1
|
Bryan AF, Reich AJ, Norton AC, Campbell ML, Schwartzstein RM, Cooper Z, White DB, Mitchell SL, Fehnel CR. Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions. CHEST CRITICAL CARE 2024; 2:100051. [PMID: 38957855 PMCID: PMC11218830 DOI: 10.1016/j.chstcc.2024.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV. RESEARCH QUESTION What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU? STUDY DESIGN AND METHODS This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole. RESULTS Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes. INTERPRETATION Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
Collapse
Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Amanda J Reich
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Andrea C Norton
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Margaret L Campbell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Richard M Schwartzstein
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Zara Cooper
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Douglas B White
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Susan L Mitchell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Corey R Fehnel
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| |
Collapse
|
2
|
Loggers SAI, Van Balen R, Willems HC, Gosens T, Polinder S, Ponsen KJ, Van de Ree CLP, Steens J, Verhofstad MHJ, Zuurmond RG, Joosse P, Van Lieshout EMM. The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture: An In-Depth Analysis. Am J Hosp Palliat Care 2024; 41:583-591. [PMID: 37403839 PMCID: PMC11032625 DOI: 10.1177/10499091231180556] [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] [Indexed: 07/06/2023] Open
Abstract
Proximal femoral fractures in frail patients have a poor prognosis. Despite the high mortality, little is known about the quality of dying (QoD) while this is an integral part of palliative care and could influence decision making on nonoperative- (NOM) or operative management (OM). To identify the QoD in frail patients with a proximal femoral fracture. Data from the prospective FRAIL-HIP study, that studied the outcomes of NOM and OM in institutionalized older patients ≥70 years with a limited life expectancy who sustained a proximal femoral fracture, was analyzed. This study included patients who died within the 6-month study period and whose proxies evaluated the QoD. The QoD was evaluated with the Quality of Dying and Death (QODD) questionnaire resulting in an overall score and 4 subcategory scores (Symptom control, Preparation, Connectedness, and Transcendence). In total 52 (64% of NOM) and 21 (53% of OM) of the proxies responded to the QODD. The overall QODD score was 6.8 (P25-P75 5.7-7.7) (intermediate), with 34 (47%) of the proxies rating the QODD 'good to almost perfect'. Significant differences in the QODD scores between groups were not noted (NOM; 7.0 (P25-P75 5.7-7.8) vs OM; 6.6 (P25-P75 6.1-7.2), P = .73). Symptom control was the lowest rated subcategory in both groups. The QoD in frail older nursing home patients with a proximal femoral fracture is good and humane. QODD scores after NOM are at least as good as OM. Improving symptom control would further increase the QoD.
Collapse
Affiliation(s)
- Sverre A. I. Loggers
- Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, the Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanna C. Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kornelis J. Ponsen
- Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | | | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Pieter Joosse
- Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | - Esther M. M. Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Iyer S, Sonawane RN, Shah J, Salins N. Semiotics of ICU Physicians' Views on End-of-life Care and Quality of Dying in a Critical Care Setting: A Qualitative Study. Indian J Crit Care Med 2024; 28:424-435. [PMID: 38738199 PMCID: PMC11080105 DOI: 10.5005/jp-journals-10071-24696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/22/2024] [Indexed: 05/14/2024] Open
Abstract
Background and aim While intensive care unit (ICU) mortality rates in India are higher when compared to countries with more resources, fewer patients with clinically futile conditions are subjected to limitation of life-sustaining treatments or given access to palliative care. Although a few surveys and audits have been conducted exploring this phenomenon, the qualitative perspectives of ICU physicians regarding end-of-life care (EOLC) and the quality of dying are yet to be explored. Methods There are 22 eligible consultant-level ICU physicians working in multidisciplinary ICUs were purposively recruited and interviewed. The study data was analyzed using reflexive thematic analysis (RTA) with a critical realist perspective, and the study findings were interpreted using the lens of the semiotic theory that facilitated the development of themes. Results About four themes were generated. Intensive care unit physicians perceived the quality of dying as respecting patients' and families' choices, fulfilling their needs, providing continued care beyond death, and ensuring family satisfaction. To achieve this, the EOLC process must encompass timely decision-making, communication, treatment guidelines, visitation rights, and trust-building. The contextual challenges were legal concerns, decision-making complexities, cost-related issues, and managing expectations. To improve care, ICU physicians suggested amplifying patient and family voices, building therapeutic relationships, mitigating conflicts, enhancing palliative care services, and training ICU providers in EOLC. Conclusion Effective management of critically ill patients with life-limiting illnesses in ICUs requires a holistic approach that considers the complex interplay between the EOLC process, its desired outcome, the quality of dying, care context, and the process of meaning-making by ICU physicians. How to cite this article Iyer S, Sonawane RN, Shah J, Salins N. Semiotics of ICU Physicians' Views on End-of-life Care and Quality of Dying in a Critical Care Setting: A Qualitative Study. Indian J Crit Care Med 2024;28(5):424-435.
