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Barrado-Martín Y, Nair P, Anantapong K, Aker N, Moore KJ, Smith CH, Rait G, Sampson EL, Manthorpe J, Davies N. Family caregivers' and professionals' experiences of supporting people living with dementia's nutrition and hydration needs towards the end of life. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:307-318. [PMID: 33955630 DOI: 10.1111/hsc.13404] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/05/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The aim of this paper was to understand the needs of family caregivers and professionals supporting people living with dementia with eating and drinking difficulties towards the end of life and the strategies they use to overcome them. A total of 41 semi-structured interviews with family caregivers (n = 21) and professionals (n = 20) were conducted in London and surrounding areas of England. Interviews were audio-recorded and transcribed verbatim. Four themes were identified: caregivers accessing and seeking help, perceived priorities of care, professionals' supportiveness and educational role, and strategies. Caregivers often struggle as they are not aware of the eating and drinking difficulties associated with dementia's progression. Care can change over time with families prioritising a person's comfort towards the end of life rather than ensuring a particular level of nutrition. Mutual support is required by both professionals and caregivers to enhance the care of the person living with dementia. Cognitive difficulties are often behind initial eating and drinking challenges in dementia, whereas physical challenges take over towards the later stages. Flexibility and creativity are key to adapting to changing needs. There is a need to raise awareness of the eating and drinking challenges associated with the progression of dementia. Professionals can help caregivers embark on the transition towards focussing on comfort and enjoyment of eating and drinking near the end of life rather than nutrition. This is particularly relevant for those caring for a relative living at home. Caregivers' input is needed to tailor professionals' recommendations.
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Affiliation(s)
- Yolanda Barrado-Martín
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Pushpa Nair
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Narin Aker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Edmonton, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit and NIHR Applied Research Collaborative (ARC) South London, King's College London, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Oncology and Palliative Care Nurses' Knowledge and Attitudes Toward Artificial Nutrition and Hydration for Patients at End of Life in Italy: A Cross-sectional Survey. Cancer Nurs 2021; 44:E99-E107. [PMID: 32195711 DOI: 10.1097/ncc.0000000000000803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nutrition is a basic patients' need and an important component of nursing. End-of-life cancer patients can experience difficulties in eating and drinking, sometimes requiring artificial nutrition and hydration (ANH). Nurses' knowledge and attitudes greatly influence nursing care. Nurses may lack knowledge of ANH. To date, no study has explored the knowledge and attitudes of oncology and palliative care nurses toward end-of-life ANH. OBJECTIVE To describe oncology and palliative care nurses' knowledge of and attitudes toward ANH. METHODS A multicenter cross-sectional study was conducted in 7 regions of Italy using the Italian version of the Questionnaire on Knowledge and Attitudes in Providing ANH for Terminal Cancer Patients. Attitudes were divided into benefits and burdens of providing ANH. Data were analyzed by descriptive statistics. RESULTS High percentages of oncology and palliative care nurses showed reasonable knowledge about ANH. More disagreement was evidenced about benefits and burdens of ANH, and lower importance was given to them. CONCLUSIONS Some misconceptions and a low level of awareness exist among some nurses about ANH. More nursing studies should be conducted and extended to different care settings. Moreover, guidelines should be reinforced with a nursing perspective to better define nurses' role in the decision-making process on ANH. IMPLICATIONS FOR PRACTICE This exploration of nurses' knowledge of and attitudes toward ANH in end-of-life cancer patients can contribute to an understanding of how nurses can be involved in better meeting cancer patients' nutritional needs at the end of life.
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Barrado‐Martín Y, Hatter L, Moore KJ, Sampson EL, Rait G, Manthorpe J, Smith CH, Nair P, Davies N. Nutrition and hydration for people living with dementia near the end of life: A qualitative systematic review. J Adv Nurs 2021; 77:664-680. [PMID: 33249602 PMCID: PMC7898342 DOI: 10.1111/jan.14654] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
AIMS To synthesize the qualitative evidence of the views and experiences of people living with dementia, family carers, and practitioners on practice related to nutrition and hydration of people living with dementia who are nearing end of life. DESIGN Systematic review and narrative synthesis of qualitative studies. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL. REVIEW METHODS Databases were searched for qualitative studies from January 2000-February 2020. Quantitative studies, or studies reporting on biological mechanisms, assessments, scales or diagnostic tools were excluded. Results were synthesized using a narrative synthesis approach with thematic analysis. RESULTS Twenty studies were included; 15 explored the views of practitioners working with people living with dementia in long-term care settings or in hospitals. Four themes were developed: challenges of supporting nutrition and hydration; balancing the views of all parties involved with 'the right thing to do'; national context and sociocultural influences; and strategies to support nutrition and hydration near the end of life in dementia. CONCLUSION The complexity of supporting nutrition and hydration near the end of life for someone living with dementia relates to national context, lack of knowledge, and limited planning while the person can communicate. IMPACT This review summarizes practitioners and families' experiences and highlights the need to include people living with dementia in studies to help understand their views and preferences about nutrition and hydration near the end of life; and those of their families supporting them in the community. The review findings are relevant to multidisciplinary teams who can learn from strategies to help with nutrition and hydration decisions and support.
