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Cid M, Quan Vega ML, Yang Z, Guglielminotti J, Li G, Hua M. Disparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State. J Am Geriatr Soc 2024; 72:2690-2699. [PMID: 38982870 PMCID: PMC11368611 DOI: 10.1111/jgs.19046] [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: 03/20/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Racial and ethnic minorities often receive care at different hospitals than non-Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. The aim of this study was to determine if disparities in end-of-life care were present among minoritized patients during terminal hospitalizations, and if these disparities varied with hospital characteristics. METHODS We identified hospitalizations where a patient died in New York State, 2016-2018. Using multilevel logistic regression, we examined whether documented end-of-life care (do-not-resuscitate status (DNR), palliative care (PC) encounter) differed by race and ethnicity, and whether these disparities differed based on receiving care in hospitals with varying characteristics (Black or Hispanic-serving hospital; teaching status; bed size; and availability of specialty palliative care). RESULTS We identified 143,713 terminal hospitalizations in 188 hospitals. Across all hospitals, only Black patients were less likely to have a PC encounter (adjusted odds ratio (aOR) 0.83 [0.80-0.87]) or DNR status (aOR 0.91 [0.87-0.95]) when compared with non-Hispanic White patients, while Hispanic patients were more likely to have DNR status (aOR 1.07 [1.01-1.13]). In non-teaching hospitals, all minoritized groups had decreased odds of PC (aOR 0.80 [0.76-0.85] for Black, aOR 0.91 [0.85-0.98] for Hispanic, aOR 0.93 [0.88-0.98] for Others), while in teaching hospitals, only Black patients had a decreased likelihood of a PC encounter (aOR 0.88 [0.82-0.93]). Also, Black patients in a Black-serving hospitals were less likely to have DNR status (aOR 0.80 [0.73-0.87]). Disparities did not differ based on whether specialty PC was available (p = 0.27 for PC encounter, p = 0.59 for DNR status). CONCLUSION During terminal hospitalizations, Black patients were less likely than non-Hispanic White patients to have documented end-of-life care. This disparity appears to be more pronounced in non-teaching hospitals than in teaching hospitals.
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Affiliation(s)
- Miguel Cid
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Main Lin Quan Vega
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Zhixin Yang
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - May Hua
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Peerboom FBAL, Friesen-Storms JHHM, van der Steen JT, Janssen DJA, Meijers JMM. Fundamentals of end-of-life communication as part of advance care planning for older people: An interview study with nursing staff. Geriatr Nurs 2024; 60:59-69. [PMID: 39217843 DOI: 10.1016/j.gerinurse.2024.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/22/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
This exploratory interview study investigated nursing staff members' perspectives on the fundamentals of end-of-life communication with older people as part of advance care planning in home care, nursing home, and hospital settings. Separate semi-structured interviews were conducted with 17 nursing staff members about their experiences, opinions, and preferences before, during, and after end-of-life conversations. Overall themes clustering the fundamentals include preconditions such as feeling comfortable talking about the end of life and creating space for open communication. Fundamentals related to the actual conversation-such as using senses and applying associative communication techniques (e.g., using understandable language), following conversation phases, and being aware of interprofessional collaboration-were also considered important. This study emphasizes the importance of moving along with the older person as well as connecting, adapting, and letting go of control over the conversation's outcome. Many fundamentals can be traced back to the basics of nursing and the humanity of conversation.
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Affiliation(s)
- Fran B A L Peerboom
- Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands.
| | - Jolanda H H M Friesen-Storms
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands; Research Center for Autonomy and Participation for Persons with a Chronic Illness and Academy for Nursing, Zuyd Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ Heerlen, the Netherlands.
| | - Jenny T van der Steen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands; Radboudumc Alzheimer Center and Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands; Cicely Saunders Institute, King's College London, UK.
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands; Department of Research and Development, Ciro, Hornerheide 1, 6085 NM Horn, the Netherlands; Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Judith M M Meijers
- Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands.
