Meaning-making following loss among bereaved spouses during the COVID-19 pandemic (the CO-LIVE study)

This study investigates how individuals construe, understand, and make sense of experiences during the first wave of the COVID-19 pandemic. Seventeen semi-structured interviews were conducted with bereaved spouses focusing on meaning attribution to the death of their partner. The interviewees were lacking adequate information, personalized care, and physical or emotional proximity; these challenges complicated their experience of a meaningful death of their partner. Concomitantly, many interviewees appreciated the exchange of experiences with others and any last moments together with their partner. Bereaved spouses actively sought valuable moments, during and after bereavement, that contributed to the perceived meaning.

Identifying patients who could benefit from palliative care by making use of the general practice information system: the Surprise Question versus the SPICT

OBJECTIVE

We compared the performance of two tools to help general practitioners (GPs) identify patients in need of palliative care: the Surprise Question (SQ) and the Supportive and Palliative Care Indicators Tool (SPICT).

METHODS

Prospective cohort study in two general practices in the Netherlands with a size of 3640 patients. At the start of the study the GPs selected patients by heart using the SQ. The SPICT was translated into a digital search in electronic patient records. The GPs then selected patients from the list thus created. Afterwards the GPs were interviewed about their experiences. The following year a record was kept of all the patients deceased in both practices. We analysed the characteristics of the patients selected and the deceased. We calculated the performance characteristics concerning predicting 1-year mortality.

RESULTS

The sensitivity of the SQ was 50%, of the SPICT 57%; the specificity 99% and 98%. When analysing the deceased (n = 36), 10 died relatively suddenly and arguably could not be identified. Leaving out these 10, the sensitivity of the SQ became 69%, of the SPICT 81%. The GPs found the performance of the digital search quite time consuming.

CONCLUSION

The SPICT seems to be better in identifying patients in need of palliative care than the SQ. It is also more time consuming than the SQ. However, as the digital search can be performed more easily after it has been done for the first time, initial investments can repay themselves.

End-of-life communication: a retrospective survey of representative general practitioner networks in four countries

CONTEXT

Effective communication is central to high-quality end-of-life care.

OBJECTIVES

This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.

METHODS

This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country.

RESULTS

In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care.

CONCLUSION

The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.

Withholding or withdrawing artificial administration of food and fluids in nursing-home patients

BACKGROUND

withholding or withdrawing artificial administration of food and fluids, especially in incompetent patients, has been the subject of turbulent discussions. Insight into this practice may be useful in the debate, and also in the development of guidelines.

OBJECTIVES

to gain insight into the frequency and circumstances of forgoing artificial administration of food and fluids in nursing homes.

DESIGN

we sent a written questionnaire to the nursing-home physicians of a stratified sample of 6060 people who died in the Netherlands in 1995, and interviewed a random sample of 74 nursing-home physicians.

SETTING

Dutch nursing homes.

MAIN OUTCOME MEASURES

incidence of withholding or withdrawing artificial administration of food, patient characteristics and features of the decision-making process.

RESULTS

in 23% of deaths in nursing homes, artificial administration of food and fluids were foregone. In two-thirds of cases, life was shortened by 1 week at most. The decision was almost always discussed with competent patients. In the case of incompetent patients, the decision was almost always discussed with the patient's relatives. Frequently mentioned considerations in the decision were: the patient's (presumed) wish, low quality of life, no prospect of improvement and the desire not unnecessarily to prolong life.

CONCLUSIONS

artificial administration of food and fluids is one of the most frequently forgone treatments in nursing homes. In general, the physician involves the patient or the patient's relatives and the nursing staff in the decision-making. In most cases, the nursing-home physicians thought that the decision to forgo artificial administration of food and fluids improved the patient's quality of dying.