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Affiliation(s)
- Yolanda Barrado‐Martín
- Centre for Ageing & Population StudiesResearch Department of Primary Care & Population HealthUniversity College LondonLondonUK
| | - Lee Hatter
- Centre for Ageing & Population StudiesResearch Department of Primary Care & Population HealthUniversity College LondonLondonUK
| | - Kirsten J. Moore
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Melbourne Ageing Research CollaborationNational Ageing Research InstituteRoyal Melbourne Hospital VictoriaParkvilleVICAustralia
| | - Elizabeth L. Sampson
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Barnet Enfield and Haringey Mental Health Trust Liaison TeamNorth Middlesex University HospitalLondonUK
| | - Greta Rait
- Centre for Ageing & Population StudiesResearch Department of Primary Care & Population HealthUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce Research UnitNIHR Applied Research Collaborative (ARC) South LondonKing’s College LondonLondonUK
| | - Christina H. Smith
- Language and CognitionDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Pushpa Nair
- Centre for Ageing & Population StudiesResearch Department of Primary Care & Population HealthUniversity College LondonLondonUK
| | - Nathan Davies
- Centre for Ageing & Population StudiesResearch Department of Primary Care & Population HealthUniversity College LondonLondonUK
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
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Anantapong K, Davies N, Chan J, McInnerney D, Sampson EL. Mapping and understanding the decision-making process for providing nutrition and hydration to people living with dementia: a systematic review. BMC Geriatr 2020; 20:520. [PMID: 33267831 PMCID: PMC7709405 DOI: 10.1186/s12877-020-01931-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This systematic review aimed to explore the process of decision-making for nutrition and hydration for people living with dementia from the perspectives and experiences of all involved. METHODS We searched CINAHL, the Cochrane Library, EMBASE, MEDLINE and PsycINFO databases. Search terms were related to dementia, decision-making, nutrition and hydration. Qualitative, quantitative and case studies that focused on decision-making about nutrition and hydration for people living with dementia were included. The CASP and Murad tools were used to appraise the quality of included studies. Data extraction was guided by the Interprofessional Shared Decision Making (IP-SDM) model. We conducted a narrative synthesis using thematic analysis. PROSPERO registration number CRD42019131497. RESULTS Forty-five studies were included (20 qualitative, 15 quantitative and 10 case studies), comprising data from 17 countries and 6020 patients, family caregivers and practitioners. The studies covered a range of decisions from managing oral feeding to the use of tube feeding. We found that decisions about nutrition and hydration for people living with dementia were generally too complex to be mapped onto the precise linear steps of the existing decision-making model. Decision-making processes around feeding for people living with dementia were largely influenced by medical evidence, personal values, cultures and organizational routine. Although the process involved multiple people, family caregivers and non-physician practitioners were often excluded in making a final decision. Upon disagreement, nutrition interventions were sometimes delivered with conflicting feelings concealed by family caregivers or practitioners. Most conflicts and negative feelings were resolved by good relationship, honest communication, multidisciplinary team meetings and renegotiation. CONCLUSIONS The decision-making process regarding nutrition and hydration for people living with dementia does not follow a linear process. It needs an informed, value-sensitive, and collaborative process. However, it often characterized by unclear procedures and with a lack of support. Decisional support is needed and should be approached in a shared and stepwise manner.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Justin Chan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Daisy McInnerney
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, UK
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Albanesi B, Marchetti A, D'Angelo D, Capuzzo MT, Mastroianni C, Artico M, Lusignani M, Piredda M, De Marinis MG. Exploring Nurses’ Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review. JPEN J Parenter Enteral Nutr 2020; 44:1220-1233. [DOI: 10.1002/jpen.1772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Beatrice Albanesi
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Anna Marchetti
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Daniela D'Angelo
- CNEC Center for Clinical Excellence and Quality of Care Istituto Superiore di Sanità Rome Italy
| | | | | | - Marco Artico
- Palliative Care and Pain Therapy Unit Azienda ULSS 4 Veneto Orientale San Donà di Piave Italy
| | - Maura Lusignani
- Biomedical Sciences for Health University of Milan Milan Italy
| | - Michela Piredda
- Research Unit Nursing Science Campus Bio‐Medico di Roma University Rome Italy
