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Kraak-Steenken FWM, Renckens SC, Pasman HRW, Bosma F, van der Heide A, Onwuteaka-Philipsen BD. Euthanasia and Physician-Assisted Suicide in People With an Accumulation of Health Problems Related to Old Age: A Cross-Sectional Questionnaire Study Among Physicians in the Netherlands. Int J Public Health 2024; 69:1606962. [PMID: 38698912 PMCID: PMC11064696 DOI: 10.3389/ijph.2024.1606962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives: We explored characteristics of people with an accumulation of health problems related to old age requesting euthanasia or physician-assisted suicide (EAS) and identified characteristics associated with granting EAS requests. Methods: We conducted a cross-sectional questionnaire study among Dutch physicians on characteristics of these people requesting EAS (n = 123). Associations between characteristics and granting a request were assessed using logistic regression analyses. Results: People requesting EAS were predominantly >80 years old (82.4%), female (70.0%), widow/widower (71.7%), (partially) care-dependent (76.7%), and had a life expectancy >12 months (68.6%). The most prevalent health problems were osteoarthritis (70.4%) and impaired vision and hearing (53.0% and 40.9%). The most cited reasons to request EAS were physical deterioration (68.6%) and dependence (61.2%). 44.7% of requests were granted. Granting a request was positively associated with care dependence, disability/immobility, impaired vision, osteoporosis, loss of control, suffering without prospect of improvement and a treatment relationship with the physician >12 months. Conclusion: Enhanced understanding of people with an accumulation of health problems related to old age requesting EAS can contribute to the ongoing debate on the permissibility of EAS in people without life-threatening conditions.
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Affiliation(s)
- Frédérique W. M. Kraak-Steenken
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Sophie C. Renckens
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Fenne Bosma
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
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Bergman TD, van der Plas AGM, Pasman HRW, Onwuteaka-Philipsen BD. Awareness and Actual Knowledge of Palliative Care Among Older People: A Dutch National Survey. J Pain Symptom Manage 2023; 66:193-202.e2. [PMID: 37207787 DOI: 10.1016/j.jpainsymman.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
CONTEXT Lack of public knowledge of palliative care may be a barrier to timely use of palliative care and hinder engagement in advance care planning (ACP). Little research has been conducted on (the relationship between) awareness and actual knowledge of palliative care. OBJECTIVES To determine awareness and actual knowledge of palliative care and explore factors that contribute to knowledge of palliative care among older people. METHODS A cross-sectional study in a representative sample of 1242 Dutch people (≥ 65 years; response 93.2%) on whether they had heard of palliative care and knowledge statements about palliative care. RESULTS The majority had heard of the term palliative care (90.1%), and 47.1% reported to know (quite) exactly what it means. Most knew palliative care is not only for people with cancer (73.9%) and is not only provided in hospice facilities (60.6%). A minority knew palliative care can be provided alongside life-prolonging treatment (29.8%) and is not only for people who have a few weeks left to live (23.5%). Experience with palliative care through family, friends and/or acquaintances (range ORs: 1.35-3.39 for the four statements), higher education (ORs: 2.09-4.81), being female (ORs: 1.56-1.91), and higher income (OR: 1.93) were positively associated with one or more statements, while increasing age (ORs: 0.52-0.66) was negatively associated. CONCLUSION Knowledge of palliative care is limited, stressing the need for population-wide interventions, including information meetings. Attention should be paid to timely attention for palliative care needs. This might stimulate ACP and raise public knowledge of (im) possibilities of palliative care.
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Affiliation(s)
- Tessa D Bergman
- Department of Public and Occupational Health (T.D.B., A.G.M.V.D.P, H.R.W.P, B.D.O.P), Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007MB Amsterdam, The Netherlands.
| | - Annicka G M van der Plas
- Department of Public and Occupational Health (T.D.B., A.G.M.V.D.P, H.R.W.P, B.D.O.P), Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007MB Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health (T.D.B., A.G.M.V.D.P, H.R.W.P, B.D.O.P), Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007MB Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health (T.D.B., A.G.M.V.D.P, H.R.W.P, B.D.O.P), Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007MB Amsterdam, The Netherlands
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3
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Kox RMK, Pasman HRW, van der Plas AGM, Huisman M, Hoogendijk EO, Onwuteaka-Philipsen BD. End-of-life treatment preference discussions between older people and their physician before and during the COVID-19 pandemic: cross sectional and longitudinal analyses from the Longitudinal Aging Study Amsterdam. BMC Geriatr 2023; 23:441. [PMID: 37464333 DOI: 10.1186/s12877-023-04140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND COVID-19 could lead to hospitalisation and ICU admission, especially in older adults. Therefore, during the pandemic, it became more important to discuss wishes and preferences, such as older peoples' desire for intensive treatment in a hospital in acute situations, or not. This study explores what percentage of Dutch older people aged 75 and over discussed Advance Care Planning (ACP) topics with a physician during the first months of the COVID-19 pandemic and whether this was different in these people before the COVID-19 pandemic. METHODS Data of two ancillary data collections of the Longitudinal Aging Study Amsterdam were used: the LASA 75 PLUS study and the LASA COVID-19 study. The latter provided cross sectional data (during COVID-19; n = 428) and longitudinal data came from participants in both studies (before and during COVID-19; n = 219). RESULTS Most older adults had thought about ACP topics during COVID-19 (76,4%), and a minority had also discussed ACP topics with a physician (20.3%). Thinking about ACP topics increased during COVID-19 compared to before COVID-19 in a sample with measurements on both timeframes (82,5% vs 68,0%). Not thinking about ACP topics decreased in the first months of the COVID-pandemic compared to before COVID-19 for all ACP topics together (68.0% vs 82.2%) and each topic separately (hospital 42.0% vs 63.9%; nursing home 36.5% vs 53.3%; treatment options 47.0% vs 62.1%; resuscitation 53.0% vs 70.7%). CONCLUSIONS Older people do think about ACP topics, which is an important first step in ACP, and this has increased during COVID-19. However, discussing ACP topics with a physician is still not that common. General practitioners could therefore take the initiative in broaching the subject of ACP. This can for instance be done by organizing information meetings.
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Affiliation(s)
- Roosmarijne M K Kox
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Annicka G M van der Plas
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
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4
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Arends SAM, Thodé M, Pasman HRW, Francke AL, Jongerden IP. How physicians see nurses' role in decision-making about life-prolonging treatments in patients with a short life expectancy: An interview study. Patient Educ Couns 2023; 114:107863. [PMID: 37356117 DOI: 10.1016/j.pec.2023.107863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Exploring physicians' views on hospital nurses' role in decision-making about potentially life-prolonging treatments in patients with a short life expectancy. METHODS A qualitative study using semi-structured interviews with hospital physicians. Data were collected from May to September 2019 and analyzed following principles of thematic analysis. RESULTS Fifteen physicians working in different hospitals and specialisms participated. Physicians stated that they are responsible for the final decision about potentially life-prolonging treatments. They considered nurses' role in decision-making to be complementary to the roles of both patients and the physicians themselves, especially when there are doubts or complex situations. Physicians varied in how important they found nurses' involvement in the decision-making process: some physicians saw the involvement of nurses as "situation-dependent", while others viewed nurses' involvement as standard practice. Furthermore, physicians mentioned practical obstacles to involving nurses, like the limited time available to both nurses and physicians themselves. CONCLUSION Physicians recognize a complementary role for nurses in decision-making about potentially life-prolonging treatment, especially in cases with doubts or complex situations. PRACTICE IMPLICATIONS Physicians and nurses should engage with each other to make nurses' involvement less situation-dependent. This inter-professional collaboration regarding decision-making about life-prolonging treatments should be stimulated, supported and maintained.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands.
| | - Maureen Thodé
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Section General Internal Medicine, Department of Internal Medicine, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands; Netherlands Institute for Health Services Research - Nivel, Utrecht, the Netherlands
| | - Irene P Jongerden
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands
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5
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Fritz L, Peeters MCM, Zwinkels H, Koekkoek JAF, Reijneveld JC, Vos MJ, Pasman HRW, Dirven L, Taphoorn MJB. Advance care planning (ACP) in glioblastoma patients: Evaluation of a disease-specific ACP program and impact on outcomes. Neurooncol Pract 2022; 9:496-508. [PMID: 36388414 PMCID: PMC9665067 DOI: 10.1093/nop/npac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The feasibility of implementing an advance care planning (ACP) program in daily clinical practice for glioblastoma patients is unknown. We aimed to evaluate a previously developed disease-specific ACP program, including the optimal timing of initiation and the impact of the program on several patient-, proxy-, and care-related outcomes. METHODS The content and design of the ACP program were evaluated, and outcomes including health-related quality of life (HRQoL), anxiety and depression, and satisfaction with care were measured every 3 months over 15 months. RESULTS Eighteen patient-proxy dyads and two proxies participated in the program. The content and design of the ACP program were rated as sufficient. The preference for the optimal timing of initiation of the ACP program varied widely, however, most of the participants preferred initiation shortly after chemoradiation. Over time, aspects of HRQoL remained stable in our patient population. Similarly, the ACP program did not decrease the levels of anxiety and depression in patients, and a large proportion of proxies reported anxiety and/or depression. The needed level of support for proxies was relatively low throughout the disease course, and the level of feelings of caregiver mastery was relatively high. Overall, patients were satisfied with the provided care over time, whereas proxies were less satisfied in some aspects. CONCLUSIONS The content and design of the developed disease-specific ACP program were rated as satisfactory. Whether the program has an actual impact on patient-, proxy-, and care-related outcomes proxies remain to be investigated.
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Affiliation(s)
- Lara Fritz
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Roeline W Pasman
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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6
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Bergman TD, Pasman HRW, Hendriksen JM, Onwuteaka-Philipsen BD. End of life in general practice: trends 2009-2019. BMJ Support Palliat Care 2022:bmjspcare-2022-003609. [PMID: 36288918 DOI: 10.1136/spcare-2022-003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess possible trends between 2009 and 2019 in the Netherlands of palliative care indicators: the provision of palliative care or treatment, hospitalisations in the last month before death, use of specialised palliative care services and place of death. METHODS The study design was a repeated retrospective cross-sectional design with questionnaires filled in by general practitioners within a clustered sample of 67 Sentinel practices. Patients whose death was non-sudden, and thus could have received palliative care, between 1 January 2009 and 31 December 2019 were included in the study, resulting in 3121 patients. RESULTS Between 2009 and 2019, there is a significant increase in the number of people who receive palliative care or treatment alongside life-prolonging or curative treatment and the number of people who die at home, while the number of hospitalisations in the last month before death and the number of people dying in hospital shows a significant decrease. However, there is no trend in the involvement of specialised palliative care services or people receiving solely palliative care or treatment. CONCLUSION This study suggests improvements in end-of-life care provided in primary care in the Netherlands. Trends coincided with increased attention to palliative care both in practice and policy. Yet, there is still considerable room for improvement as there is no significant increase in people solely receiving palliative care or treatment and the involvement of specialised palliative care services.
