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Saeed S, Malik MGR, Khan MH, Malik SAR, Aziz B. Care for the caregiver: an exploration of caregiver burden of children with chronic medical conditions at a tertiary care hospital in Karachi, Pakistan - a mixed-methods study. BMJ Open 2024; 14:e083088. [PMID: 38777589 PMCID: PMC11116860 DOI: 10.1136/bmjopen-2023-083088] [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: 12/11/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Caregiver burden often goes unrecognised and can substantially affect caregivers' physical, psychological and financial well-being, thereby impacting quality of care. This study investigates burden among caregivers of children with chronic medical conditions in a tertiary care hospital in Pakistan. The study aims to assess the extent of burden, explore influencing factors and recommendations for interventions. DESIGN Mixed-methods study, comprising of an in-person paper-based survey, employing the Zarit Burden Interview scale to assess burden scores. Qualitative component included thematic analysis of semi-structured in-depth interviews with caregivers. PARTICIPANTS 383 caregivers of children admitted to the inpatient paediatric services at our tertiary care centre were surveyed. In-depth interviews were conducted with 19 caregivers. RESULTS The survey revealed a mean burden score of 35.35±15.14, with nearly half of the participants (46%, n=177) experiencing mild burden, while 37% (n=140) reporting moderate-to-severe burden. The most common diagnosis was cancer (24%, n=92), while the highest burden (42.97±15.47) was noted for congenital cardiac disease. Greater burden was significantly associated with lower caregiver education, young age of the child at diagnosis and increased number of hospital visits (p<0.05). Caregivers highlighted financial strain, psychosocial effects and impact on lifestyle and relationships as key challenges. They emphasised the need for improved medical coordination, financial support and enhanced hospital services. CONCLUSIONS The study elucidates the multifaceted nature of caregiver burden in the context of paediatric chronic illnesses in Pakistan. Interventions should emphasise financial aid, educational support and development of system-level changes to improve access to resources and medical care coordination. These insights call for policy and practice integration to support caregivers effectively.
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Affiliation(s)
- Sana Saeed
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Maryam Hameed Khan
- Institute for Global Health and Development, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Bisma Aziz
- Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
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Molitch-Hou E, Zhang H, Gala P, Tate A. Impact of the COVID-19 Public Health Crisis and a Structured COVID Unit on Physician Behaviors in Code Status Ordering. Am J Hosp Palliat Care 2023:10499091231204943. [PMID: 37786255 PMCID: PMC10985045 DOI: 10.1177/10499091231204943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Purpose: Code status orders are standard practice impacting end-of-life care for individuals. This study reviews the impact of a COVID unit on physician behaviors towards goal-concordant end-of-life care at an urban academic tertiary-care hospital. Methods: We conducted a retrospective cohort study of code status ordering on adult inpatients comparing the pre-pandemic period to patients who tested positive, negative and were not tested during the pandemic from January 1, 2019, to December 31, 2020. Results: We analyzed 59,471 unique patient encounters (n = 35,317 pre-pandemic and n = 24,154 during). 1,631 cases of COVID-19 were seen. The rate of code status orders among all inpatients increased from 22% pre-pandemic to 29% during the pandemic (P < .001). Code status orders increased for both patients who were COVID-negative (32% P < .001) and COVID-positive (65% P < .001). Being in a cohorted COVID unit increased code status ordering by an odds of 4.79 (P < .001). Compared to the pre-pandemic cohort, the COVID-positive cohort is less female (50% to 56% P < .001), more Black (66% to 61% P < .001), more Hispanic (6.5% to 5%) and less white (26% to 30% P < .001). Compared to Black patients, white patients had lower odds (.86) of code status ordering (P < .001). Other race/ethnicity categories were not significant. Conclusions: Code status ordering remains low. Compared to pre-pandemic rates, the frequency of orders placed significantly increased for all patients during the pandemic. The largest increase occurred in patients with COVID-19. This increase likely occurred due to protocols in the COVID unit and disease uncertainty.
