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O'Connor T, Liu WM, Samara J, Lewis J, Paterson C. 'How long do you think?' Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study. Palliat Med 2024:2692163241238903. [PMID: 38654605 DOI: 10.1177/02692163241238903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care. AIM To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death. DESIGN Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient's final phase of life, taking into account variation across age, gender, diagnosis and location of death. SETTING/PARTICIPANTS A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022. RESULTS The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days. CONCLUSION This study provides valuable new knowledge to support clinicians' confidence when responding to the 'how long' question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering 'how long' questions across the illness trajectory.
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Affiliation(s)
- Tricia O'Connor
- Clare Holland House, Canberra Health Services, North Canberra Hospital, Canberra, ACT, Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies and Statistics, Australian National University, Canberra, ACT, Australia
| | - Juliane Samara
- Clare Holland House, Canberra Health Services, North Canberra Hospital, Canberra, ACT, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, Australia
| | - Catherine Paterson
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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Piracha NZ, Nickel LB, Quryshi A, Salah R, Padela AI. Muslims and End-of-Life Healthcare in Non-Muslim Majority Nations: A Systematic Literature Review. J Pain Symptom Manage 2024; 67:e299-e312. [PMID: 38218412 PMCID: PMC10939778 DOI: 10.1016/j.jpainsymman.2024.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
CONTEXT As Muslim populations in non-Muslim majority nations grow and age, they will increasingly require culturally appropriate healthcare. Delivering such care requires understanding their experiences with, as well as preferences regarding, end-of-life healthcare. OBJECTIVES To examine the experiences, needs, and challenges of Muslim patients and caregivers with end-of-life, hospice, and palliative care. METHODS A systematic literature review using five databases (MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Library) and key terms related to Islam and end-of-life healthcare. Papers were limited to English-language empirical studies of adults in non-Muslim majority nations. After removing duplicates, titles, abstracts, and articles were screened for quality and reviewed by a multidisciplinary team. RESULTS From an initial list of 1867 articles, 29 articles met all inclusion criteria. Most studies focused on end-of-life healthcare not related to palliative or hospice services and examined Muslim patient and caregiver experiences rather than their needs or challenges. Content analysis revealed three themes: (1) the role of family in caregiving as a moral duty and as surrogate communicators; (2) gaps in knowledge among providers related to Muslim needs and gaps in patient/family knowledge about advance care planning; and (3) the influence of Islam on Muslim physicians' perspectives and practices. CONCLUSION There is scant research on Muslim patients' and caregivers' engagement with end-of-life healthcare in non-Muslim majority nations. Existing research documents knowledge gaps impeding both Muslim patient engagement with end-of-life care and the delivery of culturally appropriate healthcare.
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Affiliation(s)
- Natasha Z Piracha
- Division of Critical Care and Hospital Medicine, Department of Pediatrics (N.Z.P.), Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA; Adult Palliative Care Service, Department of Medicine (N.Z.P.), Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA
| | - Lauren B Nickel
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Afiya Quryshi
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Harvard University (A.Q.), Cambridge, Massachusetts, USA
| | - Ramy Salah
- Department of Palliative Medicine (R.S.), Palo Alto Medical Foundation, San Mateo, California, USA
| | - Aasim I Padela
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Initiative on Islam and Medicine (A.I.P.), Glendale Heights, Illinois, USA
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Fisher RS, Dattilo TM, DeLone AM, Basile NL, Kenney AE, Hill KN, Chang HF, Gerhardt CA, Mullins LL. The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition. J Pediatr Psychol 2024; 49:207-223. [PMID: 38423530 DOI: 10.1093/jpepsy/jsae008] [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: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population. METHODS Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality. RESULTS The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes. CONCLUSIONS The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.
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Affiliation(s)
- Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ansley E Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Kylie N Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, OK, United States
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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Paley CA, Paley AT, Ziegler LE, Kane EC, McCleery I, Chapman EJ. Narrative review: what constitutes contemporary, high-quality end-of-life care and can lessons be learned from medieval history? Ann Palliat Med 2024; 0:apm-23-552. [PMID: 38462940 DOI: 10.21037/apm-23-552] [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] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND OBJECTIVE In modern Britain, palliative and end-of-life care is governed by quality standards and guidance, which should consider spiritual and psychological needs. However, there are significant gaps in provision of services which was highlighted during the coronavirus disease 2019 (COVID-19) pandemic where many individuals and families suffered profound spiritual and existential distress. Significant gaps remain in the provision of services to support patients with spiritual and psychological needs which can affect the management of physical symptoms. During the medieval period in Western Europe, it was important to prepare well for death throughout life. It has been suggested that lessons may be learned from medieval preparations for death which might benefit those approaching end-oflife in contemporary society. It is therefore timely to consider medieval attitudes to death and reflect on how these might inform modern end-of-life care. The objective of this review is to synthesise literature addressing modern end-of-life care in the UK and contrast this with literature on preparations for death during the medieval period in Western Europe. Our aim is to determine whether there is wisdom to be gained from history which could inform our approaches to end-of-life care today. METHODS Using online databases and broad keyword searches along with experts in the field of medieval history, we identified literature and translations of texts with a focus on preparations for death during both periods. These were narratively synthesised and discussed. KEY CONTENT AND FINDINGS A key finding is that the medieval attitude to death was as an integral part of life, whereas in modern society death is not usually considered until the situation arises. The review highlights a need for a better understanding of the individuality of spiritual and existential needs during end-of-life care in modern society, which will vary according to individual choice, culture, societal group, religion, and belief. CONCLUSIONS The lessons we can learn from our medieval counterparts include the need for lifelong and individual preparations for the end of life, with emphasis on spiritual needs. Alongside palliative interventions, we need to take time to appreciate what gives individuals spiritual support and provide the resources to facilitate this.
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Affiliation(s)
- Carole A Paley
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ash T Paley
- Institute for Medieval Studies, School of History, University of Leeds, Leeds, UK
| | - Lucy E Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Eloise C Kane
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Iona McCleery
- Institute for Medieval Studies, School of History, University of Leeds, Leeds, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Diaz MA, Angus FC, Bickenbach JE. Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities. J Appl Res Intellect Disabil 2024; 37:e13186. [PMID: 38097500 DOI: 10.1111/jar.13186] [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: 04/17/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. METHOD This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. RESULTS Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. CONCLUSIONS The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.
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Affiliation(s)
| | | | - Jerome E Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Duran S, Polat S. Nurses' Attitudes Towards Death and Its Relationship With Anxiety Levels. Omega (Westport) 2024; 88:1530-1544. [PMID: 34982589 DOI: 10.1177/00302228211065963] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined nurses' attitudes towards death, anxiety levels, and socio-demographic characteristics affecting their attitudes towards death. Three hundred and eighty-four nurses participated in the study. A questionnaire form, the Death Attitude Profile-Revised (DAP-R), and the Penn State Worry Questionnaire were applied to the nurses. Nurses' attitudes towards death were positive and their level of fear of death was low. Approach acceptance was high in younger ones; the escape acceptance score was higher in single ones. The neutral acceptance score was higher in those who received training on death. A statistically significant positive correlation was found between nurses' anxiety level and escape acceptance score. There was a statistically significant positive correlation between the length of working years of nurses and the escape acceptance and approach acceptance. Nurses should be prepared for and supported on death with in-service training. It will be useful to provide these training programs to nursing students during their education process.