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Affiliation(s)
- Tessa D Bergman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - Janneke Mt Hendriksen
- Research Unit Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
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7
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Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CRL, van der Beek AJ, Pasman HRW. Caregiver's burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers. Palliat Care 2022; 21:142. [PMID: 35945558 PMCID: PMC9364551 DOI: 10.1186/s12904-022-01031-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Growing numbers of people with advanced illnesses who wish to die at home, a concurrent decline in the accessibility of professional home care, and policies aiming at prolonging work participation are increasing the reliance on family caregivers. This study aimed to describe trajectories in burden of working family caregivers who care for patients with a life-threatening illness, and identify factors in work and care that are related to changes in burden over time. Methods Semi-structured interviews were held in one to four rounds between July 2018 and November 2020 with 17 working family caregivers of patients with a life-threatening illness living at home. Transcripts were analysed as a single unit to create timelines per participant. Next, individual burden trajectories were created and grouped based on the course of burden over time. Factors related to changes in burden were analysed, as well as similarities and differences between the groups. Results It was common for family caregivers who combine work and end-of-life care to experience a burden. Two trajectories of caregiver burden were identified; caregivers with a persistent level of burden and caregivers with an increasing burden over time. Family caregivers with a persistent level of burden seemed to be at risk for burnout throughout the illness trajectory, but were often able to cope with the situation by making arrangements in care or work. Caregivers with an increasing burden were unable to make sufficient adjustments, which often resulted in burnout symptoms and sick leave. In both groups, burden was mostly related to aspects of the care situation. The emotional burden, a decreasing burden after death and a different view on the trajectory in hindsight proved to be important overarching themes. Conclusions Providing care to a loved one nearing the end of life is often emotionally burdensome and intensive. To facilitate the combination of paid work and family care, and reduce the risk of burnout, more support is needed from employers and healthcare professionals during the illness trajectory and after death. Bereaved family caregivers also warrant more attention from their supervisors and occupational physicians in order to facilitate their return to work. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01031-1.
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Affiliation(s)
- Femmy M Bijnsdorp
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Cécile R L Boot
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, Netherlands
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8
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Arends SAM, Thodé M, De Veer AJE, Pasman HRW, Francke AL, Jongerden IP. Nurses' perspective on their involvement in decision-making about life-prolonging treatments: A quantitative survey study. J Adv Nurs 2022; 78:2884-2893. [PMID: 35307867 PMCID: PMC9541323 DOI: 10.1111/jan.15223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Aims In hospital settings, decisions about potentially life‐prolonging treatments are often made in a dialogue between a patient and their physician, with a focus on active treatment. Nurses can have a valuable contribution in this process, but it seems they are not always involved. Our aim was to explore how hospital nurses perceive their current role and preferred role in shared decision‐making about potentially life‐prolonging treatment in patients in the last phase of life. Design Cross‐sectional quantitative study conducted in the Netherlands in April and May 2019. Methods An online survey, using a questionnaire consisting of 12 statements on nurses' opinion about supporting patients in decisions about potentially life‐prolonging treatments, and 13 statements on nurses' actual involvement in these decisions. Results In total 179 hospital nurses from multiple institutions who care for adult patients in the last phase of life responded. Nurses agreed that they should have a role in shared decision‐making about potentially life‐prolonging treatments, indicating greatest agreement with ‘It is my task to speak up for my patient’ and ‘It is important that my role in supporting patients is clear’. However, nurses also said that in practice they were often not involved in shared decision‐making, with least involvement in ‘active participation in communication about treatment decisions’ and ‘supporting a patient with the decision’. Conclusion There is a discrepancy between nurses' preferred role in decision‐making about potentially life‐prolonging treatment and their actual role. More effort is needed to increase nurses' involvement. Impact Nurses' contribution to decision‐making is increasingly considered to be valuable by the nurses themselves, physicians and patients, though involvement is still not common. Future research should focus on strategies, such as training programs, that empower nurses to take an active role in decision‐making.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maureen Thodé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anke J E De Veer
- Netherlands Institute for Health Services Research - Nivel, Utrecht, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research - Nivel, Utrecht, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Klapwijk MS, Bolt SR, Boogaard JA, Ten Koppel M, Gijsberts MJH, van Leussen C, The BAM, Meijers JM, Schols JM, Pasman HRW, Onwuteaka-Philipsen BD, Deliens L, Van den Block L, Mertens B, de Vet HC, Caljouw MA, Achterberg WP, van der Steen JT. Trends in quality of care and dying perceived by family caregivers of nursing home residents with dementia 2005-2019. Palliat Med 2021; 35:1951-1960. [PMID: 34455856 PMCID: PMC8637361 DOI: 10.1177/02692163211030831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dementia palliative care is increasingly subject of research and practice improvement initiatives. AIM To assess any changes over time in the evaluation of quality of care and quality of dying with dementia by family caregivers. DESIGN Combined analysis of eight studies with bereaved family caregivers' evaluations 2005-2019. SETTING/PARTICIPANTS Family caregivers of nursing home residents with dementia in the Netherlands (n = 1189) completed the End-of-Life in Dementia Satisfaction With Care (EOLD-SWC; quality of care) and Comfort Assessment in Dying (EOLD-CAD, four subscales; quality of dying) instruments. Changes in scores over time were analysed using mixed models with random effects for season and facility and adjustment for demographics, prospective design and urbanised region. RESULTS The mean total EOLD-SWC score was 33.40 (SD 5.08) and increased by 0.148 points per year (95% CI, 0.052-0.244; adjusted 0.170 points 95% CI, 0.055-0.258). The mean total EOLD-CAD score was 30.80 (SD 5.76) and, unadjusted, there was a trend of decreasing quality of dying over time of -0.175 points (95% CI, -0.291 to -0.058) per year increment. With adjustment, the trend was not significant (-0.070 EOLD-CAD total score points, 95% CI, -0.205 to 0.065) and only the EOLD-CAD subscale 'Well being' decreased. CONCLUSION We identified divergent trends over 14 years of increased quality of care, while quality of dying did not increase and well-being in dying decreased. Further research is needed on what well-being in dying means to family. Quality improvement requires continued efforts to treat symptoms in dying with dementia.
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Affiliation(s)
- Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Huis op de Waard, Marente, Leiden, The Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jannie A Boogaard
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maud Ten Koppel
- Zorginstituut Nederland, Diemen, North Holland, The Netherlands
| | - Marie-José He Gijsberts
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | | | - B Anne-Mei The
- Tao of Care, Amsterdam, The Netherlands.,Department Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith Mm Meijers
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Jos Mga Schols
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | | | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Bart Mertens
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Henrica Cw de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Monique Aa Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
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10
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Becqué YN, van der Geugten W, van der Heide A, Korfage IJ, Pasman HRW, Onwuteaka-Philipsen BD, Zee M, Witkamp E, Goossensen A. Dignity reflections based on experiences of end-of-life care during the first wave of the COVID-19 pandemic: A qualitative inquiry among bereaved relatives in the Netherlands (the CO-LIVE study). Scand J Caring Sci 2021; 36:769-781. [PMID: 34625992 PMCID: PMC8661881 DOI: 10.1111/scs.13038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic affects care practices for critically ill patients, with or without a COVID-19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains. AIM To give insight into aspects of end-of-life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID-19 pandemic in the Netherlands. METHODOLOGY A qualitative study involving 25 in-depth interviews with purposively sampled bereaved relatives of patients who died during the COVID-19 pandemic between March and July 2020 in the Netherlands. We created a dignity-inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness-related aspects and the individual, relational and societal/organisational level of dignity. RESULTS Four themes concerning aspects of end-of-life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end-of-life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives. CONCLUSION This study illuminates possible aspects of end-of-life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating.
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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11
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Klop HT, Nasori M, Klinge TW, Hoopman R, de Vos MA, du Perron C, van Zuylen L, Steegers M, Ten Tusscher BL, Abbink FCH, Onwuteaka-Philipsen BD, Pasman HRW. Family support on intensive care units during the COVID-19 pandemic: a qualitative evaluation study into experiences of relatives. BMC Health Serv Res 2021; 21:1060. [PMID: 34615524 PMCID: PMC8494165 DOI: 10.1186/s12913-021-07095-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background During the first peak of the COVID-19 pandemic in the Netherlands, relatives of patients with COVID-19 admitted to Intensive Care Units (ICUs) were severely restricted in visiting their relatives and in communicating with treating physicians. Family communication is a core element of critical care, however, this pandemic forced medical ICU staff to arrange alternative family support for instance by Family Support Teams (FSTs), consisting of non-ICU affiliated staff who telephonically contacted relatives. This study aims to examine relatives’ experiences with FSTs on two ICUs of a Dutch university medical centre, and to evaluate its working strategies. . Methods In a semi-structured interview study, relatives of patients with COVID-19 admitted to ICU’s, who had been supported by the FSTs, were sampled purposively. Twenty-one interviews were conducted telephonically by three researchers. All interviews were topic list guided and audio-recorded. Data was analysed thematically. Results All participants indicated they went through a rough time. Almost all evaluated the FSTs positively. Four major themes were identified. First, three important pillars of the FSTs were providing relatives with transparency about the patients’ situation, providing attention to relatives’ well-being, and providing predictability and certainty by calling on a daily basis in a period characterised by insecurity. Second, relatives appeared to fulfil their information needs by calls of the FSTs, but also by calling the attending ICU nurse. Information provided by the FSTs was associated with details and reliability, information provided by nurses was associated with the patient’s daily care. Third, being a primary family contact was generally experienced as both valuable and as an emotional burden. Last, participants missed proper aftercare. Family support often stopped directly after the patient died or had left the ICU. Relatives expressed a need for extended support after that moment since they had strong emotions after discharge or death of the patient. Conclusions Family support in times of the extreme COVID-19 situation is important, as relatives are restricted in communication and have a strong need for information and support. Relatives feel encouraged by structure, frequency, support and understanding by FSTs. However, remote family support should be tailored to the needs of relatives. A fixed contact person on de ICU and video calling might be good extra options for family support, also in future post COVID-19 care, but cannot replace physical visits.