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Affiliation(s)
- Ethan Molitch-Hou
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - Hui Zhang
- Center for Health and The Social Sciences, The University of Chicago, Chicago, IL, USA
| | - Pooja Gala
- NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Alexandra Tate
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
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Courtright KR, Srinivasan TL, Madden VL, Karlawish J, Szymanski S, Hill SH, Halpern SD, Ersek M. "I Don't Have Time to Sit and Talk with Them": Hospitalists' Perspectives on Palliative Care Consultation for Patients with Dementia. J Am Geriatr Soc 2020; 68:2365-2372. [PMID: 32748393 PMCID: PMC8485634 DOI: 10.1111/jgs.16712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Specialty palliative care for hospitalized patients with dementia is widely recommended and may improve outcomes, yet rates of consultation remain low. We sought to describe hospitalists' decision-making regarding palliative care consultation for patients with dementia. DESIGN Descriptive qualitative study. SETTING Seven hospitals within a national nonprofit health system. PARTICIPANTS Hospitalist physicians. MEASUREMENTS Individual semistructured interviews. We used thematic analysis to explore factors that influence hospitalists' decision to consult palliative care for patients with dementia. RESULTS A total of 171 hospitalists were eligible to participate, and 28 (16%) were interviewed; 17 (61%) were male, 16 (57%) were white, and 18 (64%) were in practice less than 10 years. Overall, hospitalists' decisions to consult palliative care for patients with dementia were influenced by multiple factors across four themes: patient, family caregiver, hospitalist, and organization. Consultation was typically only considered for patients with advanced disease, particularly those receiving aggressive care or with family communication needs (navigating conflicts around goals of care and improving disease and prognostic understanding). Hospitalists' limited time and, for some, a lack of confidence in palliative care skills were strong drivers of consultation. Palliative care needs notwithstanding, most hospitalists would not request consultation if they perceived families would be resistant to it or had limited availability or involvement in caregiving. Additional barriers to referral at the organization level included a hospital culture that conflated palliative and end-of-life care and busy palliative care teams at some hospitals. CONCLUSION Hospitalists described a complex consultation decision process for involving palliative care specialists in the care of patients with dementia. Systematic identification of hospitalized patients with dementia most likely to benefit from palliative care consultation and strategies to overcome modifiable family and organization barriers are needed. J Am Geriatr Soc 68:2365-2372, 2020.
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Affiliation(s)
- Katherine R. Courtright
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Pulmonary, Allergy, and Critical Care Medicine Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Roybal Center on Palliative Care in Dementia, Philadelphia, Pennsylvania
| | - Trishya L. Srinivasan
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vanessa L. Madden
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Roybal Center on Palliative Care in Dementia, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
- Institute on Aging, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Szymanski
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Scott D. Halpern
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Pulmonary, Allergy, and Critical Care Medicine Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Roybal Center on Palliative Care in Dementia, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Ersek
- Penn Roybal Center on Palliative Care in Dementia, Philadelphia, Pennsylvania
- Institute on Aging, University of Pennsylvania, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Veteran Affairs, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Major VJ, Aphinyanaphongs Y. Challenges in translating mortality risk to the point of care. BMJ Qual Saf 2019; 28:959-962. [DOI: 10.1136/bmjqs-2019-009858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/03/2022]
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Beasley AM, Bakitas MA, Ivankova N, Shirey MR. Evolution and Conceptual Foundations of Nonhospice Palliative Care. West J Nurs Res 2019; 41:1347-1369. [DOI: 10.1177/0193945919853162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The term nonhospice palliative care was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers’s evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.
