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Maniam R, Tan MP, Chong MC. End of life care preference among hemodialysis population: Revisit Q methodology. PATIENT EDUCATION AND COUNSELING 2022; 105:1495-1502. [PMID: 34625322 DOI: 10.1016/j.pec.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. METHODS The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. RESULTS Four-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. CONCLUSIONS End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. PRACTICE IMPLICATION Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.
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Affiliation(s)
- Radha Maniam
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Ora L, Mannix J, Morgan L, Gregory L, Luck L, Wilkes L. Chronic obstructive pulmonary disease and advance care planning: A synthesis of qualitative literature on patients' experiences. Chronic Illn 2022; 18:221-233. [PMID: 33573389 DOI: 10.1177/1742395321990109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Advance Care Planning supports patients to share their personal values, goals, and preferences for future medical care with their family members and healthcare professionals. The aim of this review was to uncover what is known about patients with Chronic Obstructive Pulmonary Disease and their experiences with Advance Care Planning. METHODS A systematic review and thematic synthesis of qualitative studies was undertaken. Five databases were searched for qualitative articles published between 2009-2019. The review was guided by the PRISMA framework and seven studies met the eligibility criteria. Thematic synthesis of descriptive themes in each article was undertaken to develop overarching analytical themes, related to the experience of patients with Chronic Obstructive Pulmonary Disease and Advance Care Planning. RESULTS Four analytical themes emerged from the review of the articles that met the inclusion criteria: patient readiness and willingness for Advance Care Planning discussions; considering the future; trusted relationships with healthcare professionals; and shared decision making. DISCUSSION Patients with Chronic Obstructive Pulmonary Disease are generally open to Advance Care Planning discussions with healthcare professionals who are well-informed, and trusted by the patient. Models of care that integrate Advance Care Planning are beneficial in other non-malignant settings, and may be a way forward to support Advance Care Planning as part of routine care for patients with Chronic Obstructive Pulmonary Disease.
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Affiliation(s)
- Linda Ora
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Judy Mannix
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord and Nepean Clinical Schools, Concord Hospital and Nepean Hospital, University of Sydney, NSW, Australia
| | - Linda Gregory
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Lauretta Luck
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Lesley Wilkes
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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3
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Meehan E, Foley T, Kelly C, Burgess Kelleher A, Sweeney C, Hally RM, Detering K, Cornally N. Advance Care Planning for Individuals With Chronic Obstructive Pulmonary Disease: A Scoping Review of the Literature. J Pain Symptom Manage 2020; 59:1344-1361. [PMID: 31837455 DOI: 10.1016/j.jpainsymman.2019.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
CONTEXT Individuals with chronic obstructive pulmonary disease (COPD) typically experience a gradual worsening of the illness in the years before death. Owing to difficulties in predicting the disease trajectory or the timing of acute exacerbations, advance care planning (ACP) may be of particular importance for individuals with COPD. OBJECTIVES The objective of this study was to review and summarize the available literature on current practices around ACP in COPD. METHODS A scoping review of the literature was conducted following the Arksey and O'Malley framework. Original research studies of any design were included. RESULTS Twenty-eight studies were included. Across studies, there was agreement that ACP should be incorporated into routine COPD management. There was evidence that this does not occur in everyday practice, with conversations tending to focus on day-to-day symptom management. Barriers included prognosis uncertainty, insufficient time and training, and a lack of protocols for who is responsible for initiating ACP. Facilitators included the use of transition points for identifying the appropriate time to initiate ACP, and an increased focus on ACP in professional education. The occurrence of repeated episodes of acute care was identified as a key transition point for identifying the palliative stage of COPD and an appropriate time to initiate ACP. CONCLUSION The findings of this review confirm agreement among health care professionals and patients with COPD and their carers that ACP should be incorporated into routine COPD management. The use of transition points may help health care professionals overcome the barrier of prognosis uncertainty and identify patients who might benefit from ACP.