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Albanesi B, Marchetti A, Facchinetti G, Clari M, Dellafiore F, Piervisani L, Lusignani M, De Marinis MG, Piredda M. Cross-cultural adaptation and validation of questionnaire for knowledge, attitudes, and behavioral intentions in Italian nurses with regard to provision of artificial nutrition and hydration to patients terminally ill with cancer. Nutrition 2019; 72:110655. [PMID: 31918050 DOI: 10.1016/j.nut.2019.110655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/20/2019] [Accepted: 11/02/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Decision-making on artificial nutrition and hydration for patients terminally ill with cancer can be influenced by nurses' knowledge, attitudes, and behavioral intentions. A comprehensive 57-item questionnaire including six sections on the knowledge, attitudes, and behavioral intentions in providing artificial nutrition and hydration to patients terminally ill with cancer has been developed and used in Taiwan. However, the questionnaire needs further psychometric testing and adaptation for other cultures. This study aimed to cross-culturally adapt the questionnaire within the Italian cultural context and test its psychometric properties. METHODS The questionnaire was translated into Italian and cross-culturally adapted per the recommendations by Beaton. A panel of 10 experts assessed content validity. A multicenter cross-sectional study was conducted with 411 nurses to test its psychometric properties. Dimensionality and construct validity were assessed through exploratory and confirmatory factor analyses. Reliability was estimated by composite ω and traditional methods, such as the Kuder Richardson formula-20 and Cronbach's α coefficients. RESULTS The overall content validity index was 0.85. A confirmatory factor analysis was conducted for the knowledge section and the four attitudes sections. A preliminary analysis for the behavioral intentions section yielded non acceptable results. The internal consistency of the scales was adequate (range, 0.64-0.93). CONCLUSIONS This study constituted a notable advancement in the psychometric testing of the tool, and provides evidence that the Italian version of the questionnaire has acceptable psychometric characteristics for the sections on knowledge and attitudes.
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Affiliation(s)
- Beatrice Albanesi
- Department of Biomedicine and Prevention University of Rome 'Tor Vergata', Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Gabriella Facchinetti
- Department of Biomedicine and Prevention University of Rome 'Tor Vergata', Rome, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Loredana Piervisani
- Department of Biomedicine and Prevention University of Rome 'Tor Vergata', Rome, Italy
| | - Maura Lusignani
- Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.
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Ten Koppel M, Pasman HRW, van der Steen JT, van Hout HPJ, Kylänen M, Van den Block L, Smets T, Deliens L, Gambassi G, Froggatt K, Szczerbińska K, Onwuteaka-Philipsen BD. Consensus on treatment for residents in long-term care facilities: perspectives from relatives and care staff in the PACE cross-sectional study in 6 European countries. BMC Palliat Care 2019; 18:73. [PMID: 31464624 PMCID: PMC6714096 DOI: 10.1186/s12904-019-0459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/15/2019] [Indexed: 01/23/2023] Open
Abstract
Background In long-term care facilities often many care providers are involved, which could make it difficult to reach consensus in care. This may harm the relation between care providers and can complicate care. This study aimed to describe and compare in six European countries the degree of consensus among everyone involved in care decisions, from the perspective of relatives and care staff. Another aim was to assess which factors are associated with reporting that full consensus was reached, from the perspective of care staff and relatives. Methods In Belgium, England, Finland, Italy, the Netherlands and Poland a random sample of representative long-term care facilities reported all deaths of residents in the previous three months (n = 1707). This study included residents about whom care staff (n = 1284) and relatives (n = 790) indicated in questionnaires the degree of consensus among all involved in the decision or care process. To account for clustering on facility level, Generalized Estimating Equations were conducted to analyse the degree of consensus across countries and factors associated with full consensus. Results Relatives indicated full consensus in more than half of the residents in all countries (NL 57.9% - EN 68%), except in Finland (40.7%). Care staff reported full consensus in 59.5% of residents in Finland to 86.1% of residents in England. Relatives more likely reported full consensus when: the resident was more comfortable or talked about treatment preferences, a care provider explained what palliative care is, family-physician communication was well perceived, their relation to the resident was other than child (compared to spouse/partner) or if they lived in Poland or Belgium (compared to Finland). Care staff more often indicated full consensus when they rated a higher comfort level of the resident, or if they lived in Italy, the Netherland, Poland or England (compared to Finland). Conclusions In most countries the frequency of full consensus among all involved in care decisions was relatively high. Across countries care staff indicated full consensus more often and no consensus less often than relatives. Advance care planning, comfort and good communication between relatives and care professionals could play a role in achieving full consensus. Electronic supplementary material The online version of this article (10.1186/s12904-019-0459-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - H R W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - H P J van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, The Netherlands
| | - M Kylänen