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Rajaram A, Morey T, Dosani N, Pou-Prom C, Mamdani M. Palliative Care in the Twenty-First Century: Using Advanced Analytics to Uncloak Insights from Big Data. J Palliat Med 2019; 22:124-125. [PMID: 30707078 DOI: 10.1089/jpm.2018.0609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshay Rajaram
- 1 School of Medicine, Queen's University, Kingston, Ontario, Canada.,2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Trevor Morey
- 3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naheed Dosani
- 3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,4 Inner City Health Associates, Toronto, Ontario, Canada
| | - Chloé Pou-Prom
- 2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- 2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada.,5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,6 Leslie Dan Faculty of Pharmacy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abedini NC, Chopra V. A Model to Improve Hospital-Based Palliative Care: The Palliative Care Redistribution Integrated System Model (PRISM). J Hosp Med 2018; 13:868-871. [PMID: 30156581 DOI: 10.12788/jhm.3065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many hospitalized patients have unmet palliative care needs that are exacerbated by gaps in the palliative care subspecialty workforce. Training frontline physicians, including hospitalists, to provide primary palliative care has been proposed as one solution to this problem. However, improving palliative care access requires more than development of the physician workforce. Systemlevel change and interdisciplinary approaches are also needed. Using task shifting as a guiding principle, we propose a new workforce framework (the Palliative care Redistribution Integrated System Model, or PRISM), which utilizes physician and nonphysician providers and resources to their maximum potential. We highlight the central role of hospitalists in this model and provide examples of innovations in screening, workflow, quality, and benchmarking to enable hospitalists to be purveyors of quality palliative care.
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Affiliation(s)
- Nauzley C Abedini
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, USA.
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Leggett AN, Polenick CA, Maust DT, Kales HC. Falls and Hospitalizations Among Persons With Dementia and Associated Caregiver Emotional Difficulties. THE GERONTOLOGIST 2018; 58:e78-e86. [PMID: 29365102 PMCID: PMC5946818 DOI: 10.1093/geront/gnx202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Falls and hospitalizations are adverse health events commonly experienced by persons with dementia (PWDs). These events often require urgent care from a family caregiver and may increase caregiver stress. We examine falls and hospitalizations among PWDs as predictors of caregivers' reported care-related emotional difficulty, in addition to care-related stressors. Research Design and Methods Cross-sectional telephone survey of 652 informal caregivers for PWDs. A multinomial logistic regression examined falls (last month) and hospitalizations (prior year) experienced by PWDs as predictors of caregivers' care-related emotional difficulty, accounting for demographic characteristics and primary and secondary caregiving stressors. Results Over 20% of caregivers reported high levels of care-related emotional difficulty. Controlling for demographic characteristics and primary and secondary caregiving stressors, the PWD's prior month fall was significantly associated with greater care-related emotional difficulty; the PWD's hospitalizations were not associated with care-related emotional difficulty. Discussion and Implications Approximately 30% of PWDs had experienced a past year hospitalization and prior month fall, and one in five caregivers reported high emotional difficulty related to care. Although secondary strains and resources of caregiving were strong predictors of care-related emotional difficulty, PWDs' falls represent a significant stressor that increases odds of caregiver emotional difficulty over and above other strains. Consequently, a fall experienced by a PWD may represent a key time for clinicians to assess caregiver well-being.
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Affiliation(s)
- Amanda N Leggett
- Program for Positive Aging, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Courtney A Polenick
- Program for Positive Aging, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Donovan T Maust
- Program for Positive Aging, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Helen C Kales
- Program for Positive Aging, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Abstract
As the shift to value-based payment accelerates, hospitals are under increasing pressure to deliver high-quality, efficient services. Palliative care approaches improve quality of life and family well-being, and in doing so, reduce resource utilization and costs. Hospitalists frequently provide palliative care interventions to their patients, including pain and symptom management and engaging in conversations with patients and families about the realities of their illness and treatment plans that align with their priorities. Hospitalists are ideally positioned to identify patients who could most benefit from palliative care approaches and often refer the most complex cases to specialty palliative care teams. Though hospitalists are frequently called upon to provide palliative care, most lack formal training in these skills, which have not typically been included in medical education. Additional training in communication, safe and effective symptom management, and other palliative care knowledge and skills are available in both in-person and online formats.