Collapse
Affiliation(s)
- Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Rutula N Sonawane
- Department of Critical Care Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
4
|
Corcoran E, Bird M, Batchelor R, Ahmed N, Nowland R, Pitman A. The association between social connectedness and euthanasia and assisted suicide and related constructs: systematic review. BMC Public Health 2024; 24:1057. [PMID: 38627694 PMCID: PMC11020194 DOI: 10.1186/s12889-024-18528-4] [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: 10/22/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common in terminal illness. Our objective was to summarise available literature to clarify whether these and related measures of social connectedness might contribute to requests for EAS. METHODS We conducted a pre-registered (PROSPERO CRD42019160508) systematic review and narrative synthesis of quantitative literature investigating associations between social connectedness and a) requested/actual EAS, b) attitudes towards EAS, and c) a desire for hastened death (DHD) by searching six databases (PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar) from inception to November 2022, rating eligible peer-reviewed, empirical studies using the QATSO quality assessment tool. RESULTS We identified 37 eligible studies that investigated associations with a) requested/actual EAS (n = 9), b) attitudes to EAS (n = 16), and c) DHD (n = 14), with limited overlap, including 17,359 participants. The majority (62%) were rated at medium/high risk of bias. Focussing our narrative synthesis on the more methodologically sound studies, we found no evidence to support an association between different constructs of social connectedness and requested or actual EAS, and very little evidence to support an association with attitudes to EAS or an association with DHD. CONCLUSIONS Our findings for all age groups are consistent with a those of a previous systematic review focussed on older adults and suggest that poor social connectedness is not a clear risk factor for EAS or for measures more distally related to EAS. However, we acknowledge low study quality in some studies in relation to sampling, unvalidated exposure/outcome measures, cross-sectional design, unadjusted analyses, and multiple testing. Clinical assessment should focus on modifying established risk factors for suicide and EAS, such as hopelessness and depression, as well as improving any distressing aspects of social disconnectedness to improve quality of life. FUNDING UKRI, NIHR.
Collapse
Affiliation(s)
- Emma Corcoran
- UCL Division of Psychiatry, University College London, London, UK
- Oxford Centre for Psychological Health, Oxford, UK
- North East London NHS Foundation Trust, London, UK
| | - Molly Bird
- UCL Division of Psychiatry, University College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Rachel Batchelor
- Sussex Partnership NHS Foundation Trust, West Sussex, UK
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxfordshire, UK
| | - Nafiso Ahmed
- UCL Division of Psychiatry, University College London, London, UK
| | - Rebecca Nowland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| |
Collapse
|
5
|
Gahramani S, Mahmoudi M, Nouri, Valiee S. Factors associated with the quality of dying and death and missed nursing care. Int J Palliat Nurs 2024; 30:190-198. [PMID: 38630644 DOI: 10.12968/ijpn.2024.30.4.190] [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: 04/19/2024]
Abstract
BACKGROUND Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. AIMS To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. METHODS This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. FINDINGS The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. CONCLUSION Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members.
