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Dogan V, Taneska M, Novotni G, Iloski S, Novotni A, Dimitrova V, Milutinović M, Novotni L, Weber A, Joksimoski B, Chorbev I, Hasani S, Ivanovska A, Grimmer T, Fischer J. On dementia, duties, and daughters. An ethical analysis of healthcare professionals being confronted with conflicts regarding filial duties in informal dementia care. Front Psychiatry 2024; 15:1421582. [PMID: 39415892 PMCID: PMC11480755 DOI: 10.3389/fpsyt.2024.1421582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/12/2024] [Indexed: 10/19/2024] Open
Abstract
Background Existing literature on moral conflicts that healthcare professionals encounter in dementia care has explored, amongst others, issues related to autonomy, decision-making capacity, privacy, and more. Notably, conflicts related to healthcare professionals who support informal dementia caregiving and who are confronted with family members being overburdened with their care responsibly remains an underexplored topic in the current literature, particularly in the context of Low-and Middle-Income Countries. The present paper introduces such an encounter, presenting an ethical case analysis of a conflict that occurred during a larger research project conducted in North Macedonia. Case to be studied Due to the absence of formal care services that could have relieved an overburdened family caregiver, healthcare professionals felt compelled to reach out to the uninvolved adult daughters, requesting them to participate in their parents' care. Wondering about whether their reaching out to the daughters might count as an attempt of pressure and undue interference, professionals conflicted over the appropriateness of their action. This paper follows up on their concern, ethically assessing the professionals' action. To answer the question on whether the healthcare professionals acted appropriately or not, and to what extent, theories of filial duties are applied, embedding their action in the larger context of dementia care in North Macedonia. Results and conclusion It is argued that the lack of formal care services in North Macedonia is of utmost relevance to the conflict. Thus, the conclusion is that the ethical inappropriateness of the case is to be located not so much with the action of the healthcare professionals but with the state because of its failure to provide professional care services that allow healthcare professionals to take ethically sound actions to counteract overarching burdens that family members face when providing informal dementia care.
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Affiliation(s)
- Vildan Dogan
- Clinic for Psychiatry and Psychotherapy, Center for Cognitive Disorders, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Marija Taneska
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
| | - Gabriela Novotni
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
- Faculty of Medicine, University Cyril and Methodius, Skopje, North Macedonia
| | - Svetlana Iloski
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
| | - Antoni Novotni
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
- Faculty of Medicine, University Cyril and Methodius, Skopje, North Macedonia
| | - Vesna Dimitrova
- Faculty of Computer Science and Engineering, University Cyril and Methodius, Skopje, North Macedonia
| | - Miloš Milutinović
- Faculty of Medicine, University Cyril and Methodius, Skopje, North Macedonia
| | - Ljubisha Novotni
- Faculty of Medicine, University Cyril and Methodius, Skopje, North Macedonia
| | - Anne Weber
- Hannover Institute for Philosophical Research, Hannover, Germany
| | - Boban Joksimoski
- Faculty of Computer Science and Engineering, University Cyril and Methodius, Skopje, North Macedonia
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, University Cyril and Methodius, Skopje, North Macedonia
| | - Shpresa Hasani
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
| | - Andrea Ivanovska
- Institute for Alzheimer’s Disease and Neuroscience, Skopje, North Macedonia
| | - Timo Grimmer
- Clinic for Psychiatry and Psychotherapy, Center for Cognitive Disorders, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Julia Fischer
- Clinic for Psychiatry and Psychotherapy, Center for Cognitive Disorders, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Johnson MJ, Currow DC, Chynoweth J, Weatherly H, Keser G, Hutchinson A, Jones A, Dunn L, Allgar V. The cost of providing care by family and friends (informal care) in the last year of life: A population observational study. Palliat Med 2024; 38:725-736. [PMID: 38907630 DOI: 10.1177/02692163241259649] [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] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Little is known about replacement costs of care provided by informal carers during the last year of life for people dying of cancer and non-cancer diseases. AIM To estimate informal caregiving costs and explore the relationship with carer and decedent characteristics. DESIGN National observational study of bereaved carers. Questions included informal end-of-life caregiving into the 2017 Health Survey for England including estimated recalled frequency, duration and intensity of care provision. We estimated replacement costs for a decedent's last year of life valuing time at the price of a substitutable activity. Spearman rank correlations and multivariable linear regression were used to explore relationships with last year of life costs. SETTING/PARTICIPANTS Adult national survey respondents - England. RESULTS A total of 7997 adults were interviewed from 5767/9612 (60%) of invited households. Estimated replacement costs of personal care and other help were £27,072 and £13,697 per carer and a national cost of £13.2 billion and £15.5 billion respectively. Longer care duration and intensity, older age, death at home (lived together), non-cancer cause of death and greater deprivation were associated with increased costs. Female sex, and not accessing 'other care services' were related to higher costs for other help only. CONCLUSION We provide a first adult general population estimate for replacement informal care costs in the last year of life of £41,000 per carer per decedent and highlight characteristics associated with greater costs. This presents a major challenge for future universal care coverage as the pool of people providing informal care diminish with an ageing population.