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Affiliation(s)
- Hanna T Klop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands. .,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.
| | - Mana Nasori
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Tjitske W Klinge
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Rianne Hoopman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Mirjam A de Vos
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Chantal du Perron
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.,Department of Medical Oncology, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Monique Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
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12
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Fleuren N, Depla MFIA, Pasman HRW, Janssen DJA, Onwuteaka-Philipsen BD, Hertogh CMPM, Huisman M. Association Between Subjective Remaining Life Expectancy and Advance Care Planning in Older Adults: A Cross-Sectional Study. J Pain Symptom Manage 2021; 62:757-767. [PMID: 33631323 DOI: 10.1016/j.jpainsymman.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
CONTEXT Advance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). OBJECTIVES First, to describe the prevalence of ACP with health care providers or written directives ("formal engagement in ACP") and ACP with loved-ones ("informal engagement in ACP") among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. METHODS Cross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015-2016. Participants (n = 1585) were aged ≥ 57 years. RESULTS Median age was 69.4 years (IQR: 64.1-76.7), and median SRLE 25.9 years (17.7-36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93-1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93-0.99; P= .009). For respondents with SRLE ≥ 25 years there was no association between SRLE and engagement in ACP. CONCLUSION The perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP.
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Affiliation(s)
- Nienke Fleuren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Marja F I A Depla
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daisy J A Janssen
- Maastricht University, Care and Public Health Research Institute, Health Services Research, Maastricht, The Netherlands; CIRO, Research and Development, Horn, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martijn Huisman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Vrije Universiteit Amsterdam, Faculty of Sociology, Amsterdam, The Netherlands
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13
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Hagens M, Pasman HRW, van der Heide A, Onwuteaka-Philipsen BD. Intentionally ending one's own life in the presence or absence of a medical condition: A nationwide mortality follow-back study. SSM Popul Health 2021; 15:100871. [PMID: 34337130 PMCID: PMC8318894 DOI: 10.1016/j.ssmph.2021.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
In the Netherlands, people who wish to intentionally end their own life can request for physician assistance in dying (PAD). Having a classifiable medical condition is a prerequisite to receive PAD. Some people, either in the presence or absence of a medical condition, choose to end life without assistance from a physician. This study estimates the frequency of people who intentionally ended their own life, and describes their demographic and medical characteristics through a nationwide mortality follow-back study based on questionnaires from certifying physicians of a stratified sample of death certificates of people drawn from the central death registry of Statistics Netherlands (n = 7277). In 1.85% of all deaths in 2015 people intentionally ended their own life; of which 0.50% by voluntarily stopping eating and drinking, 0.20% by self-ingesting self-collected medication, and 1.15% using other methods. Estimating the frequency of suicide is influenced by definitions and the information sources. The great majority of people who ended life by voluntarily stopping eating and drinking were over 80 years old and suffered from an accumulation of health problems related to old age, somatic problems, and/or dementia. People who ended their own life through other methods were mostly under 65 years old and primarily suffered from psychiatric, psychosocial and existential problems. Few people who intentionally ended their own life requested PAD, especially those who suffered from solely psychiatric diseases and those without a medical condition. PAD in the Netherlands is embedded in the medical domain as it is currently understood by Dutch law. This raises the question how to address the desire to die from people whose wish to intentionally end their own life is not rooted in a medical condition and therefore fall outside this medical framework of assistance in dying. In the Netherlands, in 1.85% of all deaths people intentionally ended their own life. Death by voluntarily stopping eating and drinking accounts for 0.50% of all deaths. The majority of people who intentionally ended their own life had medical conditions. Few people who intentionally ended their life requested physician assistance in dying.
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Affiliation(s)
- Martijn Hagens
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Office A-325, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
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14
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Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CR, van der Beek AJ, Klop HT, Pasman HRW. Combining paid work and family care for a patient at the end of life at home: insights from a qualitative study among caregivers in the Netherlands. BMC Palliat Care 2021; 20:93. [PMID: 34167518 PMCID: PMC8228921 DOI: 10.1186/s12904-021-00780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Population ageing, an emphasis on home-based care of palliative patients and policies aimed at prolonging participation in the labour market are placing a growing demand on working family caregivers. This study aimed to provide insight into experiences with combining paid work and family care for patients at the end of life, factors facilitating and hindering this combination, and support needs. METHOD Semi-structured interviews were held between July 2018 and July 2019 with 18 working family caregivers of patients with a life-threatening illness who were living at home. Transcripts were analysed following the principles of thematic analysis. RESULTS Some family caregivers could combine paid work and family care successfully, while this combination was burdensome for others. Family caregivers generally experienced a similar process in which four domains - caregiver characteristics, the care situation, the work situation and the context - influenced their experiences, feelings and needs regarding either the combination of paid work and care or the care situation in itself. In turn, experiences, feelings and needs sometimes affected health and wellbeing, or prompted caregivers to take actions or strategies to improve the situation. Changes in health and wellbeing could affect the situation in the four domains. Good health, flexibility and support at work, support from healthcare professionals and sharing care tasks were important in helping balance work and care responsibilities. Some caregivers felt 'sandwiched' between work and care and reported physical or mental health complaints. CONCLUSIONS Experiences with combining paid work and family care at the end of life are diverse and depend on several factors. If too many factors are out of balance, family caregivers experience stress and this impacts their health and wellbeing. Family caregivers could be better supported in this by healthcare professionals, employers and local authorities.
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Affiliation(s)
- Femmy M. Bijnsdorp
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Cécile R.L. Boot
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Allard J. van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Hanna T. Klop
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
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15
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van der Plas AGM, Pasman HRW, Kox RMK, Ponstein M, Dame B, Onwuteaka-Philipsen BD. Information meetings on end-of-life care for older people by the general practitioner to stimulate advance care planning: a pre-post evaluation study. BMC Fam Pract 2021; 22:109. [PMID: 34092218 PMCID: PMC8183039 DOI: 10.1186/s12875-021-01463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022]
Abstract
Background To increase knowledge about options people have concerning end-of-life-care issues, General Practitioners (GPs) can organise meetings to inform their older patients. We evaluated these meetings, using the following research questions: How did the attendees experience the information meeting? Was there a rise in Advance Care Planning (ACP) behaviour after the information meeting? Was there a change in trust people have that physicians will provide good care at the end of life and that they will follow their end-of-life wishes after the information meetings? Methods Four GPs invited all patients of 75 years and older registered in their GP practices to the meeting via a written letter. Four meetings of 2 h took place in 2016. Meetings started with a presentation on end-of-life topics and ACP by the GP followed by time for questions. A pre-post evaluation study was done using written questionnaires distributed and filled in at the start of the meeting (T0) at the end of the meeting (T1) and 6 months after the meeting (T2). Results In total 225 older people attended a meeting of which 154 (68%) filled in the questionnaire at T0 and 145 (64%) filled in the questionnaire at T1. After six months, 90 of the 121 people who approved of being sent another questionnaire at T2, returned it (40%). The average age of the respondents was 80 years (T0). The meetings were evaluated positively by the attendees (T1). ACP issues (appointing a proxy, resuscitation, hospitalisation, euthanasia, treatment preferences under certain circumstances, preferred place of care and nursing home admittance) were discussed with a physician, a relative or both more often in the 6 months after having attended the meeting (T2), compared to before (T0). Compared to before the meeting (T0), trust in the GP providing good end-of-life care and following end-of-life wishes was higher immediately after the meeting (T1), but not after 6 months (T2). Conclusion Information meetings on end-of-life care by GPs have a positive influence on the occurrence of ACP, both with the physician and others. Although, this method especially reaches the older people that are already interested in the subject, this seems a relatively easy way to stimulate ACP. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01463-3.
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Affiliation(s)
- Annicka G M van der Plas
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Roosmarijne M K Kox
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | | | - Bea Dame
- Zorggroep Almere, Almere, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
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16
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Kox RMK, Pasman HRW, Huisman M, Benneker W, Onwuteaka-Philipsen BD. Current wishes to die; characteristics of middle-aged and older Dutch adults who are ready to give up on life: a cross-sectional study. BMC Med Ethics 2021; 22:64. [PMID: 34020628 PMCID: PMC8140496 DOI: 10.1186/s12910-021-00632-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions. AIM (1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to die; (3) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems. METHODS Data of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems. RESULTS N = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear. CONCLUSION A small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die.
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Affiliation(s)
- Roosmarijne M K Kox
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wim Benneker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
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17
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Onwuteaka-Philipsen BD, Pasman HRW, Korfage IJ, Witkamp E, Zee M, van Lent LG, Goossensen A, van der Heide A. Dying in times of the coronavirus: An online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study). Palliat Med 2021; 35:830-842. [PMID: 33825567 PMCID: PMC8114455 DOI: 10.1177/02692163211003778] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the COVID-19 outbreak restricting measures may have affected the provision of good end-of-life care for patients with and without COVID-19. AIM To describe characteristics of patients who died and the care they received, and to examine how patient characteristics, setting and visiting restrictions are related to provided care and evaluation of the dying process. DESIGN An open observational online survey among healthcare professionals about their experience of end-of-life care that was provided to a patient with or without COVID-19 who died between March and July 2020. SETTING/PARTICIPANTS Healthcare professionals (nurses, physicians and others) in the Netherlands from all settings: home (n = 163), hospital (n = 249), nursing home (n = 192), hospice (n = 89) or elsewhere (n = 68). RESULTS Of patients reported on, 56% had COVID-19. Among these patients, 358 (84.4%) also had a serious chronic illness. Having COVID-19 was negatively, and having a serious chronic illness was positively associated with healthcare staff's favourable appreciation of end-of-life care. Often there had been visiting restrictions in the last 2 days of life (75.8%). This was negatively associated with appreciation of care at the end of life and the dying process. Finally, care at the end of life was less favourably appreciated in hospitals and especially nursing homes, and more favourably in home settings and especially hospices. CONCLUSIONS Our study suggests that end-of-life care during the COVID-19 pandemic may be further optimised, especially in nursing homes and hospitals. Allowing at least some level of visits of relatives seems a key component.
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Affiliation(s)
- Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erica Witkamp
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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18
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Mieras A, Becker-Commissaris A, Klop HT, Pasman HRW, de Jong D, Pronk L, Onwuteaka-Philipsen BD. Patients with Metastatic Lung Cancer and Oncologists' Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study. Med Decis Making 2021; 41:515-526. [PMID: 33783264 DOI: 10.1177/0272989x21998951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous studies have investigated patients' treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. AIM To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. DESIGN AND PARTICIPANTS A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. RESULTS According to patients and oncologists, treatment goals were achieved in 30% and 37% for 'quality of life,' 49% and 41% for 'life prolongation,' 26% and 44% for 'decrease in tumor size,' and 44% for 'cure', respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do 'something.' CONCLUSIONS Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing 'something.'