Collapse
Affiliation(s)
- Shahin Gahramani
- Students Research Committee, Kurdistan University of Medical Sciences, Iran
| | - Mokhtar Mahmoudi
- Assistant Professor, Clinical Care Research Center, Kurdistan University of Medical Sciences, Iran
| | - Nouri
- Associate Professor, Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Iran
| | - Sina Valiee
- Professor, Clinical Care Research Center; Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Iran
| |
Collapse
|
6
|
Malakian A, Rodin G, Widger K, Ali R, Mahendiran AE, Mayo SJ. Experience of Care Among Adults With Acute Leukemia Near the End of Life: A Scoping Review. J Palliat Med 2024; 27:255-264. [PMID: 37738328 DOI: 10.1089/jpm.2023.0130] [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: 09/24/2023] Open
Abstract
Background: Acute leukemia is a cancer of the blood and bone marrow with a high symptom burden and a high mortality rate in adults. The quality of end-of-life care among this patient population is deemed to be low based on health care administrative data, though the patient experience is not included in this evaluation. Objective: This scoping review aims at exploring and mapping the current research literature on the experience of care among adults with incurable acute leukemia near the end of life. Design: The JBI framework guided our scoping review, and the protocol was prospectively registered in the Open Science Forum. Results: A total of 5661 unique articles were screened for title and abstract, and 44 were selected for full text. After a manual search, five studies published in seven articles were selected for data extraction, including three qualitative and two quantitative studies. Two studies used family caregivers as patient proxies, two studies engaged patients directly, whereas one study obtained data from patients and family caregivers. Patient care in acute settings was reported in all studies, with most patients dying in acute care settings. Patients and family caregivers often valued an open and honest approach, with sufficient time for dialogue with their providers. Discussions about prognosis, palliative care, and hospice care were often late or incomplete. The medicalization of end-of-life care, including intensive care unit admissions and invasive medical procedures, were viewed as the norm by some providers, though perceived as distressing for both patients and their loved ones. Conclusions: Adults with acute leukemia face significant challenges in accessing high-quality end-of-life care brought about by the complex nature of their disease and its treatment. A systematic exploration of the end-of-life experience among these patients through direct patient engagement or by way of patient reporting proxies is needed.
Collapse
Affiliation(s)
- Argin Malakian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Gary Rodin
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network (UHN), Toronto, Ontario, Canada
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Lifespan Program, ICES, Toronto, Ontario, Canada
| | - Ridwaanah Ali
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela E Mahendiran
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| |
Collapse
|
7
|
Wen FH, Chiang MC, Huang CC, Hu TH, Chou WC, Chuang LP, Tang ST. Quality of dying and death in intensive care units: family satisfaction. BMJ Support Palliat Care 2024; 13:e1217-e1227. [PMID: 36593102 DOI: 10.1136/spcare-2022-003950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This cohort study identified patterns/classes of surrogates' assessment of their relative's quality of dying and death (QODD) and to evaluate their associations with family satisfaction with intensive care unit (ICU) care. METHODS We identified QODD classes through latent class analysis of the frequency component of the QODD questionnaire and examined their differences in summary questions on the QODD and scores of the Family Satisfaction in the ICU questionnaire among 309 bereaved surrogates of ICU decedents. RESULTS Four distinct classes (prevalence) were identified: high (41.3%), moderate (20.1%), poor-to-uncertain (21.7%) and worst (16.9%) QODD classes. Characteristics differentiate these QODD classes including physical symptom control, emotional preparedness for death, and amount of life-sustaining treatments (LSTs) received. Patients in the high QODD class had optimal physical symptom control, moderate-to-sufficient emotional preparedness for death and few LSTs received. Patients in the moderate QODD class had adequate physical symptom control, moderate-to-sufficient emotional preparedness for death and the least LSTs received. Patients in the poor-to-uncertain QODD class had inadequate physical symptom control, insufficient-uncertain emotional preparedness for death and some LSTs received. Patients in the worst QODD class had poorest physical symptom control, insufficient-to-moderate emotional preparedness for death and substantial LSTs received. Bereaved surrogates in the worst QODD class scored significantly lower in evaluations of the patient's overall QODD, and satisfaction with ICU care and decision-making process than those in the other classes. CONCLUSIONS The identified distinct QODD classes offer potential actionable direction for improving quality of end-of-life ICU care.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University - Downtown Campus, Taipei, Taiwan
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chung-Chi Huang
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Hui Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Siew Tzuh Tang
- School of Nursing, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| |
Collapse
|
8
|
Schmitz PP, Somford MP, Jameson SS, Schreurs BW, van Susante JLC. Controversies around hip fracture treatment: clinical evidence versus trends from national registries. Hip Int 2024; 34:144-151. [PMID: 37313801 DOI: 10.1177/11207000231177642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice. METHODS A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand). RESULTS For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries. CONCLUSIONS Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved.