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Affiliation(s)
- Songul Duran
- Health Services Vocational College, Izmir Demokrasi University, Karabaglar, Turkey
| | - Selda Polat
- Department of Nursing, Faculty of Health Sciences, Bahçeşehir University, İstanbul, Turkey
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Jennerich AL. An Approach to Caring for Patients and Family of Patients Dying in the ICU. Chest 2024:S0012-3692(24)00153-3. [PMID: 38354905 DOI: 10.1016/j.chest.2024.02.007] [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: 09/01/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
TOPIC IMPORTANCE Death is common in the ICU and often occurs after a decision to withhold or withdraw life-sustaining therapies. Care of the dying is a core skill for ICU clinicians, requiring expert communication, primarily with family of critically ill patients. REVIEW FINDINGS Limited high-quality evidence support specific practices related to the care of dying patients in the ICU; thus, many of the recommendations that exist are based on expert opinion. Value exists in sharing a practical approach to caring for patients during the dying process, including topics to be addressed with family members, rationales for recommended care, and strategies for implementing comfort measures only. Through dedicated preparation and planning, clinicians can help family members navigate this intense experience. SUMMARY After a decision had been made to discontinue life-sustaining therapies, family members need to be given a clear description of comfort measures only and provided with additional detail about what it entails, including therapies or interventions to be discontinued, monitoring during the dying process, and common features of the dying process. Order sets can be a valuable resource for ensuring that adequate analgesia and sedation are available and the care plan is enacted properly. To achieve a good death for patients, a collaborative effort among members of the care team is essential.
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Affiliation(s)
- Ann L Jennerich
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, and the Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA.
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Bollig G, Gräf K, Gruna H, Drexler D, Pothmann R. "We Want to Talk about Death, Dying and Grief and to Learn about End-of-Life Care"-Lessons Learned from a Multi-Center Mixed-Methods Study on Last Aid Courses for Kids and Teens. Children (Basel) 2024; 11:224. [PMID: 38397336 PMCID: PMC10887051 DOI: 10.3390/children11020224] [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: 12/27/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Last Aid Courses (LAC) for adults have been established in 21 countries in Europe, Australia and America to improve the public discussion about death and dying and to empower people to participate in end-of-life care provision. In 2018, the first Last Aid Courses for kids and teens (LAC-KT) were introduced. The aim of the study was to explore the views and experiences of the course participants and Last Aid Course instructors on the LAC-KT. METHODS A mixed-methods approach was used. The views of the LAC-KT participants, aged 7 to 17 years, on the LAC-KT were collected using a questionnaire. In addition, the experiences of the Last Aid Course instructors were explored in focus group interviews. RESULTS The results show that 84% of the participants had experiences with death and dying and 91% found the LAC-KT helpful for everyone. The majority of the participants appreciate the opportunity to talk and learn about death, dying, grief and palliative care. CONCLUSIONS The LAC-KT is feasible, very well accepted and a welcome opportunity for exchanging and obtaining information about dying, grief and palliative care. The findings of the study indicate that the LAC-KT should be offered to all interested children and teenagers and included in the school curriculum.
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Affiliation(s)
- Georg Bollig
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Helios Klinikum, 24837 Schleswig, Germany
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, 50924 Cologne, Germany
- Last Aid Research Group International (LARGI), 24837 Schleswig, Germany
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany (H.G.); (D.D.); (R.P.)
| | - Kirsti Gräf
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany (H.G.); (D.D.); (R.P.)
- Pfeiffersche Stiftungen, 39114 Magdeburg, Germany
| | - Harry Gruna
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany (H.G.); (D.D.); (R.P.)
| | - Daniel Drexler
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany (H.G.); (D.D.); (R.P.)
- Department of Palliative Medicine, RoMed Klinikum, 83022 Rosenheim, Germany
| | - Raymund Pothmann
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany (H.G.); (D.D.); (R.P.)
- Kinder PACT, 22297 Hamburg, Germany
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Uno A. How Views on Death and Time Perspectives Relate to Palliative Care Nurses' Attitudes Toward Terminal Care? Omega (Westport) 2024; 88:1031-1050. [PMID: 34872421 DOI: 10.1177/00302228211055269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study's purpose was to explore how palliative care nurses' views on death and time perspectives are related to their terminal care attitudes. A questionnaire survey-consisting of the Death Attitude Inventory, Experiential Time Perspective Scale, and the Japanese version of the Frommelt Attitudes Toward Care of the Dying Scale-was administered to 300 individuals. Cluster analysis was conducted to categorize the way nurses perceive death, which revealed four types: Avoidant, middle, accepting, and indifferent. As a result of the analysis of variance on the terminal care attitudes, based on the types of views on death and time attitudes, it was found that the middle and accepting types, as well as the adaptive formation of time attitudes, were related to positive terminal care attitudes. In conclusion, more effective improvements in attitudes toward terminal care can be expected by incorporating time perspective, in addition to the conventional approaches focusing on death.
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Affiliation(s)
- Akari Uno
- Graduate School of Education, Tohoku University, Sendai, Japan
- Japan Society for the Promotion of Science Research Fellow, Japan
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Wilson DM, Zhou Y, Bykowski KA, Fiore C, Heron J, Salas AS. Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments. J Palliat Med 2024; 27:192-200. [PMID: 37643296 DOI: 10.1089/jpm.2023.0226] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Yiling Zhou
- School of Public Health, University of Alberta, Edmonton, Edmonton, Alberta, Canada
| | | | - Cynthia Fiore
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Heron
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Santos Salas
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Stilos K. Promoting Self-Care in Palliative Care: Through the Wisdom of My Grandmother. Creat Nurs 2024; 30:87-90. [PMID: 38291617 DOI: 10.1177/10784535241228527] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
In the post COVID-19 pandemic period, targeted efforts are needed more than ever to improve frontline nurses' well-being. In the field of palliative care, there is recognition of the importance of self-care, but the concept itself remains nebulous, and proactive implementation of self-care is lacking. Reflective writing has been noted to have positive impacts on health care providers' well-being. This piece brings to light the author's interest and work in reflective writing, sharing a personal account that provides a source of happiness and an opportunity to better understand her palliative care practice. Beyond the individual level, organizations are also encouraged to invest in their nurses' overall well-being.
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Affiliation(s)
- Kalli Stilos
- Division of Palliative Care, Adjunct Clinical Faculty for Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Çuvalci B, Akbal Y, Hintistan S. Turkish Muslim Physicians' and Nurses' Views About the Do Not Resuscitate Order: A Cross-Sectional Two Center Study. Omega (Westport) 2023; 88:690-708. [PMID: 34590886 DOI: 10.1177/00302228211049879] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to determine Turkish Muslim physicians' and nurses' views about the Do Not Resuscitate order and the factors influencing these views. This was a cross-sectional, descriptive study. The sample consisted of 327 health workers including 77 physicians and 250 nurses employed in internal and surgical clinics, intensive care units and emergency services of two different university hospitals located in the northeast of Turkey. 90.9% of Muslim Turkish physicians and 74.4% of nurses request the Do Not Resuscitate order to be legally implemented. The factors predicting 40.0% of Muslim Turkish physicians and nurses requesting the legal implementation of the Do Not Resuscitate order were determined as working at institution 1; requesting implemented before emergencies occur, in emergencies and in both cases; considering informing the patient and their surrogates about as a patient's right; and requesting to be a surrogate for one relatives.
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Affiliation(s)
- Burcu Çuvalci
- Health and Care Services/Elderly Care, Recep Tayyip Erdoğan University Health Services Vocational High School, Rize, Turkey
| | - Yağmur Akbal
- Health Services Vocational High School, Medical Services and Techniques/Anesthesia, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Sevilay Hintistan
- Internal Disease Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
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13
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Cirigliano DL. Natural Organic Reduction as a Means of Body Disposition. Omega (Westport) 2023; 88:765-773. [PMID: 36840729 DOI: 10.1177/00302228231160341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
NOR (Natural Organic Reduction) is the four-to-six-week process of composting a human corpse into soil. While to the general public, NOR may sound like a biologically-sound, basic, holistic answer to the question of body disposition, death care industry professionals know it is not nearly that simple. With NOR recently legalized in New York, major problems will be brought forth in five categories including the following: (1) Disease control with regard to soil, water and air contamination, (2) Cost efficiency, (3) Soil retrieval issues, (4) Impossible accommodations during an epidemic or pandemic, and (5)Failure to Protect What Should Be Sacred Ground/Failure To Provide A Physical Memorial For Decedents. This article will explain the NOR process and address the five problematic issues this process brings forth.