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Denise de Jong
- Department of Pulmonary Diseases, Haags Medisch Centrum, Leidschendam, Zuid-Holland, The Netherlands
| | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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19
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Hagens M, Snijdewind MC, Evenblij K, Onwuteaka-Philipsen BD, Pasman HRW. Experiences with counselling to people who wish to be able to self-determine the timing and manner of one's own end of life: a qualitative in-depth interview study. J Med Ethics 2021; 47:39-46. [PMID: 31871263 PMCID: PMC7803911 DOI: 10.1136/medethics-2019-105564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/05/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In the Netherlands, Foundation De Einder offers counselling to people who wish to be able to self-determine the timing and manner of their end of life. AIM This study explores the experiences with counselling that counselees receive(d) from counsellors facilitated by Foundation De Einder. METHODS Open coding and inductive analysis of in-depth interviews with 17 counselees. RESULTS Counselling ranged from solely receiving information about lethal medication to combining this with psychological counselling about matters of life and death, and the effects for close ones. Counselees appreciated the availability of the counsellor, their careful and open attitude, feeling respected and being reminded about their own responsibility. Some counselees felt dependent on the counsellor, or questioned their competency. Most counselees collected lethal medication. This gave them peace of mind and increased their quality of life, but also led to new concerns. Few were inclined to use their self-collected medication. Counselling contributed to thinking about if, when and how counselees would like to end their life. CONCLUSION Having obtained means to end their lives can offer people feelings of reassurance, which can increase their quality of life, but can also give rise to new concerns. Next to providing information on (collecting) lethal medication, counsellors can play an important role by having an open non-judgemental attitude, providing trustworthy information and being available. These positively valued aspects of counselling are also relevant for physicians taking care of patients who wish to self-determine the timing and manner of their end of life.
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Affiliation(s)
- Martijn Hagens
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VUMC, Amsterdam, The Netherlands
| | - Marianne C Snijdewind
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-Location AMC, Amsterdam, The Netherlands
- Department of Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VUMC, Amsterdam, The Netherlands
| | - Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VUMC, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VUMC, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VUMC, Amsterdam, The Netherlands
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20
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Honinx E, Smets T, Piers R, Pasman HRW, Payne SA, Szczerbińska K, Gambassi G, Kylänen M, Pautex S, Deliens L, Van den Block L. Lack of Effect of a Multicomponent Palliative Care Program for Nursing Home Residents on Hospital Use in the Last Month of Life and on Place of Death: A Secondary Analysis of a Multicountry Cluster Randomized Control Trial. J Am Med Dir Assoc 2020; 21:1973-1978.e2. [DOI: 10.1016/j.jamda.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 10/23/2022]
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21
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Thodé M, Pasman HRW, van Vliet LM, Damman OC, Ket JCF, Francke AL, Jongerden IP. Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review. BMJ Support Palliat Care 2020; 12:262-269. [PMID: 33020150 PMCID: PMC9411882 DOI: 10.1136/bmjspcare-2020-002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
Objective Patients with advanced diseases and frail older adults often face decisions regarding life-prolonging treatment. Our aim was to provide an overview of the feasibility and effectiveness of tools that support communication between healthcare professionals and patients regarding decisions on life-prolonging treatments in hospital settings. Design Systematic review: We searched PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and Google Scholar (2009–2019) to identify studies that reported feasibility or effectiveness of tools that support communication about life-prolonging treatments in adult patients with advanced diseases or frail older adults in hospital settings. The Mixed Methods Appraisal Tool was used for quality appraisal of the included studies. Results Seven studies were included, all involving patients with advanced cancer. The overall methodological quality of the included studies was moderate to high. Five studies described question prompt lists (QPLs), either as a stand-alone tool or as part of a multifaceted programme; two studies described decision aids (DAs). All QPLs and one DA were considered feasible by both patients with advanced cancer and healthcare professionals. Two studies reported on the effectiveness of QPL use, revealing a decrease in patient anxiety and an increase in cues for discussing end-of-life care with physicians. The effectiveness of one DA was reported; it led to more understanding of the treatment in patients. Conclusions Use of QPLs or DAs, as a single intervention or part of a programme, may help in communicating about treatment options with patients, which is an important precondition for making informed decisions.
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Affiliation(s)
- Maureen Thodé
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Center of Expertise in Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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22
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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23
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Brinkman-Stoppelenburg A, Evenblij K, Pasman HRW, van Delden JJM, Onwuteaka-Philipsen BD, van der Heide A. Physicians' and Public Attitudes Toward Euthanasia in People with Advanced Dementia. J Am Geriatr Soc 2020; 68:2319-2328. [PMID: 32652560 PMCID: PMC7689700 DOI: 10.1111/jgs.16692] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/15/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES To explore the opinion of the Dutch general public and of physicians regarding euthanasia in patients with advanced dementia. DESIGN A cross‐sectional survey. SETTING The Netherlands. PARTICIPANTS Random samples of 1,965 citizens (response = 1,965/2,641 [75%]) and 1,147 physicians (response = 1,147/2,232 [51%]). MEASUREMENTS The general public was asked to what extent they agreed with the statement “I think that people with dementia should be eligible for euthanasia, even if they no longer understand what is happening (if they have previously asked for it).” Physicians were asked whether they were of the opinion that performing euthanasia is conceivable in patients with advanced dementia, on the basis of a written advance directive, in the absence of severe comorbidities. Multivariable logistic regression was performed to identify factors associated with the acceptance of euthanasia. RESULTS A total of 60% of the general public agreed that people with advanced dementia should be eligible for euthanasia. Factors associated with a positive attitude toward euthanasia were being female, age between 40 and 69 years, and higher educational level. Considering religion important was associated with lower acceptance. The percentage of physicians who considered it acceptable to perform euthanasia in people with advanced dementia was 24% for general practitioners, 23% for clinical specialists, and 8% for nursing home physicians. Having ever performed euthanasia before was positively associated with physicians considering euthanasia conceivable. Being female, having religious beliefs, and being a nursing home physician were negatively associated with regarding performing euthanasia as conceivable. CONCLUSION There is a discrepancy between public acceptance of euthanasia in patients with advanced dementia and physicians' conceivability of performing euthanasia in these patients. This discrepancy may cause tensions in daily practice because patients' and families' expectations may not be met. It urges patients, families, and physicians to discuss mutual expectations in these complex situations in a comprehensive and timely manner. J Am Geriatr Soc 68:2319–2328, 2020.
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Affiliation(s)
| | - Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes J M van Delden
- Julius Centrum voor Gezondheidswetenschappen en Eerstelijnsgeneeskunde, UMCU, Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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24
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Mieras A, Pasman HRW, Klop HT, Onwuteaka-Philipsen BD, Tarasevych S, Tiemessen MA, Becker-Commissaris A. What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer? Clin Lung Cancer 2020; 22:242-251.e5. [PMID: 32698949 DOI: 10.1016/j.cllc.2020.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. PATIENTS AND METHODS This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n = 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. RESULTS Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. CONCLUSION Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Svitlana Tarasevych
- Department of Pulmonary Diseases, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Marian A Tiemessen
- Department of Pulmonary Diseases, Dijklander Ziekenhuis Hoorn, Hoorn, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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Mieras A, Onwuteaka-Philipsen BD, Becker-Commissaris A, Bos JCM, Pasman HRW. Relatives of deceased patients with metastatic lung cancer's views on the achievement of treatment goals and the choice to start treatment: a structured telephone interview study. BMC Palliat Care 2020; 19:86. [PMID: 32560645 PMCID: PMC7305592 DOI: 10.1186/s12904-020-00591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Lung cancer has a high impact on both patients and relatives due to the high disease burden and short life expectancy. Previous studies looked into treatment goals patients have before starting a systemic treatment. However, studies on relatives’ perceptions of treatment at the end of life are scarce. Therefore, we studied the perspectives of relatives in hindsight on the achievement of treatment goals and the choice to start treatment for metastatic lung cancer of their loved one. Methods We conducted a structured telephone interview study in six hospitals across the Netherlands, one academic and five non-academic hospitals, between February 2017 and November 2019. We included 118 relatives of deceased patients diagnosed with metastatic lung cancer who started a systemic treatment as part of usual care (chemotherapy, immunotherapy or targeted therapy with tyrosine kinase inhibitors (TKIs) and who completed a questionnaire on their treatment goals before the start of treatment and when treatment was finished. We asked the relatives about the achievement of patients’ treatment goals and relatives’ satisfaction with the choice to start treatment. This study is part of a larger study in which 266 patients with metastatic lung cancer participated who started a systemic treatment and reported their treatment goals before start of the treatment and the achievement of these goals after the treatment. Results Relatives reported the goals ‘quality of life’, ‘decrease tumour size’ and ‘life prolongation’ as achieved in 21, 37 and 41% respectively. The majority of the relatives (78%) were satisfied with the choice to start a treatment and even when none of the goals were achieved, 70% of the relatives were satisfied. About 50% of relatives who were satisfied with the patients’ choice mentioned negative aspects of the treatment choice, such as the treatment did not work, there were side effects or it would not have been the relatives’ choice. Whereas, 80% of relatives who were not satisfied mentioned negative aspects of the treatment choice. The most mentioned positive aspects were that they tried everything and that it was the patient’s choice. Conclusion The majority of relatives reported patients’ treatment goals as not achieved. However, relatives were predominantly satisfied about the treatment choice. Satisfaction does not provide a full picture of the experience with the treatment decision considering that the majority of relatives mentioned (also) negative aspects of this decision. At the time of making the treatment decision it is important to manage expectations about the chance of success and the possible side effects of the treatment.
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Affiliation(s)
- Adinda Mieras
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands. .,Public Health research Institute, Expertise Center for Palliative Care, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Annemarie Becker-Commissaris
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Jose C M Bos
- Dijklander Ziekenhuis, Department of Pulmonary Diseases, Purmerend, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
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26
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Hagens M, Pasman HRW, Onwuteaka-Philipsen BD. Cross-Sectional Research Into People Passing Away Through Self-Ingesting Self-Collected Lethal Medication After Receiving Demedicalized Assistance in Suicide. Omega (Westport) 2020; 84:1100-1121. [PMID: 32484034 PMCID: PMC8848061 DOI: 10.1177/0030222820926771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes the characteristics of-and the counseling received by-counselees who passed away through self-ingesting self-collected lethal medication after receiving demedicalised assistance in suicide. We analyzed registration forms filled in by counselors working with Foundation De Einder about 273 counselees who passed away from 2011 to 2015. The majority of these counselees had a serious disease and physical or psychiatric suffering. Half of them had requested physician assistance in dying. This shows that patients with a denied request for physician assistance in dying can persist in their wish to end life. This also shows that not all people with an underlying medical disease request for physician assistance in dying. Physicians and psychiatrist are often uninvolved in these self-chosen deaths while they could have a valuable role in the process concerning assessing competency, diagnosing diseases, and offering (or referring for) treatment.