Collapse
Affiliation(s)
- Peter P Schmitz
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Simon S Jameson
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
9
|
Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Natarajan G, Steinberg A, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data. Neurocrit Care 2023; 39:600-610. [PMID: 37704937 DOI: 10.1007/s12028-023-01796-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND To facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDEs) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the National Institutes of Health/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core", "basic", "exploratory", or "supplemental", as well as their use for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant preexisting National Institutes of Health CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
Collapse
Affiliation(s)
- Matthew N Jaffa
- Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital, Hartford, CT, USA
| | - Hannah L Kirsch
- Department of Neurology, Stanford University School of Medicine, 453 Quarry Road, MC 5235, Palo Alto, CA, USA.
| | - Claire J Creutzfeldt
- Department of Neurology, Division of Stroke and Palliative Care, University of Washington, Seattle, WA, USA
| | - Mary Guanci
- Department of Neuroscience Nursing, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Girija Natarajan
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Alexis Steinberg
- Department of Neurology, Critical Care Medicine, and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darin B Zahuranec
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesiology/Critical Care and Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| |
Collapse
|
10
|
Goombs M, Mah K, Namisango E, Luyirika E, Mwangi-Powell F, Gikaara N, Chalklin L, Rydall A, Zimmermann C, Hales S, Wolofsky K, Tilly A, Powell RA, Rodin G. The quality of death and dying of patients with advanced cancer in hospice care in Uganda and Kenya. Palliat Support Care 2023:1-10. [PMID: 37946360 DOI: 10.1017/s1478951523001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Minimal information is available about the quality of dying and death in Uganda and Kenya, which are African leaders in palliative care. We investigated the quality of dying and death in patients with advanced cancer who had received hospice care in Uganda or Kenya. METHODS Observational study with bereaved caregivers of decedents (Uganda: n = 202; Kenya: n = 127) with advanced cancer who had received care from participating hospices in Uganda or Kenya. Participants completed the Quality of Dying and Death questionnaire and a measure of family satisfaction with cancer care (FAMCARE). RESULTS Quality of Dying and Death Preparation and Connectedness subscales were most frequently rated as good to almost perfect for patients in both countries (45.5% to 81.9%), while Symptom Control and Transcendence subscales were most frequently rated as intermediate (42.6% to 60.4%). However, 35.4% to 67.7% of caregivers rated overall quality of dying and overall quality of death as terrible to poor. Ugandan caregivers reported lower Preparation, Connectedness, and Transcendence (p < .001). Controlling for covariates, overall quality of dying was associated with better Symptom Control in both countries (p < .001) and Transcendence in Uganda (p = .010); overall quality of death, with greater Transcendence in Uganda (p = .004); and family satisfaction with care, with better Preparation in Uganda (p = .004). SIGNIFICANCE OF RESULTS Findings indicate strengths in spiritual and social domains of the quality of dying and death in patients who received hospice care in Uganda and Kenya, but better symptom control is needed to improve this outcome in these countries.
Collapse
Affiliation(s)
- Mary Goombs
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | | | | | - Lesley Chalklin
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, ON, Canada
| | - Anne Rydall
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kayla Wolofsky
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, ON, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Alyssa Tilly
- Palliative Care Program, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Richard A Powell
- MWAPO Health Development Group, Nairobi, Kenya
- Ethnicity and Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Gary Rodin
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Mah K, Chow B, Swami N, Pope A, Rydall A, Earle C, Krzyzanowska M, Le L, Hales S, Rodin G, Hannon B, Zimmermann C. Early palliative care and quality of dying and death in patients with advanced cancer. BMJ Support Palliat Care 2023; 13:e74-e77. [PMID: 33619220 DOI: 10.1136/bmjspcare-2021-002893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Early palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients' QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care. METHOD Bereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU). We examined the effects of EPC, inpatient or home palliative care, and their interactions on the QODD total score and on QOL-EOL (last 7 days of life). RESULTS A total of 157 caregivers participated. Receipt of EPC showed no association with QODD total score. However, when additional palliative care was included in the model, intervention patients demonstrated better QOL-EOL than controls (p=0.02). Further, the intervention by PCU interaction was significant (p=0.02): those receiving both EPC and palliative care in a PCU had better QOL-EOL than those receiving only palliative care in a PCU (mean difference=27.10, p=0.002) or only EPC (mean difference=20.59, p=0.02). CONCLUSION Although there was no association with QODD, EPC was associated with improved QOL-EOL, particularly for those who also received inpatient care in a PCU. This suggests a long-term benefit from early interdisciplinary palliative care on care throughout the illness. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (#NCT01248624).