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Affiliation(s)
- Robin E Fail
- Center to Advance Palliative Care, New York, New York, USA.
| | - Diane E Meier
- Center to Advance Palliative Care, New York, New York, USA
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10
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Fukui N, Golabi P, Otgonsuren M, de Avila L, Bush H, Younossi ZM. Hospice care in Medicare patients with primary liver cancer: the impact on resource utilisation and mortality. Aliment Pharmacol Ther 2018; 47:680-688. [PMID: 29314093 DOI: 10.1111/apt.14484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/01/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few studies have assessed the impact of hospice care in patients with primary liver cancer. AIM To examine the determinants of hospice care and its effects on resource utilisation and survival among Medicare beneficiaries with primary liver cancer. METHODS We utilised the Surveillance, Epidemiology and End result Registry (SEER) database from 2002 to 2009 for this cross-sectional study. A total of 3385 patients with primary liver cancer were included. We used logistic regression to discern variables associated with hospice and Cox proportional hazards models to evaluate one-year mortality risk. RESULTS Compared to patients who enrolled in a hospice, those patients who did not, were younger, non-White and sicker (P < .05 for all). Half of all patients with primary liver cancer died within six months of diagnosis, and one-year mortality was similar in both groups (P = .413). After adjusting for baseline characteristics [age at diagnosis, race, disease severity, tumour stage and treatment], shorter time to hospice care was associated with reduced mortality (HR per day: 0.99 [95% CI, 0.98-0.99]). Older age, decompensated cirrhosis and advanced tumours stage were associated with decreased time to hospice, while Asian/Pacific Islander race and history of radiosurgery were associated with increased time to hospice (all P < .05). Hospitalisations were more costly for those who never enrolled in a hospice compared to hospice enrollees (median $31 607 [$18 394-$54 254] vs $22 316 [$13 741-$36 170], P < .0001). CONCLUSIONS Hospice enrolment of patients with primary liver cancer provides survival and resource utilisation benefits. Some clinical and demographic factors may represent barriers to hospice enrolment. Further studies are needed to fully understand these barriers in patients with primary liver cancer.
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Affiliation(s)
- N Fukui
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA
| | - P Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - L de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - H Bush
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Z M Younossi
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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11
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Peixoto RI, da Silveira VM, Zimmermann RD, de M Gomes A. End-of-life care of elderly patients with dementia: A cross-sectional study of family carer decision-making. Arch Gerontol Geriatr 2017; 75:83-90. [PMID: 29197715 DOI: 10.1016/j.archger.2017.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dementia syndromes pose a major worldwide challenge to public health. In terminal stage of dementia, carers are responsible for decision making in end-of-life treatment and there may be multiple factors that contribute to the choice of a palliative or invasive treatment. AIM To identify possible factors that influence the decision-making of family caregivers on implementing invasive or palliative interventions for people with end stage dementia. DESIGN A structured interview with family caregivers of elderly patients addressing aspects of the following categories: elderly with dementia, caregiver, medical treatment history. Statistical analysis was performed to test whether there was a significant association between the carer's decision (invasive or palliative treatment) and the collected variables. SETTINGAND PARTICIPANTS The study was conducted in three hospitals in Brazil. Participants were family caregivers of inpatients with end stage dementia RESULTS: Most of caregivers chose not to perform invasive procedures. The factors with the greatest association with the decision for invasive care were: elderly with tracheostomy, dementia diagnosis for less than 2 years, caregiver's age less than 50 years, history of hospital admission in the last year, affirmation that interviewee would be surprised with the death of the elderly within 1year and the denial that health care team has already explained about treatment options. CONCLUSION There were identified several factors related to the carer, the elderly person and their medical treatment that may influence the choice between palliative and invasive care for the elderly person with dementia.