- National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - L Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - T Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - L Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - G Gambassi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - K Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 7a, Krakow, Poland
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
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Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM. Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies. Palliat Med 2019; 33:274-290. [PMID: 30404576 PMCID: PMC6376607 DOI: 10.1177/0269216318809571] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. AIM: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. DESIGN: Systematic review and thematic synthesis of qualitative studies. DATA SOURCES: Electronic databases were searched from inception to July 2018. RESULTS: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). CONCLUSION: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.
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Affiliation(s)
- Marcus Sellars
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,2 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Olivia Chung
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Linda Nolte
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Allison Tong
- 3 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Dimity Pond
- 4 School of Medicine and Public Health (General Practice), The University of Newcastle, Callaghan, NSW, Australia
| | - Deirdre Fetherstonhaugh
- 5 Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, VIC, Australia
| | - Fran McInerney
- 6 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Craig Sinclair
- 7 Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Karen M Detering
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,8 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
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Canihuante J, Pérez P. Is parenteral hydration beneficial in terminally ill cancer patients? Medwave 2018; 18:e7150. [PMID: 29474350 DOI: 10.5867/medwave.2018.01.7149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION It is common for terminally ill patients to have a reduced fluid intake, which often results in a need for more medical support. However, it is not clear if this measure has a real clinical impact. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data from primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews including 51 studies overall, from which three were randomized trials. We concluded the administration of parenteral hydration might make little or no difference in terms of survival and quality of life in terminally ill cancer patients, and that it is not clear whether it has any other benefit because the certainty of the evidence is very low.
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Affiliation(s)
- José Canihuante
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Pedro Pérez
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Centro de Innovación UC Anacleto Angelini, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
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10
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Advance Care Planning in Nursing Home Patients With Dementia: A Qualitative Interview Study Among Family and Professional Caregivers. J Am Med Dir Assoc 2015; 16:979-89. [DOI: 10.1016/j.jamda.2015.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
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van Soest-Poortvliet MC, van der Steen JT, de Vet HCW, Hertogh CMPM, Onwuteaka-Philipsen BD, Deliens LHJ. Factors related to establishing a comfort care goal in nursing home patients with dementia: a cohort study among family and professional caregivers. J Palliat Med 2015; 17:1317-27. [PMID: 25226515 DOI: 10.1089/jpm.2014.0205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans. OBJECTIVE To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal. DESIGN We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses. SETTING Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD). RESULTS Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member. CONCLUSIONS Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
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Affiliation(s)
- Mirjam C van Soest-Poortvliet
- 1 Department of General Practice & Elderly Care Medicine, VU University Medical Center , EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Cogo SB, Lunardi VL. Diretivas antecipadas de vontade aos doentes terminais: revisão integrativa. Rev Bras Enferm 2015; 68:464-74, 524-34. [DOI: 10.1590/0034-7167.2015680321i] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/08/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMOObjetivo:caracterizar a produção científica nacional e internacional sobre as diretivas antecipadas de vontade aplicadas ao doente terminal.Método:a revisão integrativa, incluindo os artigos publicados no Portal Capes, SCIELO, LILACS, MEDLINE, Revista de Bioética e Bioethikos, a partir dos descritores: Diretivas antecipadas, Testamentos quanto à vida, Advance Directives, Living Will e Terminally Ill totalizando 44 artigos submetidos à análise de conteúdo.Resultados:emergiram três categorias: Estudantes e profi ssionais frente às diretivas antecipadas de vontade: percepções, opiniões e condutas; Receptividade dos pacientes às diretivas antecipadas de vontade; A família diante das diretivas antecipadas de vontade.Conclusão:evidenciou-se a relevância do tema como garantidor do respeito à dignidade e à autonomia do doente, bem como para a redução dos conflitos éticos enfrentados pelos familiares e profi ssionais da saúde frente aos cuidados em fi nal de vida.