Collapse
Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brittany Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Craig Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Steinberg A, Natarajan G, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-care and Family/Surrogate Decision-Maker Data. RESEARCH SQUARE 2023:rs.3.rs-3084539. [PMID: 37461521 PMCID: PMC10350109 DOI: 10.21203/rs.3.rs-3084539/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In order to facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDE) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the NIH/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core," "basic," "exploratory," or "supplemental," as well as their utility for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant pre-existing NIH CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
Collapse
Affiliation(s)
| | | | | | | | - David Y Hwang
- The University of North Carolina at Chapel Hill School of Medicine
| | | | | | | | | | | | | |
Collapse
|
13
|
Rezapour M, Ferraro FR. The Associations Between Death Anxiety, Supernatural Beliefs, Caring for Loved Ones and Attachments. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231169541. [PMID: 37032309 DOI: 10.1177/00302228231169541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Despite extensive efforts in a better understanding of associations between death anxiety and various factors, efforts studying the complex associations across those variables are still limited. This study was conducted to better understand the possible complexity between death anxiety and myriad of factors, by first extracting the most important features, and then assessing the complexity of variables by checking all pairwise interaction terms. We found most of associated factors of death anxiety are related to the concept of attachment or caring for loved ones. Ill-effect attachment with positive associations with death anxiety included factors such as attachment to the physical side of oneself, being alone before death, and the possibility of death being the end of us. On the other hand, supernatural conceptions of worldviews such as believing in God, believing that the soul is separate from body, and being religious buffer against the death anxiety.
Collapse
Affiliation(s)
| | - F Richard Ferraro
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| |
Collapse
|
14
|
Benichel CR, Meneguin S, Pollo CF, Oliveira MG, de Oliveira C. Psychometric Properties of the Brazilian Version of the Quality of Dying and Death for Adult Family Members of ICU Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5034. [PMID: 36981943 PMCID: PMC10049585 DOI: 10.3390/ijerph20065034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Death is a complex, subjective phenomenon that requires an understanding of experiences to be qualified to provide care during the end-of-life process. This study aimed to analyze the psychometric properties of the Portuguese version (Brazil) of the Quality of Dying and Death (QODD) scale on family members of patients who died in adult intensive care units. A methodological study was conducted with 326 family members of patients that died in three ICUs of public hospitals in the state of São Paulo, Brazil. For this study, the QODD 3.2a (25 items and six domains) was administered during the period from December 2020 to March 2022. The analysis was performed using the classic theory of the tests and the goodness of fit of the model was tested using confirmatory factor analysis. We have used Spearman's correlation coefficients between the scores of the overall scale and domains. Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used for the evaluation of internal consistency and temporal stability, respectively. The Horn's parallel analysis indicated two factors that were not confirmed in the exploratory factor analysis. A single factor retained 18 of the initial 25 items and the analysis of the goodness of fit to the unidimensional model resulted in the following: CFI = 0.7545, TLI = 0.690, chi-squared = 767.33, df = 135, RMSEA = 0.121 with 90%CI, and p = 5.04409. The inter-item correlations indicated a predominance of weak correlations among the items of the instrument. The items with the largest number of moderate correlations were questions 13b, 9b, and 10b and a strong correlation was found between questions 15b and 16b. Cronbach's alpha coefficient was 0.8 and the ICC was 0.9. The Quality of Dying and Death-Version 3.2a (intensive therapy) in Brazilian Portuguese has a unidimensional structure and acceptable reliability. However, it did not obtain a good fit to the proposed factorial model.
Collapse
Affiliation(s)
- Cariston Rodrigo Benichel
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo 18618687, Brazil
| | - Silmara Meneguin
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo 18618687, Brazil
| | - Camila Fernandes Pollo
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo 18618687, Brazil
| | - Mariele Gobo Oliveira
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo 18618687, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London WC1E 6BT, UK;
| |
Collapse
|
15
|
A systematic review of instruments measuring the quality of dying and death in Asian countries. Qual Life Res 2022:10.1007/s11136-022-03307-8. [DOI: 10.1007/s11136-022-03307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
|
16
|
Borrat-Besson C, Vilpert S, Jox RJ, Borasio GD, Maurer J. Dimensions of end-of-life preferences in the Swiss general population aged 55+. Age Ageing 2022; 51:afac162. [PMID: 36001482 PMCID: PMC9400912 DOI: 10.1093/ageing/afac162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND understanding end-of-life preferences in the general population and how they are structured in people's minds is essential to inform how to better shape healthcare services in accordance with population expectations for their end of life and optimise communication on end-of-life care issues. OBJECTIVE explore key dimensions underlying end-of-life preferences in a nationally representative sample of adults aged 55 and over in Switzerland. METHODS respondents (n = 2,514) to the Swiss version of the Survey of Health, Ageing and Retirement in Europe assessed the importance of 23 end-of-life items on a 4-point Likert scale. The factorial structure of the underlying end-of-life preferences was examined using exploratory structural equation modelling. RESULTS four dimensions underlying end-of-life preferences were identified: a medical dimension including aspects related to pain management and the maintenance of physical and cognitive abilities; a psychosocial dimension encompassing aspects related to social and spiritual support; a control dimension addressing the need to achieve some control and to put things in order before death; and a burden dimension reflecting wishes not to be a burden to others and to feel useful to others. CONCLUSION highlighting the multi-dimensionality of end-of-life preferences, our results reaffirm the importance of a holistic and comprehensive approach to the end of life. Our results also provide a general framework that may guide the development of information and awareness campaigns on end-of-life care issues in the general population, informational materials and guidelines to support healthy individuals in end-of-life thinking and planning, and advance directive templates appropriate for healthy individuals.
