outpatient clinics, and home-based care settings. Each participant was given a smartwatch to collect physiological data, including steps taken, heart rate, sleep time, and blood oxygen saturation. Clinical assessments were conducted weekly. The participants were followed until the end of life or up to 52 weeks. With these input features, we evaluated the prediction performance of several machine learning-based classifiers and a deep neural network in 7-day death events. We used area under the receiver operating characteristic curve (AUROC), F1-score, accuracy, and specificity as evaluation metrics. A Shapley additive explanations value analysis was performed to further explore the models with good performance. RESULTS From September 2021 to August 2022, overall, 1657 data points were collected from 40 patients with a median survival time of 34 days, with the detection of 28 death events. Among the proposed models, extreme gradient boost (XGBoost) yielded the best result, with an AUROC of 96%, F1-score of 78.5%, accuracy of 93%, and specificity of 97% on the testing set. The Shapley additive explanations value analysis identified the average heart rate as the most important feature. Other important features included steps taken, appetite, urination status, and clinical care phase. CONCLUSIONS We demonstrated the successful prediction of patient deaths within the next 7 days using a combination of wearable devices and AI. Our findings highlight the potential of integrating AI and wearable technology into clinical end-of-life care, offering valuable insights and supporting clinical decision-making for personalized patient care. It is important to acknowledge that our study was conducted in a relatively small cohort; thus, further research is needed to validate our approach and assess its impact on clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT05054907; https://classic.clinicaltrials.gov/ct2/show/NCT05054907.
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Affiliation(s)
- Jen-Hsuan Liu
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Shih
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
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24
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Hamano J, Takeuchi A, Mori M, Saitou Y, Yamaguchi T, Miyata N, Shimizu M, Yamamoto R, Kimura Y, Kamiyama Y, Arai Y, Matsuo H, Shishido H, Nakano K, Nishi T, Nagaoka H, Yokomichi N, Maeda I, Yamaguchi T, Morita T, Shinjo T. Comparison of survival times of advanced cancer patients with palliative care at home and in hospital. PLoS One 2023; 18:e0284147. [PMID: 37053183 PMCID: PMC10101528 DOI: 10.1371/journal.pone.0284147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES One primary concern about receiving care at home is that survival might be shortened because the quality and quantity of treatment provided at home will be inferior to that given in the hospital. Although our previous study demonstrated a longer survival of those with home-based palliative care (PC), it lacked adjustment for some potential confounders including symptoms and treatments during the stay. We aimed to compare the survival times among advanced cancer patients receiving home-based and hospital-based PC with adjusting for symptoms and treatments. METHOD We compared survival time of participants who enrolled two multicenter, prospective cohort studies of advanced cancer patients at 45-home-based PC services between July 2017 and December 2017, and at 23-hospital-based PC services between January 2017 and December 2017. We analyzed with stratification by the estimated survival of Days, Weeks, and Months, which were defined by modified Prognosis in Palliative care Study predictor models-A. We conducted a Cox regression analysis with adjusting for potential confounders including symptoms and treatments during the stay. RESULTS A total of 2,998 patients were enrolled in both studies and 2,878 patients were analyzed; 988 patients receiving home-based PC and 1,890 receiving hospital-based PC. The survival time of patients receiving home-based PC was significantly longer than that of patients receiving hospital-based PC for the Days Prognosis (estimated median survival time: 10 days [95% CI 8.1-11.8] vs. 9 days [95% CI 8.3-10.4], p = 0.157), the Weeks prognosis (32 days [95% CI 28.9-35.4] vs. 22 days [95% CI 20.3-22.9], p < 0.001), and the Months Prognosis, (65 days [95% CI 58.2-73.2] vs. 32 days [95% CI 28.9-35.4], p < 0.001). CONCLUSION In this cohort of advanced cancer patients with a Weeks or Months prognosis, those receiving home-based PC survived longer than those receiving hospital-based PC after adjusting for symptoms and treatments.
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Affiliation(s)
- Jun Hamano
- Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | | | | | | | - Ryo Yamamoto
- Saku Central Hospital Advanced Care Center, Saku-shi, Nagano, Japan
| | | | | | | | | | | | | | - Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroka Nagaoka
- Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Takashi Yamaguchi
- Department of Medicine, Division of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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