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McCormick S. Conversations on death and dying: exploring performance as a prompt. Palliat Care Soc Pract 2023; 17:26323524231209059. [PMID: 37927404 PMCID: PMC10623634 DOI: 10.1177/26323524231209059] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background Death is inevitable, yet for some, conversations around death remain difficult. The stigmatisation of death amongst some cultures has a negative impact with studies showing societies least likely to discuss end of life openly remain the lowest ranked in terms of end-of-life care quality. Out of this understanding have come several socially engaged projects (e.g. Death Cafes, The Conversation Project, Before I Die Festivals) developed to encourage engagement with the subject. Objective In this article I ask, can autobiographical performance prompt conversations on death and dying? To answer the research question, I examine the socially engaged Death, Dinner, and Performance project, and analyse the effectiveness of the performance/dramaturgical methodology developed in the project to encourage participant engagement with the difficult subjects of death and dying. Design I look specifically at the use of autobiographical performance strategies in the Death, Dinner, and Performance project and explore the outcomes associated with the adaptation of those strategies (particularly regarding relationality in a socially engaged context) in conversations between participants on death, dying and bereavement. Method The project adopted a mixed methodology that engaged both Practice as Research (PaR) and qualitative research strategies. Results PaR reflection and analysis, along with qualitative coding of participant responses allowed an inductive, thematic analysis that highlighted several recurring themes. These are analysed and discussed under two categories in the Analysis and results section at the end of this paper: firstly, in relation to recurring themes in the participants' discussion around the subject of death and dying, and secondly, in relation to the socially engaged strategy (commensality and use of autobiographical performance) used to encourage that discussion.
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Affiliation(s)
- Sheila McCormick
- School of Arts, Media and Creative Technology, The University of Salford, Room 5.12, New Adelphi Building, Salford M5 4BR, UK
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15
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Firouzkouhi M, Alimohammadi N, Abdollahimohammad A, Bagheri G, Farzi J. Bereaved Families Views on the Death of Loved Ones Due to COVID 19: An Integrative Review. Omega (Westport) 2023; 88:4-19. [PMID: 34396819 DOI: 10.1177/00302228211038206] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Families encounter some issues after the death of their loved one due to COVID-19. Therefore, this study aimed to explore the family's views on the death of their loved one due to COVID-19. This integrative review was conducted from May to Jan 2021. We searched PubMed, Google Scholar, Scopus, Web of Science, CINHAL, Magiran, and SID databases. Fifteen studies met the inclusion criteria. The results were classified into two categories, including before and after death. The issues raised before the death of the loved ones include no visit and absence at death time, fear of being infected with the COVID-19, death anxiety, failure to perform religious rites at death, and psychological problems. The after-death issues were related to funeral, burial, rituals, prolonged grieving, maladaptation, loneliness, and repeated mourning. Therefore, health policymakers should provide support before and after the death of loved ones for families.
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Affiliation(s)
- Mohammadreza Firouzkouhi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Zabol University of MedicalSciences, Zabol, Iran
| | - Nasrollah Alimohammadi
- Department of Nursing Intensive Care, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Iran
| | - Abdolghani Abdollahimohammad
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Zabol University of MedicalSciences, Zabol, Iran
| | - Gholamreza Bagheri
- Faculty of Health, Zabol University of Medical Sciences, Zabol University of Medical Sciences, Iran
| | - Jebraeil Farzi
- Department of Health Information Technology, School of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol University of Medical Sciences, Iran
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16
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Bendel Y, Gesualdo C, Pinquart M, von Blanckenburg P. Better than expected? Predictors of coping with expectation violations in the communication about death and dying. Front Psychol 2023; 14:1256202. [PMID: 38022934 PMCID: PMC10654619 DOI: 10.3389/fpsyg.2023.1256202] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background End-of-life (EOL) communication is often avoided, especially among young adults. Negative expectations concerning EOL conversations with relatives or significant others are one major reason. Objective To investigate how best to violate negative expectations concerning EOL conversations by identifying predictors of coping with expectation violations in this context. Methods Vignettes describing expectation violations in the context of EOL communication were presented to a sample of 261 university students. In a first experiment, the credibility of the expectation-disconfirming information was manipulated. In a second experiment, the valence of the disconfirming evidence was manipulated. As outcome measures, the subjective likelihood of two different responses to the expectation violation was assessed: (1) ignoring the disconfirming evidence (immunization) and (2) changing expectations (accommodation). Results Overall, participants experiencing a worse-than-expected event showed more immunization [F(1, 257) = 12.15, p < 0.001, ηp = 0.05], while participants experiencing a better-than-expected event showed more accommodation [F(1, 257) = 30.98, p < 0.001, ηp = 0.11]. Participants with higher fear of death [F(1, 257) = 12.24, p < 0.001, ηp = 0.05] as well as higher death avoidance tendencies [F(1, 257) = 17.16, p < 0.001, ηp = 0.06] showed less accommodation in response to a better-than-expected event. Conclusion In general, young adults appear to update their expectations quickly in response to unexpectedly positive experiences in the context of EOL communication. However, individuals with higher fear of death and higher death avoidance tendencies appear to be at higher risk of maintaining negative expectations despite disconfirming evidence.
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Affiliation(s)
- Yannik Bendel
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Chrys Gesualdo
- Developmental Psychology, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Martin Pinquart
- Developmental Psychology, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
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17
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Hingtgen GM, Grant-Kels JM. How to ethically deal with the patient who feels they deserve to die. J Am Acad Dermatol 2023:S0190-9622(23)02961-4. [PMID: 37806525 DOI: 10.1016/j.jaad.2023.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Affiliation(s)
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida.
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18
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Wilkinson C, Llewellyn A, McCabe C. Is there a role for citizen science in death and dying research? Front Public Health 2023; 11:1241239. [PMID: 37794893 PMCID: PMC10546016 DOI: 10.3389/fpubh.2023.1241239] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
The COVID-19 pandemic has brought conversations about death and dying to the fore in a way not experienced for generations. This raises questions around perceptions of death and dying; the role of healthcare and the community in care; and the use of digital media for information and support. Public engagement can provoke a two-way conversation between researchers and the public and includes techniques that can engage the community not only with the topic but also in research. This perspective article considers the potential role of citizen science in death and dying research, including considerations around its potential benefits and constraints.
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Affiliation(s)
- Clare Wilkinson
- Science Communication Unit, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Alison Llewellyn
- Centre for Health and Clinical Research, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
| | - Candy McCabe
- Centre for Health and Clinical Research, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
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19
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Stanich J, Sunga K, Loprinzi-Brauer C, Ginsburg A, Ingram C, Bellolio F, Cabrera D. Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study. JMIR Med Educ 2023; 9:e43710. [PMID: 37585258 PMCID: PMC10468704 DOI: 10.2196/43710] [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: 10/21/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. OBJECTIVE We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. METHODS This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool-Modified survey to evaluate perceived effectiveness in teaching end-of-life management. RESULTS Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool-Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient's condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. CONCLUSIONS This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.
