1
|
Chu WM, Tsai HB, Chen YC, Hung KY, Cheng SY, Lin CP. Palliative Care for Adult Patients Undergoing Hemodialysis in Asia: Challenges and Opportunities. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2024; 27:1-10. [PMID: 38449832 PMCID: PMC10911979 DOI: 10.14475/jhpc.2024.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.
Collapse
Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post‐Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hung-Bin Tsai
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Yu Hung
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| |
Collapse
|
2
|
Fisher MC, Chen X, Crews DC, DeGroot L, Eneanya ND, Ghildayal N, Gold M, Liu Y, Sanders JJ, Scherer JS, Segev DL, McAdams-DeMarco MA. Advance Care Planning and Palliative Care Consultation in Kidney Transplantation. Am J Kidney Dis 2024; 83:318-328. [PMID: 37734687 PMCID: PMC10922230 DOI: 10.1053/j.ajkd.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 09/23/2023]
Abstract
RATIONALE & OBJECTIVE Because of the high risk of waitlist mortality and posttransplant complications, kidney transplant (KT) patients may benefit from advance care planning (ACP) and palliative care consultation (PCC). We quantified the prevalence and racial disparities in ACP and PCC among KT candidates and recipients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,575 adult KT candidates and 1,233 adult recipients (2008-2020). EXPOSURE Race and ethnicity. OUTCOMES All reports of ACP and PCC were abstracted from chart review. ACP was defined as patient self-report of an advance directive, presence of an advance directive in the medical record, or a documented goals-of-care conversation with a provider. PCC was defined as an ordered referral or a documented palliative care note in the medical record. ANALYTICAL APPROACH Racial/ethnic disparities in ACP/PCC were estimated using adjusted logistic regression. RESULTS 21.4% of KT candidates and 34.9% of recipients engaged in ACP. There were racial/ethnic disparities in ACP among KT candidates (White, 24.4%; Black, 19.1%; Hispanic, 15%; other race and ethnicity, 21.1%; P=0.008) and recipients (White, 39.5%; Black, 31.2%; Hispanic, 26.3%; other race and ethnicity, 26.6%; P=0.007). After adjustment, Black KT recipients had a 29% lower likelihood of engaging in ACP (OR, 0.71; 95% CI, 0.55-0.91) than White KT recipients. Among older (aged≥65 years) recipients, those who were Black had a lower likelihood of engaging in ACP, but there was no racial disparity among younger recipients (P=0.020 for interaction). 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC; there were no racial disparities in PCC among KT candidates (White, 5.3%; Black, 3.6%; Hispanic, 2.5%; other race and ethnicity, 2.1%; P=0.13) or recipients (White, 5.5%; Black, 5.6%; Hispanic, 0.0%; other race and ethnicity, 1.3%; P = 0.21). LIMITATIONS Generalizability may be limited to academic transplant centers. CONCLUSIONS ACP is not common among KT patients, and minoritized transplant patients are least likely to engage in ACP; PCC is less common. Future efforts should aim to integrate ACP and PCC into the KT process. PLAIN-LANGUAGE SUMMARY Kidney transplant (KT) candidates and recipients are at elevated risk of morbidity and mortality. They may benefit from completing a document or conversation with their palliative care provider that outlines their future health care wishes, known as advance care planning (ACP), which is a component of palliative care consultation (PCC). We wanted to determine how many KT candidates and recipients have engaged in ACP or PCC and identify potential racial disparities. We found that 21.4% of candidates and 34.9% of recipients engaged in ACP. After adjustment, Black recipients had a 29% lower likelihood of engaging in ACP. We found that 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC, with no racial disparities found in PCC.