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Affiliation(s)
- Elaine Meehan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Tony Foley
- School of Medicine, University College Cork, Cork, Ireland
| | - Claire Kelly
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | | | - Ruth M Hally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Karen Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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Sinclair C, Auret KA, Evans SF, Jane F, Dormer S, Wilkinson A, Greeve K, Koay MA, Brims F. Impact of a Nurse-Led Advance Care Planning Intervention on Satisfaction, Health-Related Quality of Life, and Health Care Utilization Among Patients With Severe Respiratory Disease: A Randomized Patient-Preference Trial. J Pain Symptom Manage 2020; 59:848-855. [PMID: 31790750 DOI: 10.1016/j.jpainsymman.2019.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022]
Abstract
CONTEXT Previous work has found that facilitated advance care planning (ACP) interventions are effective in increasing ACP uptake among patients with severe respiratory disease. OBJECTIVES The objective of this study was to investigate whether a nurse-led, facilitated ACP intervention among participants with severe respiratory disease impacts self-reported or clinical outcomes. METHODS A multicenter, open-label, patient-preference, randomized controlled trial of a nurse-led facilitated ACP intervention was performed. Outcome measures included self-report scales (health care satisfaction and EQ-5D-5L health-related quality of life at three- and six-month follow-up), 12-month mortality, and health care utilization during the final 90 days of life. RESULTS One hundred forty-nine participants were recruited across two study settings (metropolitan tertiary hospital respiratory department and rural sites) and 106 were allocated to receive the ACP intervention. There was no effect of the intervention on satisfaction with health care, health-related quality of life, or 12-month mortality rates. Among those participants who died during the follow-up period (N = 54), those allocated to the ACP intervention had significantly fewer outpatient consultations (7.51 vs. 13.6, P < 0.001). There were no changes in emergency department attendances, total hospital admissions or length of stay, or home nursing visits. Among those allocated to the ACP intervention, there was a reduced length of stay in acute hospital settings (7.76 vs. 11.5 nights, P < 0.001) and increased length of stay in palliative hospital settings (5.54 vs. 2.08, P < 0.001) during the final 90 days of life. CONCLUSION A facilitated ACP intervention among patients with severe respiratory disease did not have an impact on satisfaction, health-related quality of life, or 12-month mortality rate. Facilitated ACP may be associated with a different type of health care utilization during the end-of-life period.
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Affiliation(s)
| | | | | | - Fiona Jane
- University of Western Australia, Perth, WA, Australia
| | | | | | - Kim Greeve
- Department of Health Western Australia, Perth, WA, Australia
| | - M Audrey Koay
- Department of Health Western Australia, Perth, WA, Australia
| | - Fraser Brims
- Sir Charles Gairdner Hospital, Perth, WA, Australia
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Skorstengaard MH, Brogaard T, Jensen AB, Andreassen P, Bendstrup E, Løkke A, Aagaard S, Wiggers H, Johnsen AT, Neergaard MA. Advance care planning for patients and their relatives. Int J Palliat Nurs 2019; 25:112-127. [PMID: 30892997 DOI: 10.12968/ijpn.2019.25.3.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advance care planning (ACP) has been suggested to improve the quality of life (QoL) and mental wellbeing in severely ill patients and their relatives. AIM To investigate the effects of ACP among patients with lung, heart and cancer diseases with an estimated life-span of up to 12 months. METHODS Patients and relatives were randomised into two groups: one receiving usual care and one receiving ACP and usual care. Themes from the ACP discussion were documented in patients' electronic medical file. Participants completed self-reported questionnaires four to five weeks after randomisation. FINDINGS In total, 141 patients and 127 relatives participated. No significant differences were found according to outcomes. However, patients with non-malignant diseases had the highest level of anxiety and depression; these patients seemed to benefit the most from ACP, though not showing statistically significant results. CONCLUSION No significant effects of ACP among patients with lung, heart, and cancer diseases and their relatives regarding HRQoL, anxiety, depression, and satisfaction with healthcare were found.
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Affiliation(s)
| | - Trine Brogaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Denmark
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Anders Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Susanne Aagaard
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Anna Thit Johnsen
- Department of Palliative Medicine, the Research Unit, Bispebjerg Hospital, Copenhagen University Hospital, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mette Asbjoern Neergaard
- Associate professor, Department of Oncology, Aarhus University Hospital, Denmark, The Palliative Care Team, Department of Oncology, Aarhus University Hospital, Denmark
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Abstract
The prevalence of urinary incontinence increases as a person ages, as age-related changes make it more difficult to maintain continence. Long-term conditions and treatments prescribed to treat conditions, such as heart failure, can lead to an urgency to void the bladder. Frailty can make it difficult for an older person to respond this need. At end of life, mobility is often compromised and people can experience extreme fatigue. Caregivers can obtain support to manage an individual's incontinence during the day but often struggle alone at night. Caregivers can become exhausted and a situation can reach breaking point. Working with the older person and caregivers to determine the goals of care and how to meet them can make a huge difference. It can take the pressure off the entire family, meet a person's needs and enable the person to stay at home. This article aims to enable nurses to understand the problems older people may experience and how to work with the older person and caregivers to develop solutions that maintain dignity and enhance quality of life.