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Valentini E, Giantin V, Voci A, Iasevoli M, Zurlo A, Pengo V, Maggi S, Pegoraro R, Catarini M, Andrigo M, Storti M, Manzato E. Artificial Nutrition and Hydration in Terminally Ill Patients with Advanced Dementia: Opinions and Correlates among Italian Physicians and Nurses. J Palliat Med 2014; 17:1143-9. [DOI: 10.1089/jpm.2013.0616] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Valter Giantin
- Geriatrics Division, University of Padova, Padova, Italy
| | - Alberto Voci
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Mario Iasevoli
- Geriatrics Division, University of Padova, Padova, Italy
| | - Anna Zurlo
- Geriatrics Division, University of Padova, Padova, Italy
| | | | - Stefania Maggi
- Aging Section, Institute of Neurosciences, Italian Research Council, Padova, Italy
| | | | | | | | | | - Enzo Manzato
- Geriatrics Division, University of Padova, Padova, Italy
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Kuroda Y, Kuroda R. Factors Affecting the Decision to Provide Artificial Nutrition for Elderly Adults with Oral Intake Difficulty. J Am Geriatr Soc 2013; 61:1835-6. [DOI: 10.1111/jgs.12470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Riko Kuroda
- Department of Rehabilitation; Ebisumachi Hospital; Nagasaki Japan
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15
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Clarke G, Harrison K, Holland A, Kuhn I, Barclay S. How are treatment decisions made about artificial nutrition for individuals at risk of lacking capacity? A systematic literature review. PLoS One 2013; 8:e61475. [PMID: 23613857 PMCID: PMC3628879 DOI: 10.1371/journal.pone.0061475] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/10/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Worldwide, the number of individuals lacking the mental capacity to participate in decisions about their own healthcare is increasing. Due to the ageing global population and advancing medical treatments, there are now many more people living longer with neurological disorders, such as dementia, acquired brain injuries, and intellectual disabilities. Many of these individuals have feeding difficulties and may require artificial nutrition. However, little is known about the decision-making process; the evidence base is uncertain and often ethically complex. Using the exemplar of artificial nutrition, the objective of this review is to examine how treatment decisions are made when patients are at risk of lacking capacity. METHODS AND FINDINGS We undertook a systematic review according to PRISMA guidelines to determine who was involved in decisions, and what factors were considered. We searched PubMed, AMED, CINAHL, EMBASE, PsychINFO, and OpenSigle for quantitative and qualitative studies (1990-2011). Citation, reference, hand searches and expert consultation were also undertaken. Data extraction and quality assessment were undertaken independently and in duplicate. We utilised Thomas and Harden's 'Thematic Synthesis' for analysis. Sixty-six studies met inclusion criteria, comprising data from 40 countries and 34,649 patients, carers and clinicians. Six themes emerged: clinical indications were similar across countries but were insufficient alone for determining outcomes; quality of life was the main decision-making factor but its meaning varied; prolonging life was the second most cited factor; patient's wishes were influential but not determinative; families had some influence but were infrequently involved in final recommendations; clinicians often felt conflicted about their roles. CONCLUSIONS When individuals lack mental capacity, decisions must be made on their behalf. Dynamic interactive factors, such as protecting right to life, not unnecessarily prolonging suffering, and individual preferences, need to be addressed and balanced. These findings provide an outline to aid clinical practice and develop decision-making guidelines.
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Affiliation(s)
- Gemma Clarke
- CLAHRC End of Life Care, University of Cambridge, Cambridge, United Kingdom.