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Affiliation(s)
- Jessica Stanich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kharmene Sunga
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Alexander Ginsburg
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Cory Ingram
- Division of Palliative, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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20
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de Winter RFP, Meijer CM, Enterman JH, Kool-Goudzwaard N, Gemen M, van den Bos AT, Steentjes D, van Son GE, Hazewinkel MC, de Beurs DP, de Groot MH. A Clinical Model for the Differentiation of Suicidality: Protocol for a Usability Study of the Proposed Model. JMIR Res Protoc 2023; 12:e45438. [PMID: 37566444 PMCID: PMC10457700 DOI: 10.2196/45438] [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: 12/31/2022] [Revised: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for a more targeted assessment of suicidal conditions and improves the use of evidence-based treatment strategies. The differentiation model is based on the experience with suicidality that we have encountered in clinical practice. This model distinguishes 4 subtypes of entrapment leading to suicidality. The earliest description of this model and a proposal for usability research has been previously presented in a book chapter. OBJECTIVE In this study, we present the most recent version of the 4-type differentiation model of suicidality and a protocol for a study into the usability of the proposed model. METHODS The 4-type differentiation model of suicidality distinguishes the following subtypes: (1) perceptual disintegration, (2) primary depressive cognition, (3) psychosocial turmoil, and (4) inadequate coping or communication. We plan to test the usability of the 4 subtypes in a pilot study of 25 cases, and subsequently, we will include 75 cases in a follow-up study. We looked at the case notes of 100 anonymized patients with suicidality who presented to mental health care emergency service in The Hague International Center. The summary and conclusions of the letters sent to the patients' general practitioners after suicide risk assessment will be independently rated by 3 psychiatrists and 3 nurse-scientists for absolute and dimensional scores. The Suicidality Differentiation version 2 (SUICIDI-II) instrument, developed for this study, is used for rating all the cases. Intraclass correlation coefficients for absolute and dimensional scores will be calculated to examine type agreement between raters to examine the usability of the model and the feasibility of the SUICIDI-II instrument. RESULTS We consider the model tentatively valid if the intraclass correlation coefficients are ≥0.70. Subsequently, if the model turns out to be valid, we plan to rate 75 other cases in a follow-up study, according to a similar or adjusted procedure. Study results are expected to be published by the end of 2023. CONCLUSIONS The theoretical roots of the differentiation model stem from classic and contemporary theoretical models of suicidality and from our clinical practice experiences with suicidal behaviors. We believe that this model can be used to adjust the diagnosis, management, treatment, and research of suicidality, in addition to distinguishing different dynamics between practitioners and patients with suicidality and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45438.
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Affiliation(s)
- Remco F P de Winter
- Mental Health Institute Rivierduinen, Leiden, Netherlands
- VU University, Section of Clinical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Maastricht University, MHeNs School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Connie M Meijer
- Sussex Partnership National Health Service Foundation Trust, Eastbourne, United Kingdom
| | | | | | - Manuela Gemen
- Mental Health Institute Rivierduinen, Leiden, Netherlands
| | | | | | | | | | - Derek P de Beurs
- VU University, Section of Clinical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Trimbos Institute, Utrecht, Netherlands
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21
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Carter C, Giosa J, Rizzi K, Oikonen K, Stephenson B, Holyoke P. The Reflection Room ®: Moving from Death-Avoiding to Death-Discussing. Omega (Westport) 2023:302228231192163. [PMID: 37515417 DOI: 10.1177/00302228231192163] [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] [Indexed: 07/30/2023]
Abstract
We developed, implemented, and evaluated a participatory arts-based storytelling initiative called the Reflection Room project. Our aim was to investigate if visiting a Reflection Room, (1) creates opportunities for disclosing emotions and processing thoughts, (2) increases comfort discussing dying and death, and (3) supports advance care planning (ACP), conversations. In the pilot phase of the Reflection Room project, a Reflection Room was installed in 25 sites across Canada from 2016-2017. Data collection included reflection cards (n = 463), and surveys completed by visitors upon exiting a room (n = 271) and 3 months later (n = 50). Analysis involved theoretically driven coding, inductive content analysis, and descriptive statistics. We found reflections contained both emotional disclosures and reflective processing. Survey data indicated visiting a Reflection Room increased comfort in thinking and talking about dying and death as well as the likelihood of engaging in ACP. In the future, we will explore the extent to which the project fosters social connections and well-being.
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Affiliation(s)
| | - Justine Giosa
- SE Research Centre, Markham, ON, Canada
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
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22
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Nyquist C, Cohen-Almagor R, Kim SYH. Expert Views on Medical Involvement in the Swiss Assisted Dying Practice: "We Want to Have Our Cake and Eat It Too"? AJOB Empir Bioeth 2023; 15:41-59. [PMID: 37487185 PMCID: PMC10805980 DOI: 10.1080/23294515.2023.2232796] [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] [Indexed: 07/26/2023]
Abstract
BACKGROUND Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations. METHODS We analyzed in-depth interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS. RESULTS Although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees' preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicine's role would likely impact AS practice and demonstrated the experts' attitudes toward those impacts. CONCLUSION The dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions.
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Affiliation(s)
- Christina Nyquist
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Scott Y H Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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23
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Chrastina J, Haroková M. End of Life in Boys and Young Men With Duchenne Muscular Dystrophy - The Perspective of Dying Men and Their Families: A Systematic Review and Thematic Synthesis of Qualitative Evidence. Omega (Westport) 2023:302228231186358. [PMID: 37408104 DOI: 10.1177/00302228231186358] [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] [Indexed: 07/07/2023]
Abstract
Understanding the perceptions and experiences related to the end of life (EoL) of boys and men with Duchenne muscular dystrophy from their own and/or family perspective is limited based on the available qualitative empirical studies. This systematic review was done with a thematic synthesis of qualitative evidence according to the PRISMA Statement Guidelines and the SPIDER search tool. The review included empirical, qualitative, and relevant full-text studies published in 2000-2023 in the EBSCO Discovery Service, ISI Web of Science, Scopus, PubMed, and ProQuest databases. From o total of eight included qualitative studies, four main key themes were identified: "Being a parent/caregiver" - psychosocial aspects, needs, and experiences; "Communication about EoL with healthcare and other professionals" - positive experiences and personal shortcomings; "Discussions about…" - the issue of EoL, dying and death; and "End of life" - end-of-life care, planning and the need for palliative care.
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Affiliation(s)
- Jan Chrastina
- Institute of Special Education Studies, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic
| | - Martina Haroková
- Institute of Special Education Studies, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic
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24
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Dowd A, Davies M, Short S, Morrison R, Spiller C, Carter J, Eastman P. Dying at home: enablers and barriers. Int J Palliat Nurs 2023; 29:326-333. [PMID: 37478061 DOI: 10.12968/ijpn.2023.29.7.326] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND According to the Grattan institute in 2014, 70% of Australians indicated a preference to die at home, however, only 14% of all deaths were at home. AIMS To identify how patients can be supported to die at home if that is their preference. METHODS A retrospective medical record audit of eligible Community Palliative Care (CPC) patients who indicated a wish to die at home was undertaken. FINDINGS Out of a total of 114 patients, 74% indicated a preference to die at home. Of these, 66% achieved a home death, and most lived with a carer. Enablers for home death included family support, regular nursing visits and equipment. People who attended an emergency department in their last month of life, lived alone or were undergoing oncological treatment were more likely to die elsewhere. CONCLUSION A range of enablers and barriers to home death were found, with many of the enablers being factors that prevented hospital presentations.
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Affiliation(s)
- Anna Dowd
- Clinical Trial Coordinator, Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Melanie Davies
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Sarah Short
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Ruth Morrison
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Cheryl Spiller
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Jill Carter
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Peter Eastman
- Department of Palliative Care, Barwon Health, Geelong, Australia School of Medicine, Deakin University, Geelong, Australia
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25
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Hardie P, McCabe C, Timmins F, Thompson DR. A qualitative exploration of Irish nursing students' experiences of caring for the dying patient. Nurs Open 2023. [PMID: 37277985 DOI: 10.1002/nop2.1810] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/20/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
AIM To explore Irish nursing students' experiences of caring for dying patients and their families to understand these experiences and determine whether or not students felt prepared for this role. DESIGN This study used a qualitative descriptive research design. METHODS One to one semi-structured interviews were used to collect data, implementing open-ended questions to explore seven student nurses' experiences. RESULTS Five main themes emerged: Student's first experiences, emotional experience of caring, educational preparation, challenging aspects of caring for dying patients and their families and need for support in practice. Students' first experience of caring for a dying patient and their family was a confronting event for students, both personally and professionally. Nursing students require adequate and timely education on end of life care and a practical and supportive clinical learning environment to effectively support and prepare students for caring for a dying patient and their family.