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Affiliation(s)
- Martijn Hagens
- Department of Public and
Occupational Health, Amsterdam Public Health Research Institute (APH),
Amsterdam
UMC, location VU Medical Center,
Amsterdam, the Netherlands
- Martijn Hagens, Amsterdam UMC, location VU
Medical Center, Office A-325, Van der Boechorststraat 7, 1081 BT Amsterdam, the
Netherlands. Emails: ;
| | - H. Roeline W. Pasman
- Department of Public and
Occupational Health, Amsterdam Public Health Research Institute (APH),
Amsterdam
UMC, location VU Medical Center,
Amsterdam, the Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and
Occupational Health, Amsterdam Public Health Research Institute (APH),
Amsterdam
UMC, location VU Medical Center,
Amsterdam, the Netherlands
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van Wijmen MPS, Pasman HRW, van de Ven PM, Widdershoven GAM, Onwuteaka-Philipsen BD. Preferences on forgoing end-of-life treatment are stable over time with people owning an advance directive; A cohort study. Patient Educ Couns 2020; 103:S0738-3991(20)30317-7. [PMID: 32532634 DOI: 10.1016/j.pec.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 04/27/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We studied if preferences about end-of-life care of people having an advance directive (AD) stay stable over time and if (in) stability is associated with health status. METHODS A longitudinal cohort study with a population owning different types of ADs (n = 4638). Respondents repeatedly answered questionnaires between 2005-2010. Using hypothetical scenarios about advanced cancer and dementia we assessed preferences for continuing or forgoing resuscitation, mechanical ventilation, artificial nutrition and antibiotics. Using generalized estimated equations we analysed whether life-events and quality of life influenced changes in preferences. RESULTS The proportion of respondents with stable preferences ranged from 67 to 98 %. Preferences were most stable concerning resuscitation and least stable concerning mechanical ventilation. In only a few instances we found life-events or a change in quality of life could both increase or decrease odds to change preferences. CONCLUSION Preferences concerning continuing or forgoing treatment at the end of life are stable for a majority of people with ADs, which supports their validity. PRACTICE IMPLICATIONS The value of on-going communication about preferences between patients and caregivers is confirmed by our findings concerning differences in stability between treatments and the association between stability of preferences and life-events or quality of life.
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Affiliation(s)
- Matthijs P S van Wijmen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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28
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Bijnsdorp FM, Pasman HRW, Boot CRL, van Hooft SM, van Staa A, Francke AL. Profiles of family caregivers of patients at the end of life at home: a Q-methodological study into family caregiver' support needs. BMC Palliat Care 2020; 19:51. [PMID: 32316948 PMCID: PMC7175554 DOI: 10.1186/s12904-020-00560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of patients at the end of life often experience care-related burden. To prevent caregiver burden and to enhance the capacity to provide care it is important to have insight in their support needs. The purpose of this study was to identify profiles of family caregivers who provide care to patients at the end of life at home. METHODS A Q-methodological study was conducted in which family caregivers ranked 40 statements on support needs and experiences with caregiving. Thereafter they explained their ranking in an interview. By-person factor analysis was used to analyse the rankings and qualitative data was used to support the choice of profiles. A set of 41 family caregivers with a variety on background characteristics who currently or recently provided care for someone at the end of life at home were included. RESULTS Four distinct profiles were identified; profile (1) those who want appreciation and an assigned contact person; profile (2) was bipolar. The positive pole (2+) comprised those who have supportive relationships and the negative pole (2-) those who wish for supportive relationships; profile (3) those who want information and practical support, and profile (4) those who need time off. The profiles reflect different support needs and experiences with caregiving. CONCLUSIONS Family caregivers of patients at the end of life have varying support needs and one size does not fit all. The profiles are relevant for healthcare professionals and volunteers in palliative care as they provide an overview of the main support needs among family caregivers of patients near the end of life. This knowledge could help healthcare professionals giving support.
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Affiliation(s)
- Femmy M Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Cécile R L Boot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Susanne M van Hooft
- Research Centre Innovations in Care, Rotterdam University, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Nivel, Netherlands institute for health services research, Utrecht, The Netherlands
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29
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Slev VN, Molenkamp CM, Eeltink CM, Roeline W Pasman H, Verdonck-de Leeuw IM, Francke AL, van Uden-Kraan CF. A nurse-led self-management support intervention for patients and informal caregivers facing incurable cancer: A feasibility study from the perspective of nurses. Eur J Oncol Nurs 2020; 45:101716. [PMID: 32023503 DOI: 10.1016/j.ejon.2019.101716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/09/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Investigation of the feasibility of recruitment through nurses of patients with incurable cancer, and the feasibility (adoption, usage) and nurses' evaluation of a nurse-led self-management support intervention, integrated in continuity home visits and based on the 5 A's Behavior Change Model. METHOD Questionnaire, registrations, evaluation forms, and interviews. RESULTS Recruitment was complicated; many patients were ineligible for participation, nurses appeared protective of their patients (gatekeeping), and recruitment during the first continuity home visit appeared to be a barrier as a lot of other issues had to be discussed. The adoption rate was 81%, meaning that 18 out of 22 nurses recruited were willing to use the intervention. The usage rate at the nurse level was 56%, meaning that 10 nurses applied the intervention in full (having applied all five A's) in at least one patient. Nurses used the intervention in full in 21 out of the 36 patients included, implying a usage rate at the patient level of 58%. Nurses' mean general satisfaction score for the intervention was 7.57 (range 0-10). Nurse were especially positive about the 5 A's model, and considered the continuity home visits to be an appropriate setting for the intervention. CONCLUSIONS Timing of recruitment and gatekeeping complicated recruitment of patients through nurses. Although nurses were positive about the intervention, nurses often did not fully apply the intervention. To improve its usage, it is suggested that nurses should first be trained in using the 5 A's model.
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Affiliation(s)
- Vina N Slev
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands.
| | - Cornelia M Molenkamp
- Evean, Department of Specialised Home Care Nursing, Waterlandplein 5, Purmerend, the Netherlands
| | - Corien M Eeltink
- Amsterdam UMC, location VU University Medical Center Department of Hematology, De Boelelaan, 1117, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands
| | - Irma M Verdonck-de Leeuw
- Amsterdam UMC, location VU University Medical Center Department of Otolaryngology - Head & Neck Surgery, De Boelelaan, 1117, Amsterdam, the Netherlands; Vrije Universiteit, Amsterdam Public Health, Faculty of Behavioral and Movement Sciences, Department of Clinical Psychology, Amsterdam, the Netherlands; Cancer Center Amsterdam (CCA), De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Anneke L Francke
- Amsterdam UMC, location VU University Medical Center/ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, de Boelelaan, 1117, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Van der Boechorststraat 7, Amsterdam, Netherlands; NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118 - 124, Utrecht, the Netherlands
| | - Cornelia F van Uden-Kraan
- Vrije Universiteit, Amsterdam Public Health, Faculty of Behavioral and Movement Sciences, Department of Clinical Psychology, Amsterdam, the Netherlands
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Van den Block L, Honinx E, Pivodic L, Miranda R, Onwuteaka-Philipsen BD, van Hout H, Pasman HRW, Oosterveld-Vlug M, Ten Koppel M, Piers R, Van Den Noortgate N, Engels Y, Vernooij-Dassen M, Hockley J, Froggatt K, Payne S, Szczerbinska K, Kylänen M, Gambassi G, Pautex S, Bassal C, De Buysser S, Deliens L, Smets T. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial. JAMA Intern Med 2020; 180:233-242. [PMID: 31710345 PMCID: PMC6865772 DOI: 10.1001/jamainternmed.2019.5349] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE High-quality evidence on how to improve palliative care in nursing homes is lacking. OBJECTIVE To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio. INTERVENTIONS The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning, and review of needs and problems, (3) coordination of care via monthly multidisciplinary review meetings, (4) delivery of high-quality care focusing on pain and depression, (5) care in the last days of life, and (6) care after death. MAIN OUTCOMES AND MEASURES The primary resident outcome was comfort in the last week of life measured after death by staff using the End-of-Life in Dementia Scale Comfort Assessment While Dying (EOLD-CAD; range, 14-42). The primary staff outcome was knowledge of palliative care reported by staff using the Palliative Care Survey (PCS; range, 0-1). RESULTS Concerning deceased residents, we collected 551 of 610 questionnaires from staff at baseline and 984 of 1178 postintervention in 37 intervention and 36 control homes. Mean (SD) age at time of death ranged between 85.22 (9.13) and 85.91 (8.57) years, and between 60.6% (160/264) and 70.6% (190/269) of residents were women across the different groups. Residents' comfort in the last week of life did not differ between intervention and control groups (baseline-adjusted mean difference, -0.55; 95% CI, -1.71 to 0.61; P = .35). Concerning staff, we collected 2680 of 3638 questionnaires at baseline and 2437 of 3510 postintervention in 37 intervention and 38 control homes. Mean (SD) age of staff ranged between 42.3 (12.1) and 44.1 (11.7) years, and between 87.2% (1092/1253) and 89% (1224/1375) of staff were women across the different groups. Staff in the intervention group had statistically significantly better knowledge of palliative care than staff in the control group, but the clinical difference was minimal (baseline-adjusted mean difference, 0.04; 95% CI, 0.02-0.05; P < .001). Data analyses began on April 20, 2018. CONCLUSIONS AND RELEVANCE Residents' comfort in the last week of life did not improve after introducing the PACE Steps to Success Program. Improvements in staff knowledge of palliative care were clinically not important. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN14741671.