Collapse
Affiliation(s)
- Carmen Borrat-Besson
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Sarah Vilpert
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jürgen Maurer
- Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
17
|
An E, Tilly A, Mah K, Lewin W, Chandrakumar M, Baguio A, Jaffer N, Chikasema M, Thambo L, Ntizimira C, Namisango E, Hales S, Zimmermann C, Wolofsky K, Goombs M, Rodin G. Protocol for the development and multisite validation of the Quality of Dying and Death-Revised Global Version scale. BMJ Open 2022; 12:e064508. [PMID: 35879006 PMCID: PMC9328109 DOI: 10.1136/bmjopen-2022-064508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Evaluating the quality of dying and death is essential to ensure high-quality end-of-life care. The Quality of Dying and Death (QODD) scale is the best-validated measure of the construct, but many items are not relevant to participants, particularly in low-resource settings. The aim of this multisite cross-sectional study is to develop and validate the QODD-Revised Global Version (QODD-RGV), to enhance ease of completion and relevance in higher-resource and lower-resource settings. METHODS AND ANALYSIS This study will be a two-arm, multisite evaluation of the cultural relevance, reliability and validity of the QODD-RGV across four participating North American hospices and a palliative care site in Malawi, Africa. Bereaved caregivers and healthcare providers of patients who died at a participating North American hospice and bereaved caregivers of patients who died of cancer at the Malawian palliative care site will complete the QODD-RGV and validation measures. Cognitive interviews with subsets of North American and Malawian caregivers will assess the perceived relevance of the scale items. Psychometric evaluations will include internal consistency and convergent and concurrent validity. ETHICS AND DISSEMINATION The North American arm received approval from the University Health Network Research Ethics Board (21-5143) and the University of North Carolina Institutional Review Board (21-1172). Ethics approval for the Malawi arm is being obtained from the University of North Carolina Institutional Review Board and the Malawian National Health Science Research Committee. Study findings will be disseminated through publication in peer-reviewed journals and conference presentations.
Collapse
Affiliation(s)
- Ekaterina An
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Alyssa Tilly
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Palliative Care Program, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Warren Lewin
- Kensington Hospice, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
| | | | - Arnell Baguio
- Palliative Care Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Margaret Bahen Hospice, Newmarket, Ontario, Canada
| | - Nazira Jaffer
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Yee Hong Peter K. Kwok Hospice, Scarborough, Ontario, Canada
- Hospice Palliative Care Ontario, Toronto, Ontario, Canada
| | | | | | | | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
- Cicely Saunders Institute of Palliative Care and Rehabilitation, London, UK
| | - Sarah Hales
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kayla Wolofsky
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Goombs
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Cox CE, Ashana DC, Khandelwal N, Kamal AH, Engelberg RA. Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators. J Pain Symptom Manage 2022; 63:e579-e586. [PMID: 35595371 PMCID: PMC9173670 DOI: 10.1016/j.jpainsymman.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
Abstract
Palliative care research is deeply challenging for many reasons, not the least of which is the conceptual and operational difficulty of measuring outcomes within a seriously ill population such as critically ill patients and their family members. This manuscript describes how Randy Curtis and his network of collaborators successfully confronted some of the most vexing outcomes measurement problems in the field, and by so doing, have enhanced clinical care and research alike. Beginning with a discussion of the clinical challenges of measurement in palliative care, we then discuss a selection of the novel measures developed by Randy and his collaborators and conclude with a look toward the future evolution of these concepts. Randy and his foundational work, including both successes as well as the occasional near miss, have enriched and advanced the field as well as (immeasurably) impacted the work of so many others-including this manuscript's authors.