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Honey M, Dark-Freudeman A. From theory to reality: Unraveling the development of mature death concept. DEATH STUDIES 2024:1-19. [PMID: 39093626 DOI: 10.1080/07481187.2024.2385388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Death is commonly accepted as the irreversible ending of all biological functions that keep an organism alive. However, understanding death is more complicated than merely comprehending the biological elements of death. Beyond the biological elements of death, it is also critical to understand death's social, cognitive, and environmental aspects as they influence death awareness, death anxiety, grief and bereavement, and death education. This paper explores the development of mature death concept in children, from early childhood to adolescence. Drawing on a range of developmental and death awareness theoretical frameworks, the authors create a comprehensive model describing the development of mature death concept. The goal of this paper is to propose one theoretical perspective that connects traditional cognitive, socioemotional, and ecological developmental theories with current death awareness theories.
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Affiliation(s)
- Mckenzie Honey
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Alissa Dark-Freudeman
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Heller LD. Palliative Care in Sub-Saharan Africa: A Narrative Review. J Palliat Med 2024; 27:1083-1089. [PMID: 38466990 DOI: 10.1089/jpm.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: As a person nears the end of their life, culture and ethnicity increasingly drive preferences and priorities for care. Understanding these preferences and priorities is fundamental to health care professionals' goals to respect decision making and support the individual throughout this phase of life. Across Africa, several countries are in the initial stages of implementing palliative care services in their burgeoning health care systems. Moving forward, it is imperative to consider cultural similarities and differences when compared with the Western world, where the field of palliative care evolved, to create a tailored palliative care approach that is consistent with African culture. In palliative care, understanding cultural preferences and priorities requires communication between the patient and the provider and is a crucial step toward a successful implementation in Africa. A paternalistic patient-provider relationship is the current leading model in sub-Saharan Africa.1 Aim: This narrative review explores the prevalence of paternalism and explores its appropriateness and necessity in the current application of palliative care in sub-Saharan African countries. Methods: This narrative review was conducted using four databases as well as hand searching of relevant articles sourced from references of already selected articles. A total of 730 articles were identified. Fourteen articles met the inclusion/exclusion criteria set for this narrative review. Results: In sub-Saharan Africa, the leading patient-provider relationship was determined to be paternalistic. Reasons for this were language, education, cultural norms and expectations, lack of time, and benevolence. Conclusions: The implementation of palliative care often relies on communication of patient desires and goals. Consideration is needed to determine how a provider can appropriately know these factors in a paternalistic relationship.
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Affiliation(s)
- Layne DeAnn Heller
- School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
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5
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Rahemi Z, Shalhout SZ, Bacsu JDR, Petrovsky DV, Zanwar PP, Adams SA. Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.14.24310385. [PMID: 39040173 PMCID: PMC11261929 DOI: 10.1101/2024.07.14.24310385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
The purpose of this study was to determine the healthcare utilization patterns in a national sample of older adults across several social determinants of health factors (ethnicity, gender, race, education) with normal and dementia/impaired cognition. We used datasets from the Health and Retirement Study (HRS, 2018) to evaluate healthcare utilization, including metrics such as hospital and nursing home stays, hospice care, and number of visits to the doctor. Logistic models were used to predict healthcare utilization separately in those with normal cognition and dementia. Our final sample comprised 15,607 adults (mean age: 65.2 normal cognition, mean age 71.5 dementia). Hispanics with normal cognition were less likely to stay in a hospital than non-Hispanic respondents (OR: 0.52-0.71, p<0.01). Being female was associated with a higher risk for shorter nursing home days (OR: 1.41, p<0.01) and doctor visits (OR: 1.63-2, p<0.01) in cognitively normal older adults. Being female was associated with a lower risk for hospital stay in those with dementia (OR: 0.50-0.78, p<0.01). Respondents identifying as Black or other races with dementia were less likely to experience nursing home days (OR: 0.42, p<0.04). Black respondents with normal cognition were less likely to experience doctor visits (OR: 0.32-0.37, p<0.01). Those with more than a high school education in both groups were more likely to experience doctors' visits. The study points to the continued disparities in healthcare utilization linked to participants' social determinants of health factors and cognition.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Clemson, SC, 29634-0743
| | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology- Head and Neck Surgery, Mass Eye and Ear, Boston, MA
- Mike Toth Cancer Center, Mass Eye and Ear, Boston, MA
- Department of Otolaryngology- Head and Neck Surgery Harvard Medical School, Boston, MA
| | | | - Darina V. Petrovsky
- Duke University School of Nursing, Division of Women, Children and Families, 307 Trent Drive, Box 3322 Durham, NC 27710
| | | | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC 29208