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Affiliation(s)
- Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Elisabeth Honinx
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Rose Miranda
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein van Hout
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mariska Oosterveld-Vlug
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maud Ten Koppel
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth Piers
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jo Hockley
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katherine Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katarzyna Szczerbinska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sophie Pautex
- Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
| | - Catherine Bassal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Geneva, Switzerland
| | - Stefanie De Buysser
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Luc Deliens
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
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Koper I, Pasman HRW, Schweitzer BPM, van der Zweep G, Uyttewaal G, Onwuteaka-Philipsen BD. Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study. BMC Palliat Care 2020; 19:10. [PMID: 31948417 PMCID: PMC6966787 DOI: 10.1186/s12904-020-0514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/08/2020] [Indexed: 11/22/2022] Open
Abstract
Background PaTz (palliative care at home) is a method to improve palliative care in the primary care setting in the Netherlands. PaTz has three basic principles: (1) local GPs and DNs meet at least six times per year to identify and discuss their patients with a life-threatening illness; (2) these meetings are supervised by a specialist palliative care professional; (3) groups use a palliative care register on which all identified patients are listed. Since the start in 2010, the number of PaTz-groups in the Netherlands has been growing consistently. Although the theory of all PaTz-groups is the same, the practical functioning of PaTz-groups may vary substantially, which may complicate further implementation of PaTz as well as interpretation of effect studies. This study aims to describe the variation in practice of PaTz-groups in the Netherlands. Method In this prospective observational study, ten PaTz-groups logged and described the activities in their meetings as well as the registered and discussed patients and topics of discussions in registration forms for a 1 year follow-up period. In addition, non-participatory observations were performed in all participating groups. Meeting and patient characteristics were analysed using descriptive statistics. Conventional content analysis was performed in the analysis of topic discussions. Results While the basic principles of PaTz are found in almost every PaTz-group, there is considerable variation in the practice and content of the meetings of different PaTz-groups. Most groups spend little time on other topics than their patients, although the number of patients discussed in a single meeting varies considerably, as well as the time spent on an individual patient. Most registered patients were diagnosed with cancer and patient discussions mainly concerned current affairs and rarely concerned future issues. Conclusion The basic principles are the cornerstone of any PaTz-group. At the same time, the observed variation between PaTz-groups indicates that tailoring a PaTz-group to the needs of its participants is important and may enhance its sustainability. The flexibility of PaTz-groups may also provide opportunity to modify the content and tools used, and improve identification of palliative patients and advance care planning.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bergman TD, Pasman HRW, Onwuteaka-Philipsen BD. Complexities in consultations in case of euthanasia or physician-assisted suicide: a survey among SCEN physicians. BMC Fam Pract 2020; 21:6. [PMID: 31918673 PMCID: PMC6953152 DOI: 10.1186/s12875-019-1063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the Netherlands, euthanasia or physician-assisted suicide (EAS) is allowed if due care criteria are met. One criterion is consultation of a second independent physician, often SCEN physicians. The public debate about EAS focuses on patients with psychiatric disorders, dementia, and tired of living, as complex cases. What complexities SCEN physicians perceive during consultation is unknown. This study aims to assess the frequency of EAS consultations that are perceived difficult by SCEN physicians, to explore what complexities are perceived by SCEN physicians during consultation, and to assess what characteristics are associated with difficult consultations. METHODS Data from 2015 to 2017 from an annual cross-sectional survey among SCEN physicians was used. In 2015, the survey focused on the most difficult consultation that year and in 2016/2017 on the most recent consultation. Frequencies of coded answers to an open-ended question were done to explore what complexities SCEN physicians perceived during their most difficult consultation. Univariable and multivariable logistic regression analyses were used to assess what characteristics were associated with difficult consultations. RESULTS 21.6% of cases consulted by SCEN physicians is perceived difficult. Complexities that SCEN physicians perceive were mainly in contact with patients (79.7%) and in the assessment of due care criteria (41.0%). Characteristics that were associated with a higher likelihood of a consultation being difficult are the attending physician being less certain to perform the EAS, patients staying in the hospital, main diagnosis heart failure/CVA, and accumulation of age-related health problems/psychiatry/dementia, and the presence of a psychiatric disorder, or psychosocial or existential problems besides the main diagnosis. Characteristics that were associated with a lower likelihood of a consultation being difficult are high patient's age and physical suffering as reason to request EAS. CONCLUSION Complexities perceived by SCEN physicians in EAS consultations are not limited to the 'complex' cases present in the current public debate about EAS, e.g. patients with psychiatric disorders, dementia, and tired of living. Attention for these complexities in intervision could indicate if there is a need among SCEN physicians to enhance knowledge and skills in training and to receive specific support in intervision on these complexities.
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Affiliation(s)
- Tessa D Bergman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
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Mieras A, Becker-Commissaris A, Pasman HRW, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Onwuteaka-Philipsen BD. Chemotherapy and Tyrosine Kinase Inhibitors in the last month of life in patients with metastatic lung cancer: A patient file study in the Netherlands. Eur J Cancer Care (Engl) 2019; 29:e13210. [PMID: 31863609 PMCID: PMC9285506 DOI: 10.1111/ecc.13210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/01/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022]
Abstract
Objective Chemotherapy in the last month of life for patients with metastatic lung cancer is often considered as aggressive end‐of‐life care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) is a relatively new treatment of which not much is known yet about use in the last month of life. We examined what percentage of patients received chemotherapy or TKIs in the last month of life in the Netherlands. Methods Patient files were drawn from 10 hospitals across the Netherlands. Patients had to meet the following eligibility criteria: metastatic lung cancer; died between June 1, 2013 and July 31, 2015. Results From the included 1,322 patients, 39% received no treatment for metastatic lung cancer, 52% received chemotherapy and 9% received TKIs. A total of 232 patients (18%) received treatment in the last month of life (11% chemotherapy, 7% TKIs). From the patients who received chemotherapy, 145 (21%) received this in the last month of life and 79 (11%) started this treatment in the last month of life. TKIs were given and started more often in the last month of life: from the patients who received TKIs, 87 (72%) received this treatment in the last month of life and 15 (12%) started this treatment in the last month of life. Conclusion A substantial percentage of patient received and even started chemotherapy or TKIs in the last month of life. For chemotherapy, this might be seen as aggressive care. TKIs are said to have less side effects, do not lead to many hospital visits and due to the rapid response, are considered good palliation. However, it is not known, yet possible that, when patients still receiving treatment until shortly before death, this might influence preparing for death in a negative way.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC, Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.,Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Evenblij K, Pasman HRW, van Delden JJM, van der Heide A, van de Vathorst S, Willems DL, Onwuteaka-Philipsen BD. Physicians' experiences with euthanasia: a cross-sectional survey amongst a random sample of Dutch physicians to explore their concerns, feelings and pressure. BMC Fam Pract 2019; 20:177. [PMID: 31847816 PMCID: PMC6918628 DOI: 10.1186/s12875-019-1067-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/05/2019] [Indexed: 11/27/2022]
Abstract
Background Physicians who receive a request for euthanasia or assisted suicide may experience a conflict of duties: the duty to preserve life on the one hand and the duty to relieve suffering on the other hand. Little is known about experiences of physicians with receiving and granting a request for euthanasia or assisted suicide. This study, therefore, aimed to explore the concerns, feelings and pressure experienced by physicians who receive requests for euthanasia or assisted suicide. Methods In 2016, a cross-sectional study was conducted. Questionnaires were sent to a random sample of 3000 Dutch physicians. Physicians who had been working in adult patient care in the Netherlands for the last year were included in the sample (n = 2657). Half of the physicians were asked about the most recent case in which they refused a request for euthanasia or assisted suicide, and half about the most recent case in which they granted a request for euthanasia or assisted suicide. Results Of the 2657 eligible physicians, 1374 (52%) responded. The most reported reason not to participate was lack of time. Of the respondents, 248 answered questions about a refused euthanasia or assisted suicide request and 245 about a granted EAS request. Concerns about specific aspects of the euthanasia and assisted suicide process, such as the emotional burden of preparing and performing euthanasia or assisted suicide were commonly reported by physicians who refused and who granted a request. Pressure to grant a request was mostly experienced by physicians who refused a request, especially if the patient was ≥80 years, had a life-expectancy of ≥6 months and did not have cancer. The large majority of physicians reported contradictory emotions after having performed euthanasia or assisted suicide. Conclusions Society should be aware of the impact of euthanasia and assisted suicide requests on physicians. The tension physicians experience may decrease their willingness to perform euthanasia and assisted suicide. On the other hand, physicians should not be forced to cross their own moral boundaries or be tempted to perform euthanasia and assisted suicide in cases that may not meet the due care criteria.
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Affiliation(s)
- Kirsten Evenblij
- Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes J M van Delden
- UMC Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands
| | - Agnes van der Heide
- Department of Public Health Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne van de Vathorst
- Department of General Practice, section Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of General Practice, section Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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Bijnsdorp FM, van der Beek AJ, Pasman HRW, Boot CRL, de Boer AH, Plaisier I, Onwuteaka-Philipsen BD. Home care for terminally ill patients: the experiences of family caregivers with and without paid work. BMJ Support Palliat Care 2019; 12:e226-e235. [PMID: 31748201 DOI: 10.1136/bmjspcare-2019-001949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/12/2019] [Accepted: 10/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To facilitate care at the end of life at home, support from family caregivers is crucial. A substantial number of these family caregivers also work. Work in relation to care for terminally ill patients has received limited attention. To better understand the context in which these family caregivers provide care, we provide a detailed overview of the situation and experiences of family caregivers of terminally ill patients at home, with and without paid work. METHODS We used a pooled cross-section of data from the Dutch Informal Care Study, collected in 2014 and 2016. All working and non-working family caregivers of terminally ill patients at home were included (n=292). RESULTS Working family caregivers reported more care tasks, and shared care tasks with others more often than non-working caregivers. No differences between working and non-working caregivers were found in negative and positive experiences. Non-working caregivers provided care more often because the care recipient wanted to be helped by them or because there was no one else available than working caregivers. About 70% of the working caregivers were able to combine work and family caregiving successfully. CONCLUSIONS Working and non-working family caregivers of terminally ill patients at home have similar burden and positive experiences. Working family caregivers vary in their ability to combine work and care. Although the majority of working family caregivers successfully combine work and care, a substantial number struggle and need more support with care tasks at home or responsibilities at work.
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Affiliation(s)
- Femmy M Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands .,Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Cécile R L Boot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Alice H de Boer
- The Netherlands Institute for Social Research, The Hague, The Netherlands.,Vrije Universiteit Amsterdam, Department of Sociology, Amsterdam, The Netherlands
| | - Inger Plaisier
- The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Koper I, Pasman HRW, Schweitzer BPM, Kuin A, Onwuteaka-Philipsen BD. Spiritual care at the end of life in the primary care setting: experiences from spiritual caregivers - a mixed methods study. BMC Palliat Care 2019; 18:98. [PMID: 31706355 PMCID: PMC6842508 DOI: 10.1186/s12904-019-0484-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this. Method Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding. Results Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers’ services. Also, structural funding for spiritual caregivers in the primary care setting should be organized. Conclusion Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers’ services.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Annemieke Kuin
- Spiritual caregiver, Dijklander Hospital, Hoorn and Purmerend, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
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Mieras A, Pasman HRW, Onwuteaka-Philipsen BD, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Becker-Commissaris A. Is In-Hospital Mortality Higher in Patients With Metastatic Lung Cancer Who Received Treatment in the Last Month of Life? A Retrospective Cohort Study. J Pain Symptom Manage 2019; 58:805-811. [PMID: 31283970 DOI: 10.1016/j.jpainsymman.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care. OBJECTIVES We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life. METHODS This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records. RESULTS In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital. CONCLUSION In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, The Netherlands; Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Honinx E, Smets T, Piers R, Deliens L, Payne S, Kylänen M, Barańska I, Pasman HRW, Gambassi G, Van den Block L. Agreement of Nursing Home Staff With Palliative Care Principles: A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries. J Pain Symptom Manage 2019; 58:824-834. [PMID: 31376522 DOI: 10.1016/j.jpainsymman.2019.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. OBJECTIVES To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. METHODS This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). RESULTS Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09-0.43, P = 0.003), nurses (0.59; 95% CI: 0.43-0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08-0.34, P = 0.002). CONCLUSIONS The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.