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Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | | | | | - Gamze Keser
- Hull York Medical School, University of Hull, Hull, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Annie Jones
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Laurie Dunn
- Hull York Medical School, University of Hull, Hull, UK
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Shepherd-Banigan ME, Boucher NA, McKenna K, Delgado RE, Whitaker C, Christensen L, Sperber NR. Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations. Med Care 2021; 59:961-969. [PMID: 34348392 DOI: 10.1097/mlr.0000000000001622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive care means inviting the caregiver to participate in shared decision-making and treatment planning. For aging or medically vulnerable adults, caregiver inclusion is an important facet of patient-centered care. METHODS We apply a mixed-methods approach using a survey (n=50) and semistructured interview data (n=13) from a national sample of caregivers of veterans and semistructured interview data from (n=24) providers from 3 Veterans Affairs regional networks. We elicited data from caregivers about their experiences with inclusive care and how providers communicate with them and assess their capacity. We juxtaposed these data with provider perspectives to see where there was alignment. FINDINGS We determined that caregivers play important roles in trust-building, communications management, implementation of care plans at home or in the community, and improving the care of care recipients-while maintaining a balance between competing tensions. CONCLUSIONS Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team.
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Affiliation(s)
- Megan E Shepherd-Banigan
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
| | - Nathan A Boucher
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
- Sanford School of Public Policy, Duke University
- Duke University School of Medicine, Center for the Study of Aging and Human Development, Durham, NC
| | - Kevin McKenna
- Duke University Department of Population Health Sciences
| | - Roxana E Delgado
- General and Hospital Medicine Division, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Leah Christensen
- National Caregiver Support Program, Department of Veterans Affairs, Washington, DC
| | - Nina R Sperber
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
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Zarzycki M, Morrison V. Getting back or giving back: understanding caregiver motivations and willingness to provide informal care. Health Psychol Behav Med 2021; 9:636-661. [PMID: 34345534 PMCID: PMC8281125 DOI: 10.1080/21642850.2021.1951737] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Informal caregivers are those providing care, which exceeds that which is typically provided, to a relative or friend with care needs. Informal caregiving constitutes the backbone of a society’s care supply and with ageing populations the need for informal care is growing. We know little as to why caregivers start caring and continue doing so, yet understanding of motivations and willingness to provide care is important if informal caregivers are to be supported. However, both motivations and willingness are inconsistently defined making it difficult to compare the empirical findings that do exist. Methods: This paper reviews and synthesises thinking about the theoretical constructs of motivations to provide care and willingness to perform informal care, and presents those in relation to existing theoretical and empirical literature. Results and Conclusions: Theoretical reflections based on various motivational frameworks and available empirical data are presented to illustrate that: caregiving motivations should be conceptualised as multifaceted and multiply determined; intrinsic and extrinsic motivations should not be treated as antagonistic and can occur simultaneously; the commonly applied model of extrinsic/intrinsic motivations is oversimplified and omits consideration of the diversity of caregiver motives; other motivational models can be discerned in the context of the empirical research; there are differences between motivations and willingness to provide care with the latter being more consequent to the motives; both should be considered dynamic in nature; and finally, that the two constructs may not inevitably lead to actual caregiver behaviour. The implications of these theoretical reflections for methodology and research as well as their relevance for practice and policy are indicated.