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC 29208
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McCleskey SG, Vargas Bustamante A, Ahluwalia SC, Nuckols TK, Kominski GF, Chuang E. Racial Differences in Treatment Intensity at the End of Life Among Older Adults with Heart Failure: Evidence from the Health and Retirement Study. J Palliat Med 2024; 27:854-860. [PMID: 38546482 DOI: 10.1089/jpm.2023.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Background: Black Americans experience the highest prevalence of heart failure (HF) and the worst clinical outcomes of any racial or ethnic group, but little is known about end-of-life care for this population. Objective: Compare treatment intensity between Black and White older adults with HF near the end of life. Design: Negative binomial and logistic regression analyses of pooled, cross-sectional data from the Health and Retirement Study (HRS). Setting/Subjects: A total of 1607 U.S. adults aged 65 years and older with HF who identify as Black or White, and whose proxy informant participated in an HRS exit interview between 2002 and 2016. Measurements: We compared four common measures of treatment intensity at the end of life (number of hospital admissions, receipt of care in an intensive care unit (ICU), utilization of life support, and whether the decedent died in a hospital) between Black and White HF patients, controlling for demographic, social, and health characteristics. Results: Racial identity was not significantly associated with the number of hospital admissions or admission to an ICU in the last 24 months of life. However, Black HF patients were more likely to spend time on life support (odds ratio [OR] = 2.16, confidence interval [CI] = 1.35-3.44, p = 0.00) and more likely to die in a hospital (OR = 1.53, CI = 1.03-2.28, p = 0.04) than White HF patients. Conclusion: Black HF patients were more likely to die in a hospital and to spend time on life support than White HF patients. Thoughtful and consistent engagement with HF patients regarding treatment preferences is an important step in addressing inequities.
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Affiliation(s)
- Sara G McCleskey
- Behavioral and Policy Sciences, RAND, Santa Monica, California, USA
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | - Teryl K Nuckols
- Behavioral and Policy Sciences, RAND, Santa Monica, California, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gerald F Kominski
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
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Rahemi Z, Bacsu JDR, Shalhout SZ, Sadafipoor MS, Smith ML, Adams SA. Healthcare Disparities Among Older Adults: Exploring Social Determinants of Health and Cognition Levels. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.29.24309705. [PMID: 39006418 PMCID: PMC11245058 DOI: 10.1101/2024.06.29.24309705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background The purpose was to investigate the impact of sociodemographic factors on healthcare utilization among adults with different cognition levels (normal and impairment/dementia). Methods We used cross-sectional data from the Health and Retirement Study (N=17,698) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits. Results A cohort comparison between normal and dementia/impaired cognition groups revealed significant differences. The dementia/impaired group had lower education levels, higher single/widowed status, and more racial and ethnic minorities. They experienced longer hospital and nursing home stays, varied doctor visit frequencies, and had higher mean age, greater loneliness scores, and lower family social support scores. Differences in hospitalization, nursing home, hospice care, and doctor visits were influenced by factors such as race, age, marital status, education, and rurality. Conclusion There were disparities in healthcare utilization based on participants' characteristics and cognition levels, especially in terms of race/ethnicity, education, and rural location.
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Affiliation(s)
| | | | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology- Head and Neck Surgery
- Mike Toth Cancer Center, Mass Eye and Ear, Boston, MA
- Department of Otolaryngology- Head and Neck Surgery, Harvard Medical School, Boston, MA
| | | | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health,Center for Community Health and Aging, Texas A&M University
| | - Swann Arp Adams
- Department of Biobehavioral Health and Nursing Science College of Nursing
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Yardimci Gürel T, Mert H. Understanding Family Members in the Palliative Phases of Their Loved Ones: A Qualitative Study. J Hosp Palliat Nurs 2024; 26:E98-E105. [PMID: 38597638 DOI: 10.1097/njh.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Because of aging and rising rates of chronic diseases, the demand for palliative care services is increasing worldwide, and patients need family members to care for them throughout the palliative care process. This study aimed to investigate the experiences of the relatives of palliative care patients during hospitalization. This was a qualitative study conducted with 15 family members. A topic guide was used to conduct semistructured face-to-face interviews. Content analysis was used to analyze the textual data. As a result of the analysis, 3 main themes, 6 categories, and 24 subcategories emerged. The main themes were "reactions to the admission," "feeling obligated to care," and "coping processes." The interviews revealed that most participants had misconceptions and a lack of knowledge about palliative care. Almost all of the family members expressed that they experienced various emotions during this process and had trouble coping. The significant finding of our study is that culture and religious beliefs have a considerable influence on caregiving. A limited number of studies in the literature provide detailed insight into the state of patient relatives. Therefore, this study is critical in guiding palliative care professionals in understanding the requirements of this vulnerable group.