Collapse
Affiliation(s)
- Marlena C Fisher
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lyndsay DeGroot
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D Eneanya
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nidhi Ghildayal
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Marshall Gold
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yi Liu
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Justin J Sanders
- Department of Family Medicine, Palliative Care McGill, McGill University, Montreal, QC, Canada
| | - Jennifer S Scherer
- Department of Medicine, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, NY.
| |
Collapse
|
3
|
Suntai Z, Chipalo E. Racial/Ethnic Differences in Provider-Engaged Religious Belief Discussions with Older Adults at the End of Life. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221148526. [PMID: 36567507 DOI: 10.1177/00302228221148526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
4
|
Kudo H, Miyata C, Kawaguchi Y, Yachi Y, Shinfuku M, Kinoshita T, Kurihara T, Momiyama Y, Chong T, Kobayashi Y, Takazawa M, Itoh K, Tsunoda K. Do Hospital Visit Restrictions Cause Increase in the Doses of Morphine in Terminal Care? Spiritual Pain and Palliative Care in the COVID-19 Pandemic. Am J Med 2022; 135:1156-1157. [PMID: 35476915 PMCID: PMC9040511 DOI: 10.1016/j.amjmed.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Hiroshi Kudo
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Chieko Miyata
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshiki Kawaguchi
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yutaka Yachi
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masaki Shinfuku
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takayuki Kinoshita
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tomohiro Kurihara
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yukihiko Momiyama
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tonghyo Chong
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshiro Kobayashi
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Mihiro Takazawa
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kenji Itoh
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Koichi Tsunoda
- Palliative Care Team, COVID-19 Solution Team, and Clinical Research Center of National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| |
Collapse
|
5
|
Effectiveness of International Hospice and Palliative Care Training for Health Care Professionals in Countries of the Western Pacific Region. J Hosp Palliat Nurs 2022; 24:E197-E204. [PMID: 35666778 DOI: 10.1097/njh.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As hospice and palliative care is a holistic service grounded in spirituality, training in spiritual care is essential. This study aimed to describe an international workforce training program for hospice and palliative care that emphasized spiritual care and evaluate the effectiveness of the training implementation. A quasi-experimental study was conducted with 28 health care professionals from 4 countries in the Western Pacific Region, who attended the international workforce trainings on hospice and palliative care. Data were collected before and after the trainings using a self-reported survey questionnaire. The participants' palliative care knowledge, spiritual well-being, perceived stress, and compassion competency were analyzed to evaluate the training program. Whereas the participants' knowledge of hospice and palliative care ( P < .001) and compassion competency increased ( P = .004), their perceived stress decreased post training ( P = .002). This study provided an extensive description of an international workforce training program of hospice and palliative care for potential replication of the training in other regions of the world. Because training in hospice and palliative care positively influenced health care professionals' spiritual care competency, future training and studies should consider spiritual care factors, along with intellectual aspects.
Collapse
|
6
|
Review of Religious Variables in Advance Care Planning for End-of-Life Care: Consideration of Faith as a New Construct. Am J Geriatr Psychiatry 2022; 30:747-758. [PMID: 34972634 DOI: 10.1016/j.jagp.2021.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/28/2022]
Abstract
Religion and spirituality have long been considered important social determinants of human health, and there exists an extensive body of research to support such. End-of-life (EOL) may raise complex questions for individuals about religious and spiritual (R/S) values guiding advance care planning (ACP) and EOL care decisions, including the provision of spiritual care. This commentary will review the history and current national trends of ACP activities for EOL, principally within the United States. It will describe the relationship of religious variables and the attributes of selected research instruments used to study religious variables on ACP and EOL preferences. The review also summarizes unique ACP challenges for patients with neurocognitive disorders and severe mental illness. Findings disclose that higher levels of religiosity, reliance on religious coping, conservative faith traditions, and "belief in God's control over life's length and divine intervention have lower levels of ACP and more intensive EOL care preferences, although the provision of spiritual spiritual care at EOL mitigates intensive EOL care. Based upon the curated evidence, we propose an epistemological justification to consider "faith" as a separately defined religious variable in future ACP and EOL research. This review is relevant to geriatric psychiatrists and gerontological health care professionals, as they may be part of multidisciplinary palliative care teams; provide longitudinal care to patients with neurocognitive disorders and severe mental illness; and may provide diagnostic, emotional, and therapeutic services for patients and families who may struggle with EOL care decisions.