Collapse
Affiliation(s)
- Christopher E Cox
- Duke University School of Medicine (C.E.C., D.C.A.), Division of Pulmonary and Critical Care Medicine, Durham, North Carolina, USA; Program to Support People and Enhance Recovery (ProSPER) (C.E.C., D.C.A.), Duke University, Duke University School of Medicine, Duke Cancer Institute, Durham North Carolina, USA.
| | - Deepshikha Charan Ashana
- Duke University School of Medicine (C.E.C., D.C.A.), Division of Pulmonary and Critical Care Medicine, Durham, North Carolina, USA; Program to Support People and Enhance Recovery (ProSPER) (C.E.C., D.C.A.), Duke University, Duke University School of Medicine, Duke Cancer Institute, Durham North Carolina, USA
| | - Nita Khandelwal
- Department of Anesthesiology and Pain Medicine (N.K.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (N.K., R.A.E.), University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Arif H Kamal
- Duke University School of Medicine (A.H.K.), Duke Cancer Institute, Durham, North Carolina, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence (N.K., R.A.E.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; University of Washington, Department of Medicine (R.A.E.), Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington, USA
| |
Collapse
|
19
|
Chapman AC, Lin JA, Cobert J, Marks A, Lin J, O'Riordan DL, Pantilat SZ. Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network. J Pain Symptom Manage 2022; 63:e611-e619. [PMID: 35595374 PMCID: PMC9303815 DOI: 10.1016/j.jpainsymman.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Palliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU. OBJECTIVES Compare characteristics of specialty PC consultations in the ICU to those on medical-surgical wards. METHODS Retrospective analysis of national Palliative Care Quality Network data for hospitalized patients receiving specialty PC consultation January 1, 2013 to December 31, 2019 in ICU or medical-surgical setting. 98 inpatient PC teams in 16 states contributed data. Measures and outcomes included patient characteristics, consultation features, process metrics and patient outcomes. Mixed effects multivariable logistic regression was used to compare ICU and medical-surgical units. RESULTS Of 102,597 patients 63,082 were in medical-surgical units and 39,515 ICU. ICU patients were younger and more likely to have non-cancer diagnoses (all P < 0.001). While fewer ICU patients were able to report symptoms, most patients in both groups reported improved symptoms. ICU patients were more likely to have consultation requests for GOC, comfort care, and withdrawal of interventions and less likely for pain and/or symptoms (OR-all P < 0.001). ICU patients were less often discharged alive. CONCLUSION ICU patients receiving PC consultation are more likely to have non-cancer diagnoses and less likely able to communicate. Although symptom management and GOC are standard parts of ICU care, specialty PC in the ICU is often engaged for these issues and results in improved symptoms, suggesting routine interventions and consultation targeting these needs could improve care.
Collapse
Affiliation(s)
- Allyson Cook Chapman
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California; Critical Care Medicine, Department of Anesthesia (A.C.C., J.C.), University of California San Francisco, San Francisco, California.
| | - Joseph A Lin
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California
| | - Julien Cobert
- Anesthesia Service (J.C.), San Francisco VA Health Care System, San Francisco, California; Critical Care Medicine, Department of Anesthesia (A.C.C., J.C.), University of California San Francisco, San Francisco, California
| | - Angela Marks
- Department of Medicine (A.M.), University of California San Francisco, San Francisco, California
| | - Jessica Lin
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
| |
Collapse
|
20
|
Hua M, Wunsch H, Aslakson RA. Transformational Leaders Transcend Specialities. J Pain Symptom Manage 2022; 63:e647-e648. [PMID: 35595380 DOI: 10.1016/j.jpainsymman.2022.02.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Affiliation(s)
- May Hua
- Department of Anesthesiology (M.H., H.W.), Columbia University, New York, USA; Department of Epidemiology (M.H.), Mailman School of Public Health, Columbia University, New York, USA
| | - Hannah Wunsch
- Department of Anesthesiology (M.H., H.W.), Columbia University, New York, USA; Department of Critical Care Medicine (H.W.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine (H.W.), University of Toronto, Toronto, Ontario, Canada
| | - Rebecca A Aslakson
- Department of Anesthesiology, Perioperative & Pain Medicine (R.A.A.), Stanford University, Stanford, California, USA; Division of Primary Care and Population Health (R.A.A.), Department of Medicine, Palliative Care Section, Stanford University, Stanford, California, USA.
| |
Collapse
|
21
|
McGinley JM, Marsack-Topolewski CN. A Comparative Case Study of Hospice and Hospital End-of-Life Care for Aging Adults With Developmental Disabilities. Glob Qual Nurs Res 2022; 9:23333936221087626. [PMID: 35572367 PMCID: PMC9102126 DOI: 10.1177/23333936221087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life’s end.