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Rahemi Z, Bacsu JDR, Shalhout SZ, Sabet M, Sirizi D, Smith ML, Adams SA. Past Disparities in Advance Care Planning Across Sociodemographic Characteristics and Cognition Levels in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.09.24307125. [PMID: 38766186 PMCID: PMC11100925 DOI: 10.1101/2024.05.09.24307125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
We aimed to examine past advance care planning (ACP) in U.S. older adults across different sociodemographic characteristics and cognition levels. We established the baseline trends from 10 years ago to assess if trends in 2024 have improved upon future data availability. We considered two legal documents in the Health and Retirement Study 2014 survey as measures for ACP: a living will and durable power of attorney for healthcare (DPOAH). Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Predictor variables included age, gender, ethnicity, race, education, marital status, rurality, everyday discrimination, social support, and loneliness. Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, Black, had lower levels of education, or resided in rural areas were less likely to complete ACP. Examining ACP and its linkages to specific social determinants is essential to understanding disparities and educational strategies needed to facilitate ACP uptake among different population groups. Accordingly, this study aimed to examine past ACP disparities in relation to specific social determinants of health and different cognition levels. Future studies are required to evaluate whether existing disparities have improved over the last 10 years when 2024 data is released. Addressing ACP disparities among diverse populations, including racial and ethnic minorities with reduced cognition levels, is crucial for enhancing health equity and access to care.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University Clemson, SC, 29634-0743
| | | | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Mike Toth Cancer Research Center, Mass Eye and Ear, Harvard Medical School Boston, Massachusetts, USA, 02114
| | - Morteza Sabet
- School of Mechanical and Automotive Engineering, College of Engineering, Computing and Applied Sciences, Clemson University 4 Research Dr, Greenville, SC 29607
| | - Delaram Sirizi
- Department of Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson SC 29634
| | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Center for Community Health and Aging Texas A&M University, College Station, TX 77843
| | - Swann Arp Adams
- College of Nursing and the Department of Epidemiology & Biostatistics, University of South Carolina Columbia, SC 29208
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Strange KE, Mixer SJ, Embler P, Smith JL, Troutman-Jordan M. Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study. J Transcult Nurs 2024; 35:112-124. [PMID: 38062764 DOI: 10.1177/10436596231213343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. METHODOLOGY Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. RESULTS "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. DISCUSSION Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.
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Xia Q, Kularatna M, Virdun C, Button E, Close E, Carter HE. Preferences for Palliative and End-of-Life Care: A Systematic Review of Discrete Choice Experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1795-1809. [PMID: 37543206 DOI: 10.1016/j.jval.2023.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/20/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Understanding what matters most to patients and their caregivers is fundamental to delivering high-quality care. This systematic review aimed to characterize and appraise the evidence from discrete choice experiments eliciting preferences for palliative care. METHODS A systematic literature search was undertaken for publications up until August 2022. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Attribute development, frequency, and relative importance were analyzed. Subgroup analyses were conducted to compare outcomes between patient and proxy respondents. RESULTS Seventeen studies spanning 11 countries were included; 59% of studies solely considered preferences for patients with cancer. A range of respondent groups were represented including patients (76%) and proxies (caregivers [35%], health providers [12%], and the public [18%]). A total of 117 individual attributes were extracted and thematically grouped into 8 broad categories and 21 subcategories. Clinical outcomes including quality of life, length of life, and pain control were the most frequently reported attributes, whereas attributes relating to psychosocial components were largely absent. Both patients and proxy respondents prioritized pain control over additional survival time. Nevertheless, there were differences between respondent cohorts in the emphasis on other attributes such as access to care, timely information, and low risk of adverse effects (prioritized by patients), as opposed to cost, quality, and delivery of care (prioritized by proxies). CONCLUSIONS Our review underscores the vital role of pain control in palliative care; in addition, it shed light on the complexity and relative strength of preferences for various aspects of care from multiple perspectives, which is useful in developing personalized, patient-centered models of care for individuals nearing the end of life.