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Affiliation(s)
| | - Catherine McCabe
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Fiona Timmins
- Hibernia College, Merrion Rd, Dublin, Ireland
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - David R Thompson
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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26
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Kouroglou V. Working With the Terminally Ill: An Exploration of the Experiences of Psychotherapists in Greece. Omega (Westport) 2023:302228231180784. [PMID: 37247512 DOI: 10.1177/00302228231180784] [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] [Indexed: 05/31/2023]
Abstract
The present study explored mental health professionals' experiences of working with terminally ill patients in Greece, how they make sense of their lived experiences of working with the dying, and investigated how they relate to their personal and professional growth. Semi-structured interviews were conducted with five mental health professionals who work or have worked with terminally ill patients in Greece. Their responses were analyzed using Interpretative Phenomenological Analysis (IPA). The main themes that emerged were (1) Emergence of opportunities for growth and transformation; (2) Finding satisfaction and fulfillment; (3) Openly addressing the negative side of challenges; and (4) Tuning into the spiritual side. Overall, the participants emphasized the importance of the different types of relationships these experiences touched upon, and highlighted the effect of their line on work on the relationship with their patients, their relationships with significant others and coworkers, and their relationship with their own selves.
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Garcia ACM, Ribeiro Domingues BR, Maia LO, Hood RW, Meireles E. Translation, Cultural Adaptation, and Analysis of the Psychometric Properties of the Death Transcendence Scale for the Brazilian Context. Omega (Westport) 2023:302228231179326. [PMID: 37245997 DOI: 10.1177/00302228231179326] [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] [Indexed: 05/30/2023]
Abstract
The study of the coping strategies used by humans to cope with their finitude has been the center of attention of several researchers throughout the history of psychology. The present study aimed to translate, culturally adapt, and validate the Death Transcendence Scale (DTS) for the Brazilian context. This was a cross-sectional study with a sample of 517 Brazilians. The European Organisation for Research and Treatment of Cancer - Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation process. The results of parallel analyses indicated the relevance of extracting up to five factors, which explained 58.23% of the scale's total variance. The Brazilian version of the DTS, with validity evidence, consisted of 21 items, considering that items 13, 17, 20, and 21 were excluded according to exploratory factor analysis. As far as we know, the version of the DTS developed in this study is the only instrument available in the Brazilian context that allows the measurement of a theory dedicated to understanding how humans cope with their finitude, beyond death denial.
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Affiliation(s)
- Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, Brazil
| | - Bruna Rabelo Ribeiro Domingues
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motor Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Lucas Oliveira Maia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas, Alfenas, Brazil
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Campinas, Brazil
- Brain Institute, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Ralph W Hood
- The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Everson Meireles
- Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, BA, Brazil
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28
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Galvani S, Wright S, Clayson A. Towards a Dignified Death: A New Approach to Care for People Using Substances Who Are at, or Near, the End of Their Lives. Int J Environ Res Public Health 2023; 20:ijerph20105858. [PMID: 37239584 DOI: 10.3390/ijerph20105858] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
There are no effective intervention studies for people using substances who are at, or near, the end of their lives. The needs of this group of people have been consistently overlooked even within the literature that identifies marginalised groups of people in need of greater recognition in palliative and end-of-life care. The aims of the project were to: (i) determine what a new, co-produced, model of care should look like for people using substances needing palliative and end-of-life care, and (ii) establish whether the new model had the potential to improve people's access to, and experience of, end-of-life care. This paper presents the development of the new approach to care. It was developed using participatory action research principles over a course of online workshops during the COVID-19 pandemic lockdown period in the UK. A theory of change that aims to inform future policy and practice development is presented. While the ambition of the research was stunted by the pandemic, the process of its development and dissemination of the model and its resources has continued. Response from participants highlighted the importance of this work, however, in this new field of policy and practice, preparatory work that engages a wide range of stakeholders is crucial to its success. This relationship building and topic engagement are major parts of implementation before more substantial and sustainable development goals can be met.
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Affiliation(s)
- Sarah Galvani
- Sociology Department, Faculty of Arts and Humanities, Manchester Metropolitan University, Manchester M15 6LL, UK
| | - Sam Wright
- Sociology Department, Faculty of Arts and Humanities, Manchester Metropolitan University, Manchester M15 6LL, UK
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29
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Hahn S, Butler EA, Ogle K. "We are Human too.": The Challenges of Being an End-of-Life Doula. Omega (Westport) 2023:302228231160900. [PMID: 36876361 DOI: 10.1177/00302228231160900] [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] [Indexed: 03/07/2023]
Abstract
End-of-life (EOL) doulas are emerging professionals who provide an intimate approach to the death process by focusing on the psychological, social, spiritual, and emotional needs of dying individuals. EOL doula work is stressful; it exposes individuals to recurring stressors such as suffering and grief. Trained professionals are needed to help advocate for the dying individual and their families. Despite the growing literature on EOL doulas, information regarding the challenges of being an EOL doula is underrepresented in the literature. This paper is one of the first to address this concept. Twelve in-depth, semi-structured interviews regarding the EOL doula experience were conducted as a part of a larger exploratory study. Three overarching themes emerged from the larger project: motivations to become an EOL doula, roles of an EOL doula, and challenges of an EOL doula. In this article, only challenges of EOL are discussed, along with subsequent subordinate themes.
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Affiliation(s)
- Sarah Hahn
- School of Social and Behavioral Sciences, Mercy College, Dobbs Ferry, NY, USA
| | - Emily A Butler
- Department of Psychology, Mercy College, Dobbs Ferry, NY, USA
| | - Kimberly Ogle
- A Pathway Home: Grief Support Services and End of Life Preparation, Oxford, OH, USA
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30
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Borovečki A, Nikodem K, Ćurković M, Braš M, Palić-Kramarić R, Špoljar D, Matulić T, Grosek Š, Tonković D. What Constitutes a "Good Death"?-A Representative Cross-Sectional Survey Among the General Public in Croatia. Omega (Westport) 2023; 86:1415-1431. [PMID: 33940964 DOI: 10.1177/00302228211010597] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Understanding the attitudes of a particular society on a "good death" is important when it comes to end-of-life decision-making and palliative care. In the Republic of Croatia no systematic research has been done on the attitudes of the general population about the concept of a "good death". This cross sectional survey was conducted on a three-stage random sample, stratified by regions, counties and locations within those counties (N = 1203) during November and December, 2019. ANOVA, to determine differences, factor analysis and multiple regression analysis were used. The most important characteristics of a good death outlined by the respondents were: the absence of pain, the presence and unencumberedness of family and loved ones, the importance of a sense of fulfilment and meaning in life in this regard, reconciliation with God, the presence of awareness and sobriety, and the possibility of treatment.
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Affiliation(s)
- Ana Borovečki
- School of Medicine, Andrija Stampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Krunoslav Nikodem
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Marko Ćurković
- School of Medicine, University Psychiatric Hospital Vrapče, University of Zagreb, Zagreb, Croatia
| | - Marijana Braš
- Centre for Palliative Medicine, Medical Ethics and Communication Skills, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ružica Palić-Kramarić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Diana Špoljar
- School of Medicine, University Hospital Dubrava, University of Zagreb, Zagreb, Croatia
| | - Tonči Matulić
- Catholic Faculty of Theology, University of Zagreb, Zagreb, Croatia
| | - Štefan Grosek
- Neonatology Department, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, Slovenia.,Department of Paediatric Intensive Therapy, Division of Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Dinko Tonković
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
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31
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Kragh-Furbo M, French M, Dunleavy L, Hancock S, Sanders K, Doherty M, Gadoud A. Deathbed Etiquette - The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings. J Palliat Care 2023:8258597231158325. [PMID: 36803230 DOI: 10.1177/08258597231158325] [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] [Indexed: 02/23/2023]
Abstract
Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a 'Deathbed Etiquette' guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words 'death' and 'dying' were identified. Most participants also expressed reservations about the title, with the word 'deathbed' found to be old-fashioned and the word 'etiquette' not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for 'mythbusting' death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The 'Deathbed Etiquette' guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.