Collapse
|
7
|
Gelfand SL, Fitchett G, Moss AH. Recognizing the Potential Importance of Religion and Spirituality in the Care of Black Americans with Kidney Failure. J Am Soc Nephrol 2022; 33:1255-1257. [PMID: 35304429 PMCID: PMC9257821 DOI: 10.1681/asn.2021101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Samantha L Gelfand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts .,Harvard Medical School, Boston, Massachusetts.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Alvin H Moss
- Section of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia.,Section of Geriatrics and Palliative Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.,Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, West Virginia
| |
Collapse
|
8
|
Alzayer H, Geraghty AM, Sebastian KK, Panesar H, Reddan DN. Dialysis Patients’ Preferences on Resuscitation: A Cross-Sectional Study Design. Can J Kidney Health Dis 2022; 9:20543581221113383. [PMID: 35923181 PMCID: PMC9340425 DOI: 10.1177/20543581221113383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background: End-stage kidney disease is associated with a 10- to 100-fold increase in
cardiovascular mortality compared with age-, sex-, and race-matched
population. Cardiopulmonary resuscitation (CPR) in this cohort has poor
outcomes and leads to increased functional morbidity. Objective: The aim of this study is to assess patients’ preferences toward CPR and
advance care planning (ACP). Design: cross-sectional study design. Setting: Two outpatient dialysis units. Patients: Adults undergoing dialysis for more than 3 months were included. Exclusion
criteria were severe cognitive impairment or non-English-speaking
patients. Measurements: A structured interview with the use of Willingness to Accept Life-Sustaining
Treatment (WALT) tool. Methods: Demographic data were collected, and baseline Montreal Cognitive Assessment,
Patient Health Questionnaire–9, Duke Activity Status Index, Charlson
comorbidity index, and WALT instruments were used. Descriptive analysis,
chi-square, and t test were performed along with
probability plot for testing hypotheses. Results: Seventy participants were included in this analysis representing a 62.5%
response rate. There was a clear association between treatment burden,
anticipated clinical outcome, and the likelihood of that outcome with
patient preferences. Low-burden treatment with expected return to baseline
was associated with 98.5% willingness to accept treatment, whereas
high-burden treatment with expected return to baseline was associated with
94.2% willingness. When the outcome was severe functional or cognitive
impairment, then 45.7% and 28.5% would accept low-burden treatment,
respectively. The response changed based on the likelihood of the outcome.
In terms of resuscitation, more than 75% of the participants would be in
favor of receiving CPR and mechanical ventilation at their current health
state. Over 94% of patients stated they had never discussed ACP, whereas
59.4% expressed their wish to discuss this with their primary
nephrologist. Limitations: Limited generalizability due to lack of diversity. Unclear decision stability
due to changes in health status and patients’ priorities. Conclusions: ACP should be incorporated in managing chronic kidney disease (CKD) to
improve communication and encourage patient involvement.
Collapse
Affiliation(s)
- Husam Alzayer
- Department of Nephrology, University Hospital Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin
| | | | - Kuruvilla K. Sebastian
- Department of Renal Medicine, Cork University Hospital, Ireland
- Department of Medicine, National University of Ireland, Galway
- Royal College of Physicians of Ireland, Dublin
| | - Hardarsh Panesar
- Department of Renal Medicine, Cork University Hospital, Ireland
- Western University, London, ON, Canada
| | - Donal N. Reddan
- Department of Nephrology, University Hospital Galway, Ireland
- Royal College of Physicians of Ireland, Dublin
| |
Collapse
|
9
|
Hidalgo CMT, de Freitas AJA, de Abreu LS, Santiago HR, Campolina AG. Spiritual needs among hospitalized patients at a public hospital in Brazil: a cross-sectional study. SAO PAULO MED J 2022; 141:125-130. [PMID: 36043678 PMCID: PMC10005469 DOI: 10.1590/1516-3180.2021.0985.r2.19052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.
Collapse
Affiliation(s)
- Cassio Murilo Trovo Hidalgo
- MD. Resident, Internal Medicine Department, Hospital do Servidor
Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Ana Julia Aguiar de Freitas
- BSc. Doctoral Student, Molecular Oncology Research Center,
Barretos Cancer Hospital, Teaching and Research Institute, Barretos (SP),
Brazil
| | - Lucas Salviano de Abreu
- MD. Resident, Internal Medicine Department, Hospital do
Servidor Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Hendrio Reginaldo Santiago
- MD. Resident, Internal Medicine Department, Hospital do
Servidor Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Alessandro Gonçalves Campolina
- MD, MSc, PhD. Scientific Researcher, Centro de Investigação
Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo (ICESP),
Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP),
Brasil
| |
Collapse
|