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Affiliation(s)
- Qing Xia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mineth Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Claudia Virdun
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elise Button
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eliana Close
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law (Close), Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Rahemi Z, Malatyali A, Bacsu JDR, Sefcik JS, Petrovsky DV, Baker ZG, Ma KPK, Smith ML, Adams SA. Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. J Appl Gerontol 2023; 42:2294-2303. [PMID: 37525608 PMCID: PMC10828104 DOI: 10.1177/07334648231191667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Greenville, SC, USA
| | - Ayse Malatyali
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL, USA
| | | | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Swann A Adams
- Department of Biobehavioral and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
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Rahemi Z, Malatyali A, Adams SA, Jarrín OF, Demiris G, Parker V, Anaraky RG, Dye CJ. Advance Care Planning Among Older Adults with Cognitive Impairment. Am J Hosp Palliat Care 2023; 40:1182-1189. [PMID: 36541134 PMCID: PMC10282104 DOI: 10.1177/10499091221146255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Clemson, SC, USA
| | - Ayse Malatyali
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Swann A. Adams
- Department of Epidemiology & Biostatistics, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Olga F. Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Cheryl J. Dye
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Rahemi Z, Malatyali A, Wiese LAK, Dye CJ. End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing. J Nurs Care Qual 2023; 38:319-326. [PMID: 36947814 PMCID: PMC10442095 DOI: 10.1097/ncq.0000000000000705] [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] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND End-of-life planning helps nurses meet the needs of their patients at a crucial time of life. PURPOSE This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views. METHODS Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses. RESULTS This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning. CONCLUSION This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Ayse Malatyali
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Lisa Ann Kirk Wiese
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Cheryl J. Dye
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
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15
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Rahemi Z, Jarrín OF. Older adults in the USA with limited English proficiency have high rates of intensive end-of-life care and low rates of palliative care and advance care planning. Evid Based Nurs 2023; 26:116. [PMID: 36759169 DOI: 10.1136/ebnurs-2022-103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Clemson, South Carolina, USA
| | - Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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16
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Xu X, Chau PH, Cheung DST, Ho MH, Lin CC. Preferences for end-of-life care: A cross-sectional survey of Chinese frail nursing home residents. J Clin Nurs 2023; 32:1455-1465. [PMID: 35933614 DOI: 10.1111/jocn.16483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES To assess (1) the experience, knowledge and preferences of end-of-life care among frail nursing home residents and (2) the preferences of residents' family caregivers. BACKGROUND Globally, nursing homes are becoming an important place where many older people will receive their end-of-life care. Thus, assessing the end-of-life care preferences among nursing home residents is crucial. DESIGN Cross-sectional survey. METHODS Residents aged ≥65 years, with frail or pre-frail status (n = 286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist. RESULTS 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as 'not necessary'. Nursing homes were the most preferred place to receive end-of-life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes. CONCLUSIONS This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents' awareness of these topics. RELEVANCE TO CLINICAL PRACTICE To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance.
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Affiliation(s)
- Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong, Hong Kong
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Six S, Bilsen J, Deschepper R. Dealing with cultural diversity in palliative care. BMJ Support Palliat Care 2023; 13:65-69. [PMID: 32826261 DOI: 10.1136/bmjspcare-2020-002511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/29/2023]
Abstract
Palliative care is increasingly confronted with cultural diversity. This can lead to various problems in practice. In this perspective article, the authors discuss in more detail which issues play a role in culture-sensitive palliative care, why naive culturalism will not solve such problems and in which direction research into this aspect of care can be further elaborated.
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Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
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Shabnam J, Timm HU, Nielsen DS, Raunkiær M. Palliative Care Utilisation Among Non-Western Migrants in Denmark: A Qualitative Study Of the Experiences of Patients, Family Caregivers and Healthcare Professionals. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221111933. [PMID: 35786059 DOI: 10.1177/00302228221111933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores care experiences while utilising palliative care services of non-western migrant families from the perspectives of patients, family caregivers, and healthcare professionals in Denmark. Twenty-three semi-structured individual and group interviews were conducted among eight patients with a life-threatening disease, 11 family caregivers, and ten healthcare professionals. Thematic analysis revealed three themes: 1) Communication between families and healthcare professionals; 2) Building and lack of trusting relations, and feeling safe, and 3) Access to information and navigating in the healthcare system. Moreover, ''language and culture'' emerged as transaction themes that are not mutually exclusive, however, interconnect across the mentioned three themes. Non-western migrant families can be supported by healthcare professionals' cultural competency training, negotiating on providing services concerning information, patient preferences, family involvement, and palliative care setting. This study findings urge inter-sectoral collaboration to ensure needs-oriented and linguistically and culturally appropriate palliative care services for non-western migrant families in Denmark.