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Affiliation(s)
- Mette Kragh-Furbo
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Maddy French
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Sophie Hancock
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Karen Sanders
- Institute of Business, Law and Society, 62693St Mary's University, Twickenham, UK
| | - Margaret Doherty
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Amy Gadoud
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
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32
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Abstract
In this article, I sort through some of the confusion surrounding what constitutes the controversial notion of a "good death" for children. I distinguish, first, between metaphysical and practical disagreements about the notion of a good death, and, second, between accounts of a good death that minimally and maximally promote the dying child's interests. I propose a narrowed account of the dying child's interests, because they differ from the interests of non-dying children. Importantly, this account illustrates how disagreements at the end of a child's life are sometimes the result of a shift from a future to a present-oriented understanding of the child's interests on the part of some stakeholders but not others, and sometimes the result of a values-based disagreement about how different interests should be weighted. This brings into sharper focus the questions of for whom, and in what way, a child's death might be considered good.
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Affiliation(s)
- Bryanna Moore
- University of Texas Medical Branch, Galveston, Texas, USA
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33
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Abstract
Patterns of linguistic and interactional behavior by people at the very end of their lives are not well described, partly because data is difficult to obtain. This paper analyzes descriptions of 486 deaths gathered from 1900 to 1904 in the first-ever clinical study of dying by noted Canadian physician, Sir William Osler. Only 16 patients were noted speaking, and only four canonical last words were reported. The most frequent observation by medical staff was that the deaths were quiet (n = 30), though range of other behaviors were noted (e.g., moaning, delirium, seeming intention to speak). Osler's problematic study left behind data whose analysis is a small step toward empirically characterizing the linguistic and interactional details of a previously under-described phenomena as well as the importance of the social context in which they occur.
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Affiliation(s)
- Michael Erard
- Institute of Data Science,
Maastricht University, Maastricht, the Netherlands,Michael Erard, Institute of Data Science,
Maastricht University, Paul Henri Spaklaan 1, 6229 GT Maastricht, the
Netherlands.
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34
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Bloomer MJ, Yuen E, Williams R, Bouchoucha S, Poon P, Runacres F, Mooney C, Hutchinson AM. Perspectives of family-centred care at the end of life during the COVID-19 pandemic: A qualitative descriptive study. J Clin Nurs 2023. [PMID: 36653924 DOI: 10.1111/jocn.16627] [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: 11/12/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/20/2023]
Abstract
AIM To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID-19 pandemic. BACKGROUND To minimise the transmission of COVID-19, stringent infection prevention and control measures resulted in restricted hospital access for non-essential workers and visitors, creating challenges for the provision of family-centred care at the end of life. DESIGN Qualitative descriptive approach based on naturalistic inquiry. METHODS At a large public hospital in Melbourne, Australia, individual semi-structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID-19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting. RESULTS Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements; (ii) nurse-family communication; (iii) family-centred care and interrupted connections; (iv) well-being and negative emotions; and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy. CONCLUSIONS Negative consequences for communication and the patient-family connection at the end of life were felt deeply. The evolving COVID-19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply. RELEVANCE TO CLINICAL PRACTICE Technology-facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family-centred approach to care and emphasising the patient-family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies. PATIENT OR PUBLIC CONTRIBUTION Bereaved family members contributed their first-hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Eva Yuen
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Ruth Williams
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Stephane Bouchoucha
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Clayton, Victoria, Australia.,School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Clayton, Victoria, Australia.,School of Medicine, Monash University, Clayton, Victoria, Australia.,Department of Palliative Care, Calvary Health Care Bethlehem, Parkdale, Victoria, Australia
| | - Christine Mooney
- Supportive and Palliative Care Unit, Monash Health, Clayton, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Barwon Health Partnership, Barwon Health, Geelong, Victoria, Australia
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35
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Chapman EA, Baker J, Aggarwal P, Hughes DM, Nwosu AC, Boyd MT, Mayland CR, Mason S, Ellershaw J, Probert CS, Coyle S. GC-MS Techniques Investigating Potential Biomarkers of Dying in the Last Weeks with Lung Cancer. Int J Mol Sci 2023; 24. [PMID: 36675106 DOI: 10.3390/ijms24021591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Predicting when a patient with advanced cancer is dying is a challenge and currently no prognostic test is available. We hypothesised that a dying process from cancer is associated with metabolic changes and specifically with changes in volatile organic compounds (VOCs). We analysed urine from patients with lung cancer in the last weeks of life by headspace gas chromatography mass spectrometry. Urine was acidified or alkalinised before analysis. VOC changes in the last weeks of life were identified using univariate, multivariate and linear regression analysis; 12 VOCs increased (11 from the acid dataset, 2 from the alkali dataset) and 25 VOCs decreased (23 from the acid dataset and 3 from the alkali dataset). A Cox Lasso prediction model using 8 VOCs predicted dying with an AUC of 0.77, 0.78 and 0.85 at 30, 20 and 10 days and stratified patients into a low (median 10 days), medium (median 50 days) or high risk of survival. Our data supports the hypothesis there are specific metabolic changes associated with the dying. The VOCs identified are potential biomarkers of dying in lung cancer and could be used as a tool to provide additional prognostic information to inform expert clinician judgement and subsequent decision making.
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36
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von der Hude K, Garten L. Psychosocial Support within the Context of Perinatal Palliative Care: The "SORROWFUL" Model. Children (Basel) 2022; 10:children10010038. [PMID: 36670589 PMCID: PMC9856455 DOI: 10.3390/children10010038] [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: 11/16/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
Against the background of a society that tends to underrate the grief experienced by parents whose infants have died prematurely, the model "SORROWFUL" is presented here with the intent to highlight the significance of the death of a newborn for the affected family. It is a supportive tool in counseling for parents grieving the (impending) loss of an infant(s) during peri- or neonatal life and may be implemented within the parental psychosocial support setting beginning with the initial diagnosis until well after the death of the child. The model intentionally allows flexibility for cultural and individual adaptation, for the accommodation to the varying needs of the affected parents, as well as to available local resources.
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37
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Suntai Z, Chipalo E. Racial/Ethnic Differences in Provider-Engaged Religious Belief Discussions with Older Adults at the End of Life. Omega (Westport) 2022:302228221148526. [PMID: 36567507 DOI: 10.1177/00302228221148526] [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] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to determine racial/ethnic differences in provider-engaged religious belief discussion with older adults in the final month of life. Data were derived from the combined 2012 to 2020 National Health and Aging Trends Study. Chi-square tests were used for bivariate analysis, and a binary logistic regression model was used to test the association between race/ethnicity and provider-engaged religious belief discussions at the end of life. After controlling for other explanatory factors during the analysis, results showed that providers were less likely to have religious belief discussions with Black and Hispanic older adults compared to Whites. The results of this study point to a significant gap in knowledge among healthcare providers whose diversity training may not be inclusive of religious/spiritual cultural humility. Implications for research, policy, and practice are provided.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, TX, USA
| | - Edson Chipalo
- Department of Social Work, College of Education and Social Sciences, Lewis University, Romeoville, IL, USA
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38
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Garten L, von der Hude K. Palliative Care in the Delivery Room: Challenges and Recommendations. Children (Basel) 2022; 10. [PMID: 36670565 DOI: 10.3390/children10010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Palliative care in the delivery room is an interprofessional and interdisciplinary challenge addressing the dying newborn and parents as well as the caregivers. It differs in some significant aspects from palliative care in the neonatal intensive care unit. Clinical experience suggests that many details regarding this unique specialized palliative care environment are not well known, which may result in some degree of insecurity and emotional distress for health care providers. This article presents basic background information regarding the provision of palliative care to newborns within the delivery room. It offers orientation along with a preliminary set of practical recommendations regarding the following central issues: (i) the basic elements of perinatal palliative care, (ii) the range of non-pharmacological and pharmacological interventions available for infant symptom control near the end of life, (iii) meeting the personal psychological, emotional, and spiritual needs of the parents, and (iv) care and self-care for medical personnel.