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16
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del Río M, Shand B, Bonati P, Palma A, Maldonado A, Taboada P, Nervi F. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology 2011; 21:913-21. [DOI: 10.1002/pon.2099] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 10/13/2011] [Accepted: 10/15/2011] [Indexed: 11/10/2022]
Affiliation(s)
- M. I. del Río
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - B. Shand
- Departamento de Neurología; Pontificia Universidad Católica de Chile; Santiago Chile
| | - P. Bonati
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - A. Palma
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - A. Maldonado
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
| | - P. Taboada
- Centro de Bioética; Pontificia Universidad Católica de Chile; Santiago Chile
| | - F. Nervi
- Programa de Medicina Paliativa y Cuidados Continuos; Departamento de Medicina Interna, Pontificia Universidad Católica de Chile; Santiago Chile
- División de Medicina, Departamento de Gastroenterología; Pontificia Universidad Católica de Chile; Santiago Chile
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[Palliative care decision making among the elderly and family: a theoretical model]. Can J Aging 2011; 30:127-42. [PMID: 21401975 DOI: 10.1017/s0714980810000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The elderly in palliative care are confronted with difficult decisions relating to treatments. The philosophy of palliative care, namely, including the patient and his/her family right away, leads the doctor to consult with the two parties involved when choosing a treatment. As no theoretical model allows us to understand how the decision-making process hinges on the trio (a capable elderly person, a family caregiver, and the doctor) in a context of palliative care, we propose one which was developed from three strategies of document analysis: theoretical synthesis, theoretical analysis, and theoretical derivation. According to our model, the decision-making process depends on individual factors influencing the decision of the participant, expectations and attitudes as to the role, the level of confidence amongst the parties involved, the manner in which they communicate with each other, their mutual understanding of the clinical and ethical issues, and, finally, their ability to cooperate.
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Goodman C, Evans C, Wilcock J, Froggatt K, Drennan V, Sampson E, Blanchard M, Bissett M, Iliffe S. End of life care for community dwelling older people with dementia: an integrated review. Int J Geriatr Psychiatry 2010; 25:329-37. [PMID: 19688739 DOI: 10.1002/gps.2343] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review the evidence for end-of-life care for community dwelling older people with dementia (including those resident in care homes). DESIGN An integrated review synthesised the qualitative and quantitative evidence on end-of-life care for community dwelling older people with dementia. English language studies that focused on prognostic indicators for end-of-life care, assessment, support/relief, respite and educational interventions for community dwelling older people with dementia were included. A user representative group informed decisions on the breadth of literature used. Each study selected was screened independently by two reviewers using a standardised check list. RESULTS Sixty eight papers were included. Only 17% (12) exclusively concerned living and dying with dementia at home. Six studies included direct evidence from people with dementia. The studies grouped into four broad categories: Dementia care towards the end of life, palliative symptom management for people with dementia, predicting the approach of death for people with dementia and decision-making. The majority of studies were descriptive. The few studies that developed dementia specific tools to guide end of life care and outcome measures specific to improve comfort and communication, demonstrated what could be achieved, and how much more needs to be done. CONCLUSIONS Research on end-of-life care for people with dementia has yet to develop interventions that address the particular challenges that dying with dementia poses. There is a need for investigation of interventions and outcome measures for providing end-of-life care in the settings where the majority of this population live and die.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Lopez RP, Amella EJ, Mitchell SL, Strumpf NE. Nurses' perspectives on feeding decisions for nursing home residents with advanced dementia. J Clin Nurs 2010; 19:632-8. [PMID: 20500304 PMCID: PMC2878272 DOI: 10.1111/j.1365-2702.2009.03108.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To develop a broad understanding of nursing beliefs, knowledge and roles in feeding decisions for nursing home residents with advanced dementia. BACKGROUND Concern is growing about the common use of feeding tubes in nursing home residents with advanced dementia. Nurses can play an important role in providing information and guiding family members through difficult feeding decisions. Little is known about nurses' perspectives on feeding decisions. DESIGN Qualitative descriptive. METHODS In-depth semi-structured interviews of 11 licensed nurses who were experienced in caring for nursing home residents with dementia. RESULTS Analysis of the interview transcripts revealed three themes: insufficient empirical information, ambiguous role in feeding decisions and uncertainty about moral agency in decisions about the placement of feeding tubes. CONCLUSIONS Despite views that family members would benefit from guidance in decisions regarding the placement of feeding tubes, nurses were, nevertheless, reluctant to become involved in these difficult decisions. RELEVANCE TO CLINICAL PRACTICE If nurses are to guide family members in decisions about the use of feeding tubes, they need more education about evidence-based practice as well as support in exercising their nursing responsibilities.
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Affiliation(s)
- Ruth Palan Lopez
- MGH Institute of Health Professions School of Nursing, Boston, MA 02129-4557, USA.