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Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- University Hospitals Center for Health Research (UCSF), Rigshospital, Copenhagen, Denmark
| | - Dorthe Susanne Nielsen
- Migrant Health Clinic, Department of Geriatric Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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19
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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20
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Palliative Care Utilization Among Non-Western Migrants in Europe: A Systematic Review. J Immigr Minor Health 2021; 24:237-255. [PMID: 34709528 DOI: 10.1007/s10903-021-01302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants.
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21
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Rahemi Z, Parker V. Does Culture Matter? Young and Middle-Aged Iranian-American Adults' Perspectives Regarding End-of-Life Care Planning. Am J Hosp Palliat Care 2021; 39:555-561. [PMID: 34365832 DOI: 10.1177/10499091211036894] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND An increase of cultural diversity and treatment options offer opportunities and challenges related to end-of-life (EOL) care for healthcare providers and policymakers. EOL care planning can help reduce confusion and uncertainty when individuals and family members need to make decisions about EOL care options. OBJECTIVE The purpose of this study was to investigate preferences, attitudes, and behaviors regarding EOL care planning among young and middle-aged Iranian-American adults. METHODS A cross-sectional national sample of 251 Iranian-American adults completed surveys. Paper and online surveys in English and Persian were offered to potential participants. RESULTS All the participants completed online survey in English language. In incurable health conditions, 56.8% preferred hospitalization and intensive treatments. From the 40.6% participants who preferred comfort care, most preferred care at home (29.5%) compared to an institution (11.1%). Those who preferred hospitalization at EOL mostly preferred intensive and curative treatments. The mean score of attitudes toward advance decision-making was moderately high (11.48 ± 2.77). Favorable attitudes were positively associated with acculturation (r = .31, p < .001), age (r = .15, p < .05), and number of years living in the U.S. (r = .26, p < .001). Conversely, spirituality and favorable attitudes were negatively associated (r = -.17, p < .05). CONCLUSION Immigrant and culturally diverse individuals have experienced different living and healthcare environments. These differences can influence their EOL care planning and decisions. Knowledge of diverse perspectives and cultures is essential to design culturally congruent plans of EOL care.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, Greenville, SC, USA
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22
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Chen MC, Palmer MH, Lin SY. Pilot test of a learned resourcefulness program for older family caregivers in Taiwan. Geriatr Nurs 2021; 42:1129-1134. [PMID: 34314942 DOI: 10.1016/j.gerinurse.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Learned resourcefulness, a theory-based education intervention, can be applied to provide strategies to improve the health status and reduce caregiver burden for older family caregivers. We developed a culturally relevant SOURCE program and designed a pilot study to its effect and feasibility for older family caregivers living in Taiwan. Using a quasi-experimental study with one-group, pre-test and post-test design, we recruited a convenience sample of 30 older family caregivers who received home-care services from a regional hospital in southern Taiwan. The older family caregivers participated in and completed the four-week SOURCE program. Effectiveness and feasibility data were collected after the completion of the program. Results indicated that the SOURCE program significantly improved caregiving burden (t = 3.05, p = .005) and revealed that the program was helpful and useful to older family caregivers. The next step will be to use the SOURCE program with more older family caregivers.