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Affiliation(s)
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, Wales, UK
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Future provision of home end-of-life care: Family carers' willingness for caregiving and needs for support. Palliat Support Care 2020; 19:580-586. [PMID: 33295268 DOI: 10.1017/s1478951520001273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to examine family carers' willingness, perceived difficulties and confidence in providing home end-of-life care to family members in future and their needs for support for doing so. Specific focus was on whether significant differences were found between carers of low and high levels of psychological distress. METHOD Family carers who had been providing care to family members living in the community were recruited via a local elderly agency in Hong Kong. A survey was conducted. Carers were asked to complete a questionnaire which included self-developed items, the Hospital Anxiety and Depression Scale, and the Carers' Support Need Assessment Tool. RESULTS Of the 89 participants, 63.8% reported willingness to provide end-of-life care in future (increased to 78.5% if support needs were met), but most perceived it as difficult, and over half were not confident about doing so. The three greatest needs for support in end-of-life care are understanding the relative's illness, knowing what to expect in future, and knowing who to contact if concerned. Participants of the high psychological distress group experienced a significantly greater need for support in "dealing with your feelings and worries" and "looking after your own health." SIGNIFICANCE OF RESULTS Current family carers may not be ready for future provision of home end-of-life care. Meeting their support needs in providing end-of-life care is crucial to ensure the continuity of care provision. Psychologically distressed carers may often ignore self-care and may need helping professionals' additional support.
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Hodiamont F, Allgar V, Currow DC, Johnson MJ. Mental wellbeing in bereaved carers: A Health Survey for England population study. BMJ Support Palliat Care 2019; 12:e592-e598. [PMID: 31492672 DOI: 10.1136/bmjspcare-2019-001957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The experience of caregiving may affect carers' well-being into bereavement. We explored associations between mental well-being and previous experience of bereavement of, and caring for, someone close at the end-of-life. METHODS An end-of-life set of questions was included in population-based household survey administered to adults (age 16 years and above). We used univariable regression to explore the cross-sectional relationship between our primary outcome (Warwick-Edinburgh Mental Well-being Scale (WEMWBS)) and possible explanatory variables: sociodemographic; death and bereavement including ability to continue with their life; disease and carer characteristics; service use and caregiving experience. RESULTS The analysis dataset included 7606 of whom 5849 (77%) were not bereaved, 1174 (15%) were bereaved but provided no care and 583 (8%) were bereaved carers. WEMWBS was lower in the oldest age class (85 years and above) in both bereaved groups compared with not bereaved (p<0.001). The worst WEMWBS scores were seen in the 'bereaved but no care' group who had bad/very bad health self-assessed general health (39.8 (10.1)) vs 41.6 (9.5)) in those not bereaved and 46.4 (10.7) in bereaved carers. Among the bereaved groups, those who would not be willing to care again had lower WEMWBS scores than those who would (48.3 (8.3) vs 51.4 (8.4), p=0.024). CONCLUSION Mental well-being in bereavement was worse in people with self-reported poor/very poor general health and those with a worse caregiving experience. Although causality cannot be assumed, interventions to help people with worse mental and physical health to care, so that their experience is as positive as possible, should be explored prospectively.
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Affiliation(s)
| | - Victoria Allgar
- Department of Health Sciences, HYMS, York University, York, UK
| | - David C Currow
- Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Janssen DJA, Rechberger S, Wouters EFM, Schols JMGA, Johnson MJ, Currow DC, Curtis JR, Spruit MA. Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration. J Clin Med 2019; 8:jcm8070922. [PMID: 31252579 PMCID: PMC6678953 DOI: 10.3390/jcm8070922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.
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Affiliation(s)
- Daisy J A Janssen
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands.
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands.