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Involvement of hospital nurses in care decisions related to administration of artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study. Int J Nurs Stud 2010; 47:1105-16. [PMID: 20188370 DOI: 10.1016/j.ijnurstu.2010.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/15/2010] [Accepted: 01/31/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nurses that care for patients with advanced dementia are increasingly faced with consequences of disease progression, often requiring them to decide whether to artificially feed these patients. Clarifying how nurses can be better supported in complex care processes involving ethically sensitive decision-making requires that their practice be mapped out. OBJECTIVES The aims of this study were to explore and describe how nurses are involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with dementia. DESIGN We used a qualitative interview design. Data collection and analysis were informed by the grounded theory approach. SETTING Nine hospitals geographically spread throughout the five provinces of Flanders, Belgium. PARTICIPANTS Twenty-one nurses were purposively selected for interview, with the aim of including nurses that reflected diverse personal characteristics and experiences with the subject matter. METHODS Between April 2008 and June 2009, we conducted 21 interviews that were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards-backwards wave, (3) continuous dialogue with the data, and (4) interactive team processes. RESULTS Nurses' involvement was characterized by a desire to provide 'good care', which was the basis for their motivation and aspiration during the care process. Early in the process, nurses developed a holistic picture of their patients, laying the foundation of their 'good care' view. During the actual decision-making, nurses fulfilled the roles of messengers and guiding communicators, as they attempted to realize their 'good care' view. Nurses judged the physicians' decisions in light of their care view. If a decision matched their view, they supported the decision. If not, they resisted it openly or covertly. Some nurses remained passively in the background, while others took action to override the decision. Nurses' involvement ended with the intensive aftercare of the patients and their family. CONCLUSIONS Nurses are closely and continuously involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with advanced dementia. During the care process, nurses play several and specific roles, giving their contribution a unique and variable character.
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Schmidlin E. Artificial hydration: the role of the nurse in addressing patient and family needs. Int J Palliat Nurs 2008; 14:485-9. [DOI: 10.12968/ijpn.2008.14.10.31492] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther Schmidlin
- Communication and Ethics at the End of Life, Institute Universitaire Kurt Boesch, Sion, Switzerland
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Bryon E, Gastmans C, de Casterlé BD. Decision-making about artificial feeding in end-of-life care: literature review. J Adv Nurs 2008; 63:2-14. [DOI: 10.1111/j.1365-2648.2008.04646.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The case of Terri Schiavo resulted in substantial media attention about the use of artificial nutrition and hydration (ANH) especially by percutaneous endoscopic gastrostomy (PEG). In this article, I review ethical and legal principles governing decisions to choose or forgo ANH at the end of life, including issues of autonomy and decision-making capacity, similarities and differences between ANH and other medical treatments, the role of proxies when patients lack decision-making capacity, and the equivalence of withholding and withdrawing treatment. Evidence for palliative or life-sustaining benefits for ANH are reviewed in three disease processes: amyotrophic lateral sclerosis (ALS), cancer, and dementias, including Alzheimer's disease. Although more recent studies suggest a possible palliative role for ANH in ALS and terminal cancer, feeding tubes do not appear to prolong survival or increase comfort in advanced dementia of the Alzheimer's type.
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Affiliation(s)
- Linda Ganzini
- Department of Psychiatry and Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Rurup ML, Onwuteaka-Philipsen BD, Pasman HRW, Ribbe MW, van der Wal G. Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia. PATIENT EDUCATION AND COUNSELING 2006; 61:372-80. [PMID: 15975757 DOI: 10.1016/j.pec.2005.04.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 04/20/2005] [Accepted: 04/23/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties. METHODS Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia. RESULTS In general, physicians, nurses and relatives agree on many aspects of end-of-life decision-making for nursing home patients with dementia. However, on some issues the outcomes of the decision-making may differ. Relatives attach more importance to advance directives than physicians, and have more permissive attitudes towards hastening death. CONCLUSION Although physicians, nurses and relatives are all guided by the best interest of the patient, it seems that differences in religious beliefs, perspective of the patient, and responsibility can lead to different attitudes towards end-of-life decisions. PRACTICE IMPLICATIONS Physicians should discuss end-of-life decisions more openly. Physicians should be aware of the influences on attitudes and incorporate them into communication about end-of-life decisions.
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Affiliation(s)
- Mette L Rurup
- VU University Medical Center, Institute for Research in Extramural Medicine, Department of Public and Occupational Health, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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