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Affiliation(s)
- Meng-Chun Chen
- Department of Nursing, I-Shou University, Kaohsiung; 8 Yida Rd., Jiaosu Village Yanchao District, Kaohsiung City, 82445 Taiwan; Department of Nursing, Chang Gung Memorial Hospital, Chiayi; 6 Chia-Pu Rd., West Section, Putz City, Chiayi County, Taiwan 61363
| | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599, USA
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University; 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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23
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Hurlow A, Wyld L, Breen A. An evaluation of advance care planning during the COVID-19 pandemic: a retrospective review of patient involvement in decision making using routinely collected data from digital ReSPECT records. Clin Med (Lond) 2021; 21:e395-e398. [PMID: 33958345 DOI: 10.7861/clinmed.2020-1036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review advance care planning (ACP) practice during the COVID-19 pandemic, evaluating the number of plans created, patient participation, cardiopulmonary resuscitation recommendations and variation between different population groups. DESIGN A retrospective analysis and comparison of routinely collected data from electronic recommended summary plan for emergency care and treatment (ReSPECT) records documented in April 2020 and January to December 2019. SETTING/PARTICIPANTS Electronic ReSPECT documents completed for adult patients at a large, acute hospital trust in the UK. RESULTS The number of plans created per 1,000 admissions in April 2020 was 333.0% higher than in 2019. A greater proportion of plans created during April 2020 were discussed with the patient and the proportion containing a 'for cardiopulmonary resuscitation' recommendation was higher across all population groups. A greater proportion of plans were created for younger adults and Black and minority ethnic groups during the pandemic. CONCLUSION Increased ACP during a crisis can be achieved alongside increased patient participation in decision making. A tool such as ReSPECT that supports recommendations for, as well as limitations on, treatment may have enabled the expansion of ACP observed.
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Affiliation(s)
- Adam Hurlow
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lucy Wyld
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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24
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End-of-Life Care Terminology: A Scoping Review. ANS Adv Nurs Sci 2021; 44:148-156. [PMID: 33181566 DOI: 10.1097/ans.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this scoping review is to present an overview of terms found in publications associated with end-of-life care management that can impact decision making by patients, health care providers, and researchers. Connotative terminology and syntax can influence the decision-making approach and process. We examined 49 publications for positive, negative, and neutral connotations. We consistently found negative terminology in the publications. To advance the development of nursing knowledge regarding end-of-life care, researchers should be aware of their biases of terminology and syntax use. We propose modifications to language used in end-of-life care planning models and literature can improve care congruency.
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25
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Giannitrapani KF, Satija A, Ganesh A, Gamboa R, Fereydooni S, Hennings T, Chandrashekaran S, Mickelsen J, DeNatale M, Spruijt O, Bhatnagar S, Lorenz KA. Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India. J Gen Intern Med 2021; 36:366-373. [PMID: 32901438 PMCID: PMC7878595 DOI: 10.1007/s11606-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 08/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects. OBJECTIVE To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India. PARTICIPANTS We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts. RESULTS Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture. CONCLUSIONS Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Aanchal Satija
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Archana Ganesh
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raziel Gamboa
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Soraya Fereydooni
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Taylor Hennings
- University of California Berkeley School of Public Health, Berkeley, CA, USA
| | | | | | | | - Odette Spruijt
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Sushma Bhatnagar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karl A Lorenz
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
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26
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Marino VR, Hyer K, Hamilton L, Wenders AM, Andel R. Evaluation of a quality improvement initiative to increase rates of advance directive conversation documentation in primary care. Geriatr Nurs 2020; 42:303-308. [PMID: 33039201 DOI: 10.1016/j.gerinurse.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
As life expectancy increases, long periods of comorbidity and low quality of life commonly precede death. Advance care planning within primary care settings is necessary to increase patient agency and prioritize personal wishes. This article disseminates a quality improvement initiative within a federally qualified health center. New procedures were developed to systematically track advance directive conversations using current procedural terminology codes. The systems change resulted in a substantial and sustained increase in advance directive conversation documentation. The increase was presumably due to the implementation of small-scale changes, providers' commitment to geriatric primary care, increases in appointment times, allocation of tasks across disciplines, availability of Spanish speaking staff and translated forms, and the change to record keeping that enabled codes to be easily captured and tracked in the electronic medical record. This work may inform future quality improvement efforts to boost advance care planning among underserved populations in diverse settings.
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Affiliation(s)
- Victoria R Marino
- School of Aging Studies, University of South Florida, United States; Florida Policy Exchange Center on Aging, University of South Florida, United States.
| | - Kathryn Hyer
- School of Aging Studies, University of South Florida, United States; Florida Policy Exchange Center on Aging, University of South Florida, United States
| | | | - Anne Maynard Wenders
- School of Aging Studies, University of South Florida, United States; Florida Policy Exchange Center on Aging, University of South Florida, United States
| | - Ross Andel
- School of Aging Studies, University of South Florida, United States; Florida Policy Exchange Center on Aging, University of South Florida, United States
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