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Affiliation(s)
- Elisabeth Honinx
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Tinne Smets
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Deliens
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Sheila Payne
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Ilona Barańska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine Jagiellonian University Medical College, Kraków, Poland; Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Vrije Universiteit, Amsterdam Medisch Centrum, BT Amsterdam, the Netherlands
| | - Giovanni Gambassi
- Department of Internal Medicine, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore Largo F, Rome, Italy
| | - Lieve Van den Block
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Ten Koppel M, Onwuteaka-Philipsen BD, Van den Block L, Deliens L, Gambassi G, Heymans MW, Kylänen M, Oosterveld-Vlug MG, Pasman HRW, Payne S, Smets T, Szczerbińska K, Twisk JW, van der Steen JT, Mammarella F, Mercuri M, Pivodic L, Pac A, Rossi P, Segat I, Sowerby E, Stodolska A, van Hout H, Wichmann A, Adang E, Andreasen P, Finne-Soveri H, Collingridge Moore D, Froggatt K, Kijowska V, Van Den Noortgate N, Vernooij-Dassen M. Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE). Palliat Med 2019; 33:1176-1188. [PMID: 31258004 DOI: 10.1177/0269216319861229] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. AIM To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. DESIGN Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. SETTING/PARTICIPANTS Nurses or care assistants who are most involved in care for the resident. RESULTS We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%-Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%-the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. CONCLUSION The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.
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Affiliation(s)
- Maud Ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Giovanni Gambassi
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mariska G Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jos Wr Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Evenblij K, Pasman HRW, van der Heide A, van Delden JJM, Onwuteaka-Philipsen BD. Public and physicians' support for euthanasia in people suffering from psychiatric disorders: a cross-sectional survey study. BMC Med Ethics 2019; 20:62. [PMID: 31510976 PMCID: PMC6737595 DOI: 10.1186/s12910-019-0404-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/02/2019] [Indexed: 01/09/2023] Open
Abstract
Background Although euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. Methods A survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Results Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. Conclusion The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria. Supplementary information Supplementary information accompanies this paper at 10.1186/s12910-019-0404-8.
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Affiliation(s)
- Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
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Ten Koppel M, Pasman HRW, van der Steen JT, van Hout HPJ, Kylänen M, Van den Block L, Smets T, Deliens L, Gambassi G, Froggatt K, Szczerbińska K, Onwuteaka-Philipsen BD. Consensus on treatment for residents in long-term care facilities: perspectives from relatives and care staff in the PACE cross-sectional study in 6 European countries. BMC Palliat Care 2019; 18:73. [PMID: 31464624 PMCID: PMC6714096 DOI: 10.1186/s12904-019-0459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/15/2019] [Indexed: 01/23/2023] Open
Abstract
Background In long-term care facilities often many care providers are involved, which could make it difficult to reach consensus in care. This may harm the relation between care providers and can complicate care. This study aimed to describe and compare in six European countries the degree of consensus among everyone involved in care decisions, from the perspective of relatives and care staff. Another aim was to assess which factors are associated with reporting that full consensus was reached, from the perspective of care staff and relatives. Methods In Belgium, England, Finland, Italy, the Netherlands and Poland a random sample of representative long-term care facilities reported all deaths of residents in the previous three months (n = 1707). This study included residents about whom care staff (n = 1284) and relatives (n = 790) indicated in questionnaires the degree of consensus among all involved in the decision or care process. To account for clustering on facility level, Generalized Estimating Equations were conducted to analyse the degree of consensus across countries and factors associated with full consensus. Results Relatives indicated full consensus in more than half of the residents in all countries (NL 57.9% - EN 68%), except in Finland (40.7%). Care staff reported full consensus in 59.5% of residents in Finland to 86.1% of residents in England. Relatives more likely reported full consensus when: the resident was more comfortable or talked about treatment preferences, a care provider explained what palliative care is, family-physician communication was well perceived, their relation to the resident was other than child (compared to spouse/partner) or if they lived in Poland or Belgium (compared to Finland). Care staff more often indicated full consensus when they rated a higher comfort level of the resident, or if they lived in Italy, the Netherland, Poland or England (compared to Finland). Conclusions In most countries the frequency of full consensus among all involved in care decisions was relatively high. Across countries care staff indicated full consensus more often and no consensus less often than relatives. Advance care planning, comfort and good communication between relatives and care professionals could play a role in achieving full consensus. Electronic supplementary material The online version of this article (10.1186/s12904-019-0459-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - H R W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - H P J van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, The Netherlands
| | - M Kylänen
- National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - L Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - T Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - L Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - G Gambassi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - K Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 7a, Krakow, Poland
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
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Fritz L, Zwinkels H, Koekkoek JAF, Reijneveld JC, Vos MJ, Dirven L, Pasman HRW, Taphoorn MJB. Advance care planning in glioblastoma patients: development of a disease-specific ACP program. Support Care Cancer 2019; 28:1315-1324. [PMID: 31243585 PMCID: PMC6989589 DOI: 10.1007/s00520-019-04916-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown if the implementation of an advance care planning (ACP) program is feasible in daily clinical practice for glioblastoma patients. We aimed to develop an ACP program and assess the preferred content, the best time to introduce such a program in the disease trajectory, and possible barriers and facilitators for participation and implementation. METHODS A focus group with health care professionals (HCPs) and individual semi-structured interviews with patients and proxies (of both living and deceased patients) were conducted. RESULTS All predefined topics were considered relevant by participants, including the current situation, worries/fears, (supportive) treatment options, and preferred place of care/death. Although HCPs and proxies of deceased patients indicated that the program should be implemented relatively early in the disease trajectory, patient-proxy dyads were more ambiguous. Several patient-proxy dyads indicated that the program should be initiated later in the disease trajectory. If introduced early, topics about the end of life should be postponed. A frequently mentioned barrier for participation was that the program would be too confronting, while a facilitator was adequate access to information. CONCLUSION This study resulted in an ACP program specifically for glioblastoma patients. Although participants agreed on the program content, the optimal timing of introducing such a program was a matter of debate. Our solution is to offer the program shortly after diagnosis but let patients and proxies decide which topics they want to discuss and when. The impact of the program on several patient- and care-related outcomes will be evaluated in the next step.
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Affiliation(s)
- Lara Fritz
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (location VUmc), Amsterdam, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative care Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands.
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Bijnsdorp FM, Pasman HRW, Francke AL, Evans N, Peeters CFW, Broese van Groenou MI. Who provides care in the last year of life? A description of care networks of community-dwelling older adults in the Netherlands. BMC Palliat Care 2019; 18:41. [PMID: 31092227 PMCID: PMC6521417 DOI: 10.1186/s12904-019-0425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home-based care networks differ in size and composition, but little is known about the characteristics of care networks for those nearing the end of their lives. This study aimed to identify different types of home-based care networks of community-dwelling older adults in the Netherlands and to assess the association between care network type and the health status and socio-demographic characteristics of care recipients. METHODS/DESIGN We used data from participants of the Longitudinal Aging Study Amsterdam (2001-2013) with chronic diseases or functional limitations who died within 12 months of their last interview and received home based personal and/or household care (n = 146). Latent Class Analysis was used to model distinct end-of-life care networks among this pooled cross-section of older people whose characteristics imply care needs. The Akaike information criterion was used to determine the optimal model. Associations between network type and care recipient characteristics were explored using conditional inference trees. RESULTS We identified four types of care networks; a partner network (19%) in which care was mainly provided by partners, with little care from private caregivers or professionals, a mixed network (25%) in which care was provided by a combination of children, professionals and/or other family members, a private network (15%) in which only privately paid care was provided, and a professional network (40%) in which care was mainly provided by publicly paid professionals, sometimes with additional care from family or privately paid caregivers. Care networks near the end of life showed similar characteristics to those identified for older people more generally, but care seemed to be more intensive in the last year of life compared to the years preceding it. End-of-life care networks were mostly related to age, educational level and partner status. Formal care substitutes informal care whenever there is no partner or child present and able to provide care. CONCLUSION Our findings indicate that personal and household care can be quite intensive in the last year of life, especially for partner caregivers. To prevent caregiver burden, it is important that professionals make sure partner caregivers receive adequate and timely support to cope with the care situation.
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Affiliation(s)
- Femmy M. Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Anneke L. Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Nivel, Netherlands Institute for Health Services Research, Otterstraat, 118 Utrecht, The Netherlands
| | - Natalie Evans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Carel F. W. Peeters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, De Boelelaan, 1117 Amsterdam, Netherlands
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Evenblij K, Pasman HRW, van der Heide A, Hoekstra T, Onwuteaka-Philipsen BD. Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age. BMC Med 2019; 17:39. [PMID: 30777057 PMCID: PMC6379969 DOI: 10.1186/s12916-019-1276-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted. METHODS A nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361). RESULTS The frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia. CONCLUSIONS EAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.
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Affiliation(s)
- Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Evenblij K, Pasman HRW, Pronk R, Onwuteaka-Philipsen BD. Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists. BMC Psychiatry 2019; 19:74. [PMID: 30782146 PMCID: PMC6381744 DOI: 10.1186/s12888-019-2053-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/11/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context. EAS in psychiatric patients appears to become more frequent in the Netherlands. However, little is known about the experiences of psychiatrists with this practice. This study aims to estimate the incidence of EAS (requests) in psychiatric practice in The Netherlands and to describe the characteristics of psychiatric patients requesting EAS, the decision-making process and outcomes of these requests. METHODS In the context of the third evaluation of the Dutch Euthanasia Act, a cross-sectional study was performed between May and September 2016. A questionnaire was sent to a random sample of 500 Dutch psychiatrists. Of the 425 eligible psychiatrists 49% responded. Frequencies of EAS and EAS requests were estimated. Detailed information was asked about the most recent case in which psychiatrists granted and/or refused an EAS request, if any. RESULTS The total number of psychiatric patients explicitly requesting for EAS was estimated to be between 1100 and 1150 for all psychiatrists in a one year period from 2015 to 2016. An estimated 60 to 70 patients received EAS in this period. Nine psychiatrists described a case in which they granted an EAS request from a psychiatric patient. Five of these nine patients had a mood disorder. Three patients had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'suffering without prospect of improvement'. Sixty-six psychiatrists described a case in which they refused an EAS request. 59% of these patients had a personality disorder and 19% had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'desperate situations in several areas of life'. Most requests were refused because the due care criteria were not met. CONCLUSIONS Although the incidence of EAS in psychiatric patients increased over the past two decades, this practice remains relatively rare. This is probably due to the complexity of assessing the due care criteria in case of psychiatric suffering. Training and support may enable psychiatrists to address this sensitive issue in their work better.