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Affiliation(s)
- Rafaella I Peixoto
- Department of Geriatrics, Hospital das Clínicas, Universidade Federal de Pernambuco, Brazil.
| | - Vera M da Silveira
- Programa de pós-graduação em Gerontologia, Universidade Federal de Pernambuco, Brazil
| | - Rogério D Zimmermann
- Programa de pós-graduação em Gerontologia, Universidade Federal de Pernambuco, Brazil
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13
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Abstract
BACKGROUND Health crises in persons living with dementia challenge their caregivers to make pivotal decisions, often under pressure, and to act in new ways on behalf of their care recipient. Disruption of everyday routines and heightened stress are familiar consequences of these events. Hospitalization for acute illness or injury is a familiar health crisis in dementia. The focus of this study is to describe the lived experience of dementia family caregivers whose care recipients had a recent unplanned admission, and to identify potential opportunities for developing preventive interventions. METHODS Family caregivers (n = 20) of people with dementia who experienced a recent hospitalization due to an ambulatory care sensitive condition or fall-related injury completed phone interviews. Interviews used semi-structured protocols to elicit caregivers' reactions to the hospitalization and recollections of the events leading up to it. RESULTS Analysis of interview data identified four major themes: (1) caregiver is uncertain how to interpret and act on the change; (2) caregiver is unable to provide necessary care; (3) caregiver experiences a personal crisis in response to the patient's health event; (4) mitigating factors may prevent caregiver crises. CONCLUSIONS This study identifies a need for clinicians and family caregivers to work together to avoid health crises of both caregivers and people with dementia and to enable caregivers to manage the health of their care recipients without sacrificing their own health and wellness.
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14
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Chmelik E, Emtman R, Borisovskaya A, Borson S. Communication in dementia care. Neurodegener Dis Manag 2016; 6:479-490. [DOI: 10.2217/nmt-2016-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Dementia is a progressive neurodegenerative illness that affects a growing number of older adults in our country. We discuss ways to improve the management of persons with dementia within current healthcare models. Specifically, we argue that structured communication at regular intervals is essential for dementia care at all phases of illness. We emphasize the need for a single healthcare provider to take on a central role in organizing communication between patient, family and other healthcare providers in the outpatient setting. We also emphasize the need for healthcare providers to begin conversations about prognosis, care transitions and end of life early while balancing these difficult conversations with a hopeful attitude of realistic optimism that the disease can be managed.
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Affiliation(s)
- Elizabeth Chmelik
- VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA
| | - Reiko Emtman
- Department of Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA
| | - Anna Borisovskaya
- VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA
| | - Soo Borson
- Department of Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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Okafor PN, Stobaugh DJ, Nnadi AK, Talwalkar JA. Determinants of Palliative Care Utilization Among Patients Hospitalized With Metastatic Gastrointestinal Malignancies. Am J Hosp Palliat Care 2016; 34:269-274. [DOI: 10.1177/1049909115624373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Gastrointestinal tract cancers account for a significant proportion of the national cancer burden. Aim: We sought to explore patient- and hospital-level determinants of palliative care utilization among patients hospitalized with metastatic gastrointestinal tract cancers using a national database. Methods: An analysis of the 2012 National Inpatient Sample was performed. International Classification of Diseases, Ninth Revision codes were used to identify hospital discharges associated with metastatic digestive tract cancers and patient/hospital covariates for inclusion in a logistic regression model. Total charges and length of stay were analyzed in a linear regression model. Results: Compared to males, females were more likely to receive inpatient palliative care (adjusted odds ratio [OR] 1.12, P = .002). No difference was seen between white and Asian patients (adjusted OR 1.2, P = .11) or Native Americans patients (adjusted OR 1.4, P = .22). However, relative to white patients, African Americans (adjusted OR 1.13, P = .02) and Hispanics (adjusted OR 1.25, P = .001) had significantly higher odds of inpatient palliative care. Medicare patients were least likely to receive palliative care compared to those with Medicaid or commercial payers. Length of stay during these hospitalizations was longer in African Americans ( P = .0001), Asians ( P = .0001), and Native Americans ( P = .03) compared to white patients. No difference was seen when total charges were compared between white and African American patients ( P = .08). Conversely, total charges were higher in Hispanics ( P = .005) and Asians ( P = .001) relative to white patients. Conclusion: Gender and racial differences exist in utilization of inpatient palliative care among patients hospitalized with metastatic gastrointestinal tract cancers.
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Affiliation(s)
- Philip N. Okafor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jayant A. Talwalkar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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