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands.
| | | | - Emiel F M Wouters
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, 6229HA Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull and York Medical School, University of Hull, Hull HU6 7RX, UK
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW2007 New South Wales, Australia
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229ER Maastricht, The Netherlands
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium
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Abstract
Palliative care is an approach to the care of patients, affected by serious illness, and their families that aims to reduce suffering through the management of medical symptoms, psychosocial issues, spiritual well-being, and setting goals of care. Patients and families affected by a neurodegenerative illness have significant palliative care needs beginning at the time of diagnosis and extending through end-of-life care and bereavement. We advocate an approach to addressing these needs where the patient's primary care provider or neurologist plays a central role. Key skills in providing effective palliative care to this population include providing the diagnosis with compassion, setting goals of care, anticipating safety concerns, caregiver assessment, advance care planning, addressing psychosocial concerns, and timely referral to a hospice. Managing distressing medical and psychiatric symptoms is critical to improving quality of life throughout the disease course as well as at end-of-life. Many symptoms are common across illnesses; however, there are issues that are specific to the most common classes of neurodegenerative illness, namely dementia, parkinsonism, and motor neuron disease. Incorporating a palliative approach to care, although challenging in many ways, empowers physicians to provide greater support and guidance to patients and families in making the difficult journey through a neurodegenerative illness.
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Rosenberg JP, Horsfall D, Leonard R, Noonan K. Informal care networks' views of palliative care services: Help or hindrance? DEATH STUDIES 2018; 42:362-370. [PMID: 28678634 DOI: 10.1080/07481187.2017.1350216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Most people indicate their preference to die at home; however, in the developed world, most die in hospital. Dying at home requires complex factors to be in place in health services and informal networks of care to successfully provide support. This study examines the ways health systems, services, and individual health care professionals influence care at home at the end of life. Three principles guide the reorientation of health services and enable their transition from hindrance to help: re-evaluation of organizational values, recognition of the primacy of caring networks, and realignment of the inherent paternalism in health care provision.
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Affiliation(s)
- John P Rosenberg
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Kelvin Grove , QLD , Australia
| | - Debbie Horsfall
- b School of Social Sciences and Psychology , Western Sydney University , Penrith , Australia
| | - Rosemary Leonard
- b School of Social Sciences and Psychology , Western Sydney University , Penrith , Australia
| | - Kerrie Noonan
- b School of Social Sciences and Psychology , Western Sydney University , Penrith , Australia
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Johnson MJ, Gozal D. Vicarious breathlessness: an inferential perceptual learned transposition process that may not be inconsequential to either patient or caregiver. Eur Respir J 2018; 51:51/4/1800306. [PMID: 29618605 DOI: 10.1183/13993003.00306-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pulmonology, Dept of Paediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
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Johnson MJ, Allgar V, Chen H, Dunn L, Macleod U, Currow DC. The complex relationship between household income of family caregivers, access to palliative care services and place of death: A national household population survey. Palliat Med 2018; 32:357-365. [PMID: 28590165 DOI: 10.1177/0269216317711825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous work shows that more affluent patients with cancer are more likely to die at home, whereas those dying from non-cancer conditions are more likely to die in hospital. Family caregivers are an important factor in determining place of death. AIM To investigate associations between family caregivers' household income, patients' access to specialist palliative care and place of patients' death, by level of personal end-of-life care. DESIGN A cross-sectional community household population survey. SETTING AND PARTICIPANTS Respondents to the Household Survey for England. RESULTS One-third of 1265 bereaved respondents had provided personal end-of-life care (caregivers) (30%). Just over half (55%) of decedents accessed palliative care services and 15% died in a hospice. Place of death and access to palliative care were strongly related ( p < 0.001). Palliative care services reduced the proportion of deaths in hospital ( p < 0.001), and decedents accessing palliative care were more likely to die at home than those who did not ( p < 0.001). Respondents' income was not associated with palliative care access ( p = 0.233). Overall, respondents' income and home death were not related ( p = 0.106), but decedents with caregivers in the highest income group were least likely to die at home ( p = 0.069). CONCLUSION For people who had someone close to them die, decedents' access to palliative care services was associated with fewer deaths in hospital and more home deaths. Respondents' income was unrelated to care recipients' place of death when adjusted for palliative care access. When only caregivers were considered, decedents with caregivers from higher income quartiles were the least likely to die at home. Family caregivers from higher income brackets are likely to be powerful patient advocates. Caregiver information needs must be addressed especially with regard to stage of disease, aim of care and appropriate interventions at the end of life.