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Affiliation(s)
- Kirsten Evenblij
- Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands.
| | - H. Roeline W. Pasman
- 0000 0004 1754 9227grid.12380.38Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, P.O. Box 7057, 1007 Amsterdam, MB Netherlands
| | - Rosalie Pronk
- 0000000084992262grid.7177.6Department of General Practice, section Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- 0000 0004 1754 9227grid.12380.38Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, P.O. Box 7057, 1007 Amsterdam, MB Netherlands
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Evenblij K, Ten Koppel M, Smets T, Widdershoven GAM, Onwuteaka-Philipsen BD, Pasman HRW. Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy. BMC Palliat Care 2019; 18:1. [PMID: 30621703 PMCID: PMC6323808 DOI: 10.1186/s12904-018-0388-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background End-of-life conversations are rarely initiated by care staff in long-term care facilities. A possible explanation is care staff’s lack of self-efficacy in such conversations. Research into the determinants of self-efficacy for nurses and care assistants in end-of-life communication is scarce and self-efficacy might differ between care staff of mental health facilities, nursing homes, and care homes. This study aimed to explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication. Methods Two cross-sectional Dutch studies, one in mental health facilities and one in nursing and care homes (PACE study). Nurses and care assistants were invited to complete a questionnaire in 2015. Multivariable logistic regression analyses were performed to identify determinants of high self-efficacy. Results Five hundred forty one nurses and care assistants completed a survey; 137 worked in mental health facilities, 172 in nursing homes, and 232 in care homes. Care staff at mental health facilities were the most knowledgeable about the World Health Organization’s definition of palliative care: 76% answered 4–5 out of 5 items correctly compared to 38% of nursing home staff and 40% of care home staff (p < 0.001). Around 60% of care staff in all settings experienced time pressure. Care staff had high self-efficacy regarding end-of-life communication with patients: the overall mean score across all facilities was 5.47 out of 7 (standard deviation 1.25). Determinants of high self-efficacy were working in a mental health facility, age > 36, female, with formal palliative care training, and knowledge of the palliative care definition. Conclusion Mental healthcare staff knew more about palliative care and had higher self-efficacy in end-of-life communication compared to nursing and care home staff. Educating care staff about providing palliative care and training them in it might improve end-of-life communication in these facilities.
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Affiliation(s)
- Kirsten Evenblij
- Amsterdam UMC, Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands.
| | - Maud Ten Koppel
- Amsterdam UMC, Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Guy A M Widdershoven
- Amsterdam UMC, Department of Medical Humanities, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Department of Public and Occupational Health, VUmc Expertise Center for Palliative Care, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
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van Wijmen MPS, Pasman HRW, Twisk JWR, Widdershoven GAM, Onwuteaka-Philipsen BD. Stability of end-of-life preferences in relation to health status and life-events: A cohort study with a 6-year follow-up among holders of an advance directive. PLoS One 2018; 13:e0209315. [PMID: 30562403 PMCID: PMC6298688 DOI: 10.1371/journal.pone.0209315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
Background Stating preferences about care beforehand using advance care planning and advance directives has become increasingly common in current medicine. There is still lack of clarity what happens over the course of time in relation to these preferences. We wanted to determine whether the preferences about end-of-life care of a person owning an advance directive stay stable after the experience of a life-event; how often advance directives are altered and discussed with family members and physicians over time. Design A longitudinal cohort study with a population consisting of people owning the most common advance directives in the Netherlands, with a follow-up of 6-years from 2005 until 2011. Respondents were recruited using two associations that provided the advance directives, Right to Die-NL (n = 4463) and the Dutch Patient Organisation (n = 1263). Each 1.5 year a questionnaire was sent. We analyzed the relationship between variables using generalized estimated equations. Results 96.9–98.1% of the respondents who had experienced a life-event had stable preferences. 89.9–93.7% of Right-to-Die-NL-members who had experienced a life-event didn’t make any alterations in their advance directives. During the 6-year course of our study, a minority of both groups didn’t discuss their advance directive with anyone (8.7–16.4%), while a majority didn’t discuss it with physicians (ranging 58.1–95.1%). Factors related to health, such as deterioration in experienced health, increased the odds to discuss advance directives. Conclusion Our results largely dispute criticism concerning usability of advance directives due to lack of stability of preferences. Whereas a change in health status and the experience of other life-events were not related to instability in preferences, they did increase the odds of communication about advance directives. Because our results show that the possession of an advance directive does not necessarily result in frequent discussions between patients and caregivers, a more structured approach like advance care planning might be a solution.
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Affiliation(s)
- Matthijs P. S. van Wijmen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A. M. Widdershoven
- Department of Medical Humanities, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Koper I, Pasman HRW, Onwuteaka-Philipsen BD. Experiences of Dutch general practitioners and district nurses with involving care services and facilities in palliative care: a mixed methods study. BMC Health Serv Res 2018; 18:841. [PMID: 30409204 PMCID: PMC6225713 DOI: 10.1186/s12913-018-3644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. Methods Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding. Results Most GPs reported that they sometimes or often involved palliative home care teams (99%), hospices (94%), and palliative care consultation services (93%). Most DNs reported sometimes or often involving volunteers (90%), hospices (88%), and spiritual caregivers (80%). The least involved services and facilities were psychologists and psychiatrists (51% and 50%) and social welfare (44% and 57%). Main reason for not involving services and facilities was ‘not needing’ them. If they had used them, most GPs and DNs (68–93%) reported solely positive experiences. Hardly anyone (0–3%) reported solely negative experiences with any of the services and the facilities. GPs and DNs suggested improvements in three areas: (1) establishment of local centers giving information on available services and facilities, (2) presentation of services and facilities in local multidisciplinary meetings, and (3) support organizations to proactively offer their facilities and services. Conclusion Psychological, social, and spiritual services are involved less often, suggesting that the classic care model, which focuses strongly on somatic issues, is still well entrenched. More familiarity with services that can provide additional care in these areas, regarding their availability and their added value, could improve the quality of life for patients and relatives at the end of life.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
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Smets T, Pivodic L, Piers R, Pasman HRW, Engels Y, Szczerbińska K, Kylänen M, Gambassi G, Payne S, Deliens L, Van den Block L. The palliative care knowledge of nursing home staff: The EU FP7 PACE cross-sectional survey in 322 nursing homes in six European countries. Palliat Med 2018; 32:1487-1497. [PMID: 29972343 PMCID: PMC6158686 DOI: 10.1177/0269216318785295] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The provision of high-quality palliative care in nursing homes (NHs) is a major challenge and places demands on the knowledge and skills of the staff. AIM This study assesses the palliative care knowledge of staff in NHs in Europe. DESIGN Cross-sectional study using structured survey Setting/participants: Nurses and care assistants working in 322 representative samples of NHs in Belgium, the Netherlands, England, Finland, Poland and Italy. Palliative care knowledge is measured with the Palliative Care Survey. Scores on the scales range between 0 and 1; higher scores indicate more knowledge. RESULTS A total of 3392 NH-staff were given a questionnaire, and 2275 responded (67%). Knowledge of basic palliative care issues ranged between 0.20 in Poland (95% confidence interval (CI) 0.19; 0.24) and 0.61 in Belgium (95% CI 0.59; 0.63), knowledge of physical aspects that can contribute to pain ranged between 0.81 in Poland (95% CI 0.79; 0.84) and 0.91 in the Netherlands (95% CI 0.89; 0.93), and knowledge of psychological reasons that can contribute to pain ranged between 0.56 in England (95% CI 0.50; 0.62) and 0.87 in Finland (95% CI 0.83; 0.90). Factors associated with knowledge were country, professional role and having undertaken formal training in palliative care. CONCLUSIONS Knowledge of nurses and care assistants concerning basic palliative care issues appears to be suboptimal in all participating countries, although there is substantial heterogeneity. Education of nursing staff needs to be improved across, but each country may require its own strategy to address the unique and specific knowledge gaps.
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Affiliation(s)
- Tinne Smets
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lara Pivodic
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Ruth Piers
- 3 Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - H Roeline W Pasman
- 4 EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvonne Engels
- 5 Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Katarzyna Szczerbińska
- 6 Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marika Kylänen
- 7 National Institute for Health and Welfare, Helsinki, Finland
| | | | - Sheila Payne
- 9 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Luc Deliens
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,9 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Lieve Van den Block
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Slev VN, Pasman HRW, Eeltink CM, van Uden-Kraan CF, Verdonck-de Leeuw IM, Francke AL. Self-management support and eHealth for patients and informal caregivers confronted with advanced cancer: an online focus group study among nurses. BMC Palliat Care 2017; 16:55. [PMID: 29162081 PMCID: PMC5699199 DOI: 10.1186/s12904-017-0238-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/14/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Self-management by patients and informal caregivers confronted with advanced cancer is not self-evident. Therefore they might need self-management support from nurses. This article reports on nurses' perspectives on self-management support for people confronted with advanced cancer, and nurses' experiences with eHealth in this context. METHODS Six online focus groups were organized, with a total of 45 Dutch nurses with different educational levels and working in different care settings. Nurses were asked how they support patients and informal caregivers facing advanced cancer in managing physical and psychosocial problems in their daily life. Questions were also asked regarding the nurses' experiences with eHealth. Transcripts of the online focus group discussions were analyzed qualitatively following the principles of thematic analysis. The main themes derived from the analyses were ordered according to the elements in the 5 A's Behavior Change Model. RESULTS Within the scope of self-management support, nurses reported that they discuss the background, personal situation, wishes, and needs of advanced cancer patients ('Assess' in the 5 A's model), and they provide information about cancer and specifically the advanced type ('Advise'). However, nurses hardly give any advice on how patients can manage physical and psychological problems themselves and/or pay any attention to collaborative goal-setting ('Agree'). Neither do they explain how follow-up can be arranged ('Arrange'). In addition, they do not appear to pay much attention to self-management support for informal caregivers. Nurses' attitudes towards eHealth within the scope of self-management support are positive. They see many advantages, such as allowing advanced cancer patients to stay in charge of their own care and lives. However, nurses also explicitly stressed that eHealth can never be a substitute for personal contact between nurses and patients. CONCLUSIONS Nurses value self-management support and eHealth for advanced cancer patients and their informal caregivers. However, they seem to disregard important elements in the support of self-management, such as providing practical advice, collaborative goal-setting, and arrangement of follow-up. We recommend further promoting and clarifying the essence and importance of self-management support, including self-management support for informal caregivers.
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Affiliation(s)
- Vina N Slev
- Department of Public and Occupational Health, VU University Medical Center/Amsterdam Public Health research institute, Van Der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands. .,Expertise Center for Palliative Care, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, VU University Medical Center/Amsterdam Public Health research institute, Van Der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.,Expertise Center for Palliative Care, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Corien M Eeltink
- Department of Hematology, VU University Medical Center, De Boelelaan 1118, 1081 HZ, Amsterdam, Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands.,Department of Otolaryngology - Head & Neck Surgery, VU University Medical Center, De Boelelaan 1118, 1081 HZ, Amsterdam, Netherlands.,Cancer Center Amsterdam (CCA), De Boelelaan 1118, 1081 HZ, Amsterdam, Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center/Amsterdam Public Health research institute, Van Der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.,Expertise Center for Palliative Care, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118 - 124, 3513 CR, Utrecht, Netherlands
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