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39
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Mavragani A, Banegas MP, Henrikson NB. Conceptions of Legacy Among People Making Treatment Choices for Serious Illness: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e40791. [PMID: 36485023 PMCID: PMC9789496 DOI: 10.2196/40791] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Legacy-what one leaves behind and how one hopes to be remembered after death-is an unexplored and important dimension of decision-making for people facing serious illnesses. A preliminary literature review suggests that patients facing serious illness consider legacy when making medical decisions, for example, forgoing expensive treatment with limited or unknown clinical benefit to preserve one's inheritance for their children. To date, very little is known about the conceptual foundations of legacy. No conceptual frameworks exist that provide a comprehensive understanding of how legacy considerations relate to patient choices about their medical care. OBJECTIVE The objective of this scoping review is to understand the extent and type of research addressing the concept of legacy by people facing serious illness to inform a conceptual framework of legacy and patient treatment choices. METHODS This protocol follows the guidelines put forth by Levac et al, which expands the framework introduced by Arksey and O'Malley, as well as the Joanna Briggs Institute Reviewer's manual. This scoping review will explore several electronic databases including PubMed, Medline, CINAHL, Cochrane Library, PsycINFO, and others and will include legacy-specific gray literature, including dissertation research available via ProQuest. An initial search will be conducted in English-language literature from 1990 to the present with selected keywords to identify relevant articles and refine the search strategy. After the search strategy has been finalized, 2 independent reviewers will undertake a 2-part study selection process. In the first step, reviewers will screen article titles and abstracts to identify the eligibility of each article based on predetermined exclusion or inclusion criteria. A third senior reviewer will arbitrate discrepancies regarding inclusions or exclusions. During the second step, the full texts will be screened by 2 reviewers, and only relevant articles will be kept. Relevant study data will be extracted, collated, and charted to summarize the key findings related to the construct of legacy. RESULTS This study will identify how people facing serious illness define legacy, and how their thinking about legacy impacts the choices they make about their medical treatments. We will note gaps in the literature base. The findings of this study will inform a conceptual model that outlines how ideas about legacy impact the patient's treatment choices. The results of this study will be submitted to an indexed journal. CONCLUSIONS Very little is known about the role of legacy in the treatment decisions of patients across the continuum of serious illness. In particular, no comprehensive conceptual model exists that would provide an understanding of how legacy is considered by people making decisions about their care during serious illness. This study will be among the first to construct a conceptual model detailing how considerations of legacy impact medical decision-making for people facing or living with serious illnesses. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40791.
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Affiliation(s)
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, United States.,Radiation Medicine and Applied Science School, University of California San Diego, La Jolla, CA, United States
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.,Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States.,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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40
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Roche N, Darzins S, Oakman J, Stuckey R. Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review. Omega (Westport) 2022:302228221117902. [PMID: 36476137 DOI: 10.1177/00302228221117902] [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] [Indexed: 12/22/2023]
Abstract
Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.
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Affiliation(s)
- Natalie Roche
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Susan Darzins
- School of Allied Health, Australian Catholic University, Melbourne, VIC, Australia
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Public Health, La Trobe University, Melbourne, VIC, Australia
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41
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Wilson DM, Fabris LG, Martins ALB, Dou Q, Errasti-Ibarrondo B, Bykowski KA. Location of Death in Developed Countries: Are Hospitals a Primary Place of Death and Dying Now? Omega (Westport) 2022:302228221142430. [PMID: 36475942 DOI: 10.1177/00302228221142430] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Hospitals used to be a common site of death and dying. This scoping project sought published and unpublished information on current hospital death rates in developed countries. In total, death place information was gained from 21 countries, with the hospital death rate varying considerably from 23.9% in the Netherlands to 68.3% in Japan. This major difference is discussed, as well as the problem that death place information does not appear to be routinely collected or reported on in many developed countries. Without this information, efforts to ensure high quality end-of-life (EOL) care and good deaths are hampered.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lucas G Fabris
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Arthur L B Martins
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Qinqin Dou
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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42
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Schmidt V, Kaiser J, Treml J, Kersting A. The Relationship Between Pre-Loss Grief, Preparedness and Psychological Health Outcomes in Relatives of People With Cancer. Omega (Westport) 2022:302228221142675. [PMID: 36420732 DOI: 10.1177/00302228221142675] [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] [Indexed: 12/22/2023]
Abstract
The aim of this study was to examine the simultaneous effects of pre-loss grief, preparedness for death and preparedness for caregiving on different psychological health outcomes in relatives of people with cancer. Two hundred ninety-nine relatives of people with cancer participated in a cross-sectional online survey. Participants were included if they spoke German and were 18 years or older. Multivariate regression analysis was conducted. Pre-loss grief was significantly associated with depression (β = .388, p < .001), anxiety (β = .429, p < .001), somatization (β = .221, p < .001) and satisfaction with life (β = -.205, p < .001). Preparedness for death was significantly associated with somatization (β = -.247, p < .001). Results suggest that people with high scores in pre-loss grief and low scores in preparedness for death are in need of early support. Interventions should address pre-loss grief and the various aspects of preparedness for death and take into account the psychological health in relatives of people with cancer. Future studies should investigate underlying mechanisms.
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Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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Kripalani S, Joy S, Raizada S, Cerceo E. A biopsychosocial approach to death, dying, and bereavement: a course on end-of-life education for medical students. MedEdPublish (2016) 2022; 12:44. [PMID: 37538834 PMCID: PMC10394390 DOI: 10.12688/mep.19140.4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background: Despite the inevitable nature of death and dying, the conversations surrounding this subject are still uncomfortable for many physicians and medical students. Methods: A six-week humanities-based course, "A Biopsychosocial Approach to Death, Dying, & Bereavement," at Cooper Medical School of Rowan University, United States, which covers definitions of death and dying, the process of dying, ethical dilemmas, and new concepts of the grieving process. Through development of a curriculum using various academic and medical literature and resources, we sought to bring attention to the necessity of having a medical education curriculum on death and dying to prepare medical students for the difficult conversations and patient experiences that lie ahead of them. Qualitative data in the form of surveys and reflection papers submitted by students and quantitative data (Likert scores on course satisfaction) were collected and analyzed both pre- and post-course. Results: 90.7% (49/54) of the respondents answered that they agree or strongly agree with the statement that this selective course was useful in the student's medical education experience. The top three qualitative themes brought up the most in reflection papers (n=54) were: the utility and instruction of the course (21 times), the importance of hospice and palliative care (20 times), avoidance around topics of death (15 times). Conclusions : Medical students are often not prepared to cope with the realities of patient loss and of caring for the patient and their families throughout the dying process. We created this course to familiarize medical students with an aspect of the medical experience that is frequently neglected in traditional medical curricula. We learned that integrating such a course can help educate medical students facilitate important conversations, teach them to act with kindness and dignity in a physician-patient setting, and enhance their personal understanding of death and dying.
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Affiliation(s)
- Simran Kripalani
- Cooper Medical School of Rowan University, Camden, NJ, 18103, USA
| | - Sandra Joy
- Cooper Medical School of Rowan University, Camden, NJ, 18103, USA
- Rowan University, Glassboro, New Jersey, 08028, USA
| | - Shivani Raizada
- Cooper Medical School of Rowan University, Camden, NJ, 18103, USA
| | - Elizabeth Cerceo
- Cooper Medical School of Rowan University, Camden, NJ, 18103, USA
- Cooper University Hospital, Camden, NJ, 08103, USA
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Abstract
Nearly 170,000 people die in the world daily-estimating to about 60 million individuals a year. This number is abstract until you ask the mourners, identify the mourning, and become one who mourns while trying to live. So, where is the grief education? Where is the initiative in the public health sphere to not simply teach "How to Mourn" but "How To Go on Loving?" Where is the health policy that protects the time scientists say we need to grieve? There are a number of people at this moment grieving as you read this-perhaps even you. Grief is a natural response to loss; however, our society's imagination around bereavement, honor, and slowing down to fully acknowledge death's impact has been stunted by the enormous expectation to push through and grind for capitalism. This poem captures moments navigating the silences of grief, tending to the shadows of mental health breakdown, learning to chop among the trees and stars. This poem serves as a timestamp of a winter visit to the woods, processing themes such as death, dying, letting go, transitioning, and letting go again. This particular poem was generated from a prompt received on December 10, 2021, while participating in a Death Ritual. The day's focus was forming a practice and expressing death as art thanks to artist, facilitator, and Love Extremist, Ethan Lipsitz, for prompting me to reflect on our mortality. To learn more about Ethan Lipsitz and this movement, visit extremist.love or www.deathfriendsforever.com. To view the original version of this poem, see the supplemental material section of this article online.