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Affiliation(s)
| | | | - Hong Chen
- 1 Hull York Medical School, University of Hull, Hull, UK
| | - Laurie Dunn
- 1 Hull York Medical School, University of Hull, Hull, UK
| | - Una Macleod
- 1 Hull York Medical School, University of Hull, Hull, UK
| | - David C Currow
- 1 Hull York Medical School, University of Hull, Hull, UK.,3 University of Technology Sydney, Sydney, NSW, Australia
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Rowland C, Hanratty B, Pilling M, van den Berg B, Grande G. The contributions of family care-givers at end of life: A national post-bereavement census survey of cancer carers' hours of care and expenditures. Palliat Med 2017; 31:346-355. [PMID: 28281406 PMCID: PMC5406012 DOI: 10.1177/0269216317690479] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Family members provide vital care at end of life, enabling patients to remain at home. Such informal care contributes significantly to the economy while supporting patients' preferences and government policy. However, the value of care-givers' contributions is often underestimated or overlooked in evaluations. Without information on the activities and expenditures involved in informal care-giving, it is impossible to provide an accurate assessment of carers' contribution to end-of-life care. AIM The aim of this study was to investigate the contributions and expenditure of informal, family care-giving in end-of-life cancer care. DESIGN A national census survey of English cancer carers was conducted. Survey packs were mailed to 5271 people who registered the death of a relative to cancer during 1-16 May 2015. Data were collected on decedents' health and situation, care support given, financial expenditure resulting from care, carer well-being and general background information. RESULTS In all, 1504 completed surveys were returned (28.5%). Over 90% of respondents reported spending time on care-giving in the last 3 months of the decedent's life, contributing a median 69 h 30 min of care-giving each week. Those who reported details of expenditure (72.5%) spent a median £370 in the last 3 months of the decedent's life. CONCLUSION Carers contribute a great deal of time and money for day-to-day support and care of patients. This study has yielded a unique, population-level data set of end-of-life care-giving and future analyses will provide estimates of the economic value of family care-givers' contributions.
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Affiliation(s)
- Christine Rowland
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Barbara Hanratty
- 2 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pilling
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bernard van den Berg
- 3 Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Gunn Grande
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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McCaffrey N, Al-Janabi H, Currow D, Hoefman R, Ratcliffe J. Protocol for a systematic review of preference-based instruments for measuring care-related outcomes and their suitability for the palliative care setting. BMJ Open 2016; 6:e012181. [PMID: 27619829 PMCID: PMC5030581 DOI: 10.1136/bmjopen-2016-012181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite informal caregivers' integral role in supporting people affected by disease or disability, economic evaluations often ignore the costs and benefits experienced by this group, especially in the palliative setting. The purpose of this systematic review is to identify preference-based instruments for measuring care-related outcomes and provide guidance on the selection of instrument in palliative care economic evaluations. METHODS AND ANALYSIS A comprehensive search of the literature will be conducted from database inception (ASSIA; CINAHL; Cochrane library including DARE, NHS EED, HTA; Econlit; Embase; PsychINFO; PubMed). Published peer-reviewed, English-language articles reporting preference-based instruments for measuring care-related outcomes in any clinical area will be included. One researcher will complete the searches and screen the results for potentially eligible studies. A randomly selected subset of 10% citations will be independently screened by two researchers. Any disagreement will be resolved by consensus among the research team. Subsequently, a supplementary search will identify studies detailing the development, valuation, validation and application of the identified instruments. The degree of suitability of the instruments for palliative economic evaluations will be assessed using criteria in the International Society for Quality of Life Research minimum standards for patient-reported outcome measures, the checklist for reporting valuation studies of multiattribute utility-based instruments and information on the development of the instrument in the palliative setting. A narrative summary of the included studies and instruments will be provided; similarities and differences will be described and possible reasons for variations explored. Recommendations for practice on selection of instruments in palliative care economic analyses will be provided. ETHICS AND DISSEMINATION This is a planned systematic review of published literature. Therefore, ethics approval to conduct this research is not required. Findings will be presented at leading palliative care and health economic conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42016034188.
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Affiliation(s)
- Nikki McCaffrey
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
- Flinders Health Economics Group, Flinders University, Bedford Park, South Australia, Australia
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Currow
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Renske Hoefman
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, Bedford Park, South Australia, Australia
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Parker Oliver D. Recognizing the Caregiver as a Patient. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:2-5. [PMID: 27143567 DOI: 10.1080/15524256.2016.1160699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Debra Parker Oliver
- a Department of Family and Community Medicine , University of Missouri , Columbia , MO , USA .
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