Family Caregivers' Preparations for Death: A Qualitative Analysis

Palliative care in motor neurone disease: where are we now?

Palliative care has a very important role in the care of patients with motor neurone disease and their families. There is increasing emphasis on the multidisciplinary assessment and support of patients within guidelines, supported by research. This includes the telling of the diagnosis, the assessment and management of symptoms, consideration of interventions, such as gastrostomy and ventilatory support, and care at the end of life. The aim of palliative care is to enable patients, and their families, to maintain as good a quality of life as possible and helping to ensure a peaceful death.

Caregivers' Experiences With Medical Aid-In-Dying in Vermont: A Qualitative Study

CONTEXT

Eight jurisdictions in the U.S. currently permit medical aid-in-dying (AID), yet little is known about the direct experience of caregivers in supporting a loved one through the process.

OBJECTIVES

To explore the experiences of lay caregivers involved with AID in the U.S., focusing on the day of death.

METHODS

Semistructured in-depth interviews were conducted with caregivers of terminally ill patients who pursued AID under Vermont's 2013 "Patient Choice and Control at End of Life" Act. Deidentified interview transcripts were analyzed using an inductive iterative approach.

RESULTS

The final sample included 19 caregivers who had cared for a total of 11 patients. Most caregivers were females (89%), and more than half were close friends. Their mean age was 60.3. Social support provided by caregivers on the day of an AID death fell into two broad categories: emotional and instrumental. These overarching forms of support were further distributed between four distinct temporal phases: preparation, ingestion, waiting, and after death.

CONCLUSION

Although AID is often presented as a simple matter of individual choice and autonomy, most patients who pursue it do so with tremendous support from caregivers, who are in turn deeply implicated, socially and morally, in the process. Including caregivers in education and planning, where warranted, can mitigate feelings of unpreparedness and ensure a smoother experience for everyone involved.

Examining the transitions between living and dying roles at end-of-life

Improvements in the diagnosis and disclosure of dying mean that nowadays dying people typically live with an awareness of their status for longer than they have previously. However, little is known regarding how transitions between living and dying roles occur during this time. In this grounded theory study, we investigated role transitions at end-of-life. We found that dying people periodically foreground and background living and dying selfhoods, focus on living day-by-day and goal-by-goal and reframe dying roles with an orientation to living. We argue that with better understanding of role transitions at end-of-life more compassionate and responsive care becomes possible.