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Affiliation(s)
- Shanaé R Burch
- Teachers College, Columbia University, New York, NY, USA
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Lee H. Death, Dying, and Bereavement Around the World: Theories, Varied Views, and Customs. J Gerontol Soc Work 2022; 65:904-907. [PMID: 35669996 DOI: 10.1080/01634372.2022.2084195] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Although death is inevitable as a human being, talking about or planning for it may be an uncomfortable topic. Recently, due to the COVID-19 pandemic, we are witnessing an increase in deaths around us as well as globally, and health and social services professionals are more engaged in the death, dying, and bereavement services than ever. Dr. Eyetsemitan's book, Death, Dying, and Bereavement Around the World: Theories, Varied Views and Customs, would be a great textbook assisting health and social service professionals and students at both undergraduate and graduate levels to understand the concepts of death, dying, and bereavement across cultures. Additional relevant grief theories/models, diverse views, and customs/rituals in losses and grief provide useful supporting information.
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Affiliation(s)
- HeeSoon Lee
- Department of Human Services, Bowling Green State University, Bowling Green, Ohio, USA
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López Pérez Y, Cruzado JA, Lacasta Reverte MA, Lallana-Frías E. Predictors of Complicated Grief in Caregivers of Palliative Care Patients. Omega (Westport) 2022:302228221133437. [PMID: 36252273 DOI: 10.1177/00302228221133437] [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] [Indexed: 11/15/2022]
Abstract
Introduction: It is important to identify the factors s associated with complicated grief (CG) in order to prevent it. Objective: To determine the factors associated with CG in the end-of-life phase within the palliative care context. Method: The PRISMA model was followed for the review. We accessed the following databases: PUBMED, SCOPUS, and PsycoINFO, to review publications from 2006. Results: A total of 17 studies were obtained. A direct relationship between factors prior to bereavement and CG is established: intensity of anticipated grief, previous mental and physical health of the caregiver, social support; quality of patient care, communication at the end-of-life, preparation for death, spirituality, and sociodemographic factors. Conclusions: Previous mental health and level of anticipatory grief in the main caregiver are shown to be the most powerful predictors of CG. Patient age and quality of care are factors considered as strong predictors of CG in almost every study.
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Affiliation(s)
- Yolanda López Pérez
- EAPS Psychologist at the San Camilo Palliative Care Unit, Centro Asistencial San Camilo, Madrid, Spain
| | - Juan Antonio Cruzado
- Facultad de Psicología, Universidad Complutense de Madrid, Ciudad Universitaria Campus de Somosaguas, Madrid, Spain
| | - María Antonia Lacasta Reverte
- Clinical Psychologist, Unidad de Cuidados Paliativos y Equipo Soporte Hospitalario, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Lallana-Frías
- Palliative Care EAPS Psychologist, Hospital Support Team in Hospital Universitario de Getafe, Home Support Team in ESAD Leganés, at Fundación Instituto San José, Madrid. Spain
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Caswell G, Wilson E, Turner N, Pollock K. 'It's Not Like in the Films': Bereaved People's Experiences of the Deathbed Vigil. Omega (Westport) 2022:302228221133413. [PMID: 36240054 DOI: 10.1177/00302228221133413] [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] [Indexed: 11/16/2022]
Abstract
This paper explores how people enact and experience the deathbed vigil when someone close to them is dying. It draws on qualitative interviews with 34 bereaved people carried out as part of a wider study exploring public perceptions of death and dying. Participants were aware of the expectation that they would attend the deathbed and did their best to do so. Findings are reported using four themes: gathering, enacting the deathbed vigil, experiencing the deathbed vigil and moment of death. Participants' experiences varied. Some families kept vigil as a group, while others established a shift system or waited alone. Activities at the bedside included reading to the dying person, talking amongst themselves, sharing memories, saying goodbye. The covid-19 pandemic highlighted families' wish to accompany their dying relatives.
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Affiliation(s)
- Glenys Caswell
- Independent Social researcher, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Turner
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Kristian Pollock
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
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Cybulska AM, Żołnowska MA, Schneider-Matyka D, Nowak M, Starczewska M, Grochans S, Cymbaluk-Płoska A. Analysis of Nurses' Attitudes toward Patient Death. Int J Environ Res Public Health 2022; 19:13119. [PMID: 36293697 PMCID: PMC9602489 DOI: 10.3390/ijerph192013119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
(1) The aim of the study was to analyze nurses' attitudes toward a patient's death, taking into account the emotions they experience and the general perception of death. (2) The study involved 516 nurses from the West Pomeranian Voivodeship in Poland. The research was carried out using the diagnostic survey method using The Death Attitudes Profile Revisited (DAP-R-PL), the Scale of Fear and Fascination with Death, and a demographic questionnaire. (3) Research has shown that nurses accept the phenomenon of death as a natural process of human life; however, they adopt the attitude of fear of death. Most of the respondents experienced: sadness (73.4%), helplessness (58.5%), and regret (43.6%) due to the patient's death. (4) Both age, sex, marital status, and place of residence significantly influenced the attitudes of nurses toward the patient's death. Therefore, it is important to provide psychological support or special education in the case of dealing with the fear of death.
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Affiliation(s)
- Anna Maria Cybulska
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Monika Anna Żołnowska
- Department of Cardiology and Invasive Cardiology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Marta Nowak
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Małgorzata Starczewska
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland
| | - Szymon Grochans
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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Abstract
The current phenomenological-qualitative study explored the meaning of death and dying from a Jordanian-Muslim perspective. Data were collected through face-to-face interviews with eight patients and five family caregivers, then analyzed following the Braun and Clarke steps. The analysis revealed two main themes; confronting death and preparing for a good death. The experience of terminal illness compelled the patients and their family caregivers to think of imminent death and want to prepare for it. On the other hand, Muslim terminally-ill patients accepted death and surrendered to God's decree; however, they feared the unknown of the dying experience. Furthermore, the patients were concerned about being a burden to their families during the last days of their lives. Additionally, Muslim patients and caregivers identified five components of a 'good death' from the Arab-Muslims' perspectives, including having a good closure, dying with dignity, coming to peace, not dying alone, and having a religious engagement.
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Affiliation(s)
- Elham H Othman
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Inaam A Khalaf
- School of Nursing, The University of Jordan, Amman, Jordan
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Wilson DM, Bykowski KA, Banamwana G, Bryenton FM, Dou Q, Errasti-Ibarrondo B. Intra-Family End-Of-Life Conflict: Findings of a Research Investigation to Identify Its Incidence, Cause, and Impact. Omega (Westport) 2022:302228221133504. [PMID: 36216497 DOI: 10.1177/00302228221133504] [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] [Indexed: 11/15/2022]
Abstract
With few investigations of intra-family end-of-life conflict, this study sought to identify its incidence, cause, and impacts. A questionnaire was completed by 102 hospice/palliative nurses, physicians, and other care providers in Alberta, a Canadian province. Participants reported on how often they had observed intra-family conflict when someone in the family was dying, and the impacts of that conflict. 12 survey participants were then interviewed about the intra-family conflict that they had encountered, with interviews focused on why conflict occurred and what the impacts (if any) were. Nearly 80% of families were thought to experience end-of-life conflict, periodically or continuously, among various family members. The interviews confirmed three reasons for intra-family end-of-life conflict and three conflict outcomes that were revealed in a recent literature review. The findings indicate routine assessments for intra-family end-of-life conflict are advisable. Attention should be paid to preventing or mitigating this conflict for the good of all.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | | | | | | | - Qinqin Dou
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | - Begoña Errasti-Ibarrondo
- Faculty of Nursing, University of Navarra and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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