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Affiliation(s)
- Linda Nazarko
- Consultant nurse, physical healthcare, West London Mental Health Trust
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Gardener AC, Ewing G, Kuhn I, Farquhar M. Support needs of patients with COPD: a systematic literature search and narrative review. Int J Chron Obstruct Pulmon Dis 2018; 13:1021-1035. [PMID: 29628760 PMCID: PMC5877489 DOI: 10.2147/copd.s155622] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Understanding the breadth of patients’ support needs is important for the delivery of person-centered care, particularly in progressive long-term conditions such as chronic obstructive pulmonary disease (COPD). Existing reviews identify important aspects of managing life with COPD with which patients may need support (support needs); however, none of these comprehensively outlines the full range of support needs that patients can experience. We therefore sought to systematically determine the full range of support needs for patients with COPD to inform development of an evidence-based tool to enable person-centered care. Methods We conducted a systematic search and narrative review of the literature. Medline (Ovid), EMBASE, PsycINFO, Cochrane Library, and CINAHL were systematically searched for papers which included data addressing key aspects of support need, as identified by patients with COPD. Relevant data were extracted, and a narrative analysis was conducted. Results Thirty-one papers were included in the review, and the following 13 domains (broad areas) of support need were identified: 1) understanding COPD, 2) managing symptoms and medication, 3) healthy lifestyle, 4) managing feelings and worries, 5) living positively with COPD, 6) thinking about the future, 7) anxiety and depression, 8) practical support, 9) finance work and housing, 10) families and close relationships, 11) social and recreational life, 12) independence, and 13) navigating services. These 13 domains of support need were mapped to three of the four overarching categories of need commonly used in relevant national strategy documents (ie, physical, psychological, and social); however, support needs related to the fourth category (spiritual) were notably absent. Conclusion This review systematically identifies the comprehensive set of domains of support need for patients with COPD. The findings provide the evidence base for a tool to help patients identify and express their support needs, which underpins a proposed intervention to enable the delivery of person-centered care: the Support Needs Approach for Patients (SNAP).
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Affiliation(s)
- A Carole Gardener
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- University of Cambridge Medical School Library, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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Jabbarian LJ, Zwakman M, van der Heide A, Kars MC, Janssen DJA, van Delden JJ, Rietjens JAC, Korfage IJ. Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices. Thorax 2017; 73:222-230. [DOI: 10.1136/thoraxjnl-2016-209806] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 08/22/2017] [Accepted: 09/18/2017] [Indexed: 11/04/2022]
Abstract
BackgroundAdvance care planning (ACP) supports patients in identifying and documenting their preferences and timely discussing them with their relatives and healthcare professionals (HCPs). Since the British Thoracic Society encourages ACP in chronic respiratory disease, the objective was to systematically review ACP practice in chronic respiratory disease, attitudes of patients and HCPs and barriers and facilitators related to engagement in ACP.MethodsWe systematically searched 12 electronic databases for empirical studies on ACP in adults with chronic respiratory diseases. Identified studies underwent full review and data extraction.ResultsOf 2509 studies, 21 were eligible: 10 were quantitative studies. Although a majority of patients was interested in engaging in ACP, ACP was rarely carried out. Many HCPs acknowledged the importance of ACP but were hesitant to initiate it. Barriers to engagement in ACP were the complex disease course of patients with chronic respiratory diseases, HCPs’ concern of taking away patients’ hopes and lack of continuity of care. The identification of trigger points and training of HCPs on how to communicate sensitive topics were identified as facilitators to engagement in ACP.ConclusionsIn conclusion, ACP is surprisingly uncommon in chronic respiratory disease, possibly due to the complex disease course of chronic respiratory diseases and ambivalence of both patients and HCPs to engage in ACP. Providing patients with information about their disease can help meeting their needs. Additionally, support of HCPs through identification of trigger points, training and system-related changes can facilitate engagement in ACP.Systematic review registration numberCRD42016039787.
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9
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Sinclair C, Auret KA, Evans SF, Williamson F, Dormer S, Wilkinson A, Greeve K, Koay A, Price D, Brims F. Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention. BMJ Open 2017; 7:e013415. [PMID: 28237955 PMCID: PMC5337715 DOI: 10.1136/bmjopen-2016-013415] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. DESIGN A multicentre open-label randomised controlled trial with preference arm. SETTING Metropolitan teaching hospital and a rural healthcare network. PARTICIPANTS 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. INTERVENTION Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). OUTCOME MEASURES The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. RESULTS At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. CONCLUSIONS Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake. TRIAL REGISTRATION NUMBER ACTRN12614000255684.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Kirsten Anne Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Sharon Frances Evans
- Rural Clinical School of Western Australia, University of Western Australia,Perth, Western Australia, Australia
| | - Fiona Williamson
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Siobhan Dormer
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne Wilkinson
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Kim Greeve
- Department of Health, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Audrey Koay
- Department of Health, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Dot Price
- Western Australian Country Health Service, District Health Advisory Committee, Albany, Western Australia, Australia
| | - Fraser Brims
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Wong JSH, Gottwald M. Advance Care Planning Discussions in Chronic Obstructive Pulmonary Disease: A critical review. J Palliat Care 2016; 31:258-64. [PMID: 26856127 DOI: 10.1177/082585971503100408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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"The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories. Palliat Support Care 2014; 13:1213-22. [PMID: 25315360 DOI: 10.1017/s1478951514001151] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives. METHOD Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis. RESULT All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable. SIGNIFICANCE OF RESULTS The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.
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