Collapse
|
22
|
Loggers SAI, Willems HC, Van Balen R, Gosens T, Polinder S, Ponsen KJ, Van de Ree CLP, Steens J, Verhofstad MHJ, Zuurmond RG, Van Lieshout EMM, Joosse P. Evaluation of Quality of Life After Nonoperative or Operative Management of Proximal Femoral Fractures in Frail Institutionalized Patients: The FRAIL-HIP Study. JAMA Surg 2022; 157:424-434. [PMID: 35234817 PMCID: PMC8892372 DOI: 10.1001/jamasurg.2022.0089] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Decision-making on management of proximal femoral fractures in frail patients with limited life expectancy is challenging, but surgical overtreatment needs to be prevented. Current literature provides limited insight into the true outcomes of nonoperative management and operative management in this patient population. Objective To investigate the outcomes of nonoperative management vs operative management of proximal femoral fractures in institutionalized frail older patients with limited life expectancy. Design, Setting, and Participants This multicenter cohort study was conducted between September 1, 2018, and April 25, 2020, with a 6-month follow-up period at 25 hospitals across the Netherlands. Eligible patients were aged 70 years or older, frail, and institutionalized and sustained a femoral neck or pertrochanteric fracture. The term frail implied at least 1 of the following characteristics was present: malnutrition (body mass index [calculated as weight in kilograms divided by height in meters squared] <18.5) or cachexia, severe comorbidities (American Society of Anesthesiologists physical status class of IV or V), or severe mobility issues (Functional Ambulation Category ≤2). Exposures Shared decision-making (SDM) followed by nonoperative or operative fracture management. Main Outcomes and Measures The primary outcome was the EuroQol 5 Dimension 5 Level (EQ-5D) utility score by proxies and caregivers. Secondary outcome measures were QUALIDEM (a dementia-specific quality-of-life instrument for persons with dementia in residential settings) scores, pain level (assessed by the Pain Assessment Checklist for Seniors With Limited Ability to Communicate), adverse events (Clavien-Dindo classification), mortality, treatment satisfaction (numeric rating scale), and quality of dying (Quality of Dying and Death Questionnaire). Results Of the 172 enrolled patients with proximal femoral fractures (median [25th and 75th percentile] age, 88 [85-92] years; 135 women [78%]), 88 opted for nonoperative management and 84 opted for operative management. The EQ-5D utility scores by proxies and caregivers in the nonoperative management group remained within the set 0.15 noninferiority limit of the operative management group (week 1: 0.17 [95% CI, 0.13-0.29] vs 0.26 [95% CI, 0.11-0.23]; week 2: 0.19 [95% CI, 0.10-0.27] vs 0.28 [95% CI, 0.22-0.35]; and week 4: 0.24 [95% CI, 0.15-0.33] vs 0.34 [95% CI, 0.28-0.41]). Adverse events were less frequent in the nonoperative management group vs the operative management group (67 vs 167). The 30-day mortality rate was 83% (n = 73) in the nonoperative management group and 25% (n = 21) in the operative management group, with 26 proxies and caregivers (51%) in the nonoperative management group rating the quality of dying as good-almost perfect. Treatment satisfaction was high in both groups, with a median numeric rating scale score of 8. Conclusions and Relevance Results of this study indicated that nonoperative management of proximal femoral fractures (selected through an SDM process) was a viable option for frail institutionalized patients with limited life expectancy, suggesting that surgery should not be a foregone conclusion for this patient population.
Collapse
Affiliation(s)
- Sverre A. I. Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanna C. Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center location AMC, Amsterdam, the Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kornelis J. Ponsen
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | | | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Esther M. M. Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | | |
Collapse
|
23
|
Nagamatsu Y, Sakyo Y, Barroga E, Koni R, Natori Y, Miyashita M. Bereaved Family Members’ Perspectives of Good Death and Quality of End-of-Life Care for Malignant Pleural Mesothelioma Patients: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11092541. [PMID: 35566667 PMCID: PMC9099626 DOI: 10.3390/jcm11092541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: This study investigated whether malignant pleural mesothelioma (MPM) patients achieved good deaths and good quality of end-of-life care compared with other cancer patients from the perspective of bereaved family members in Japan. Methods: This cross-sectional study was part of a larger study on the achievement of good deaths of MPM patients and the bereavement of their family members. Bereaved family members of MPM patients in Japan (n = 72) were surveyed. The Good Death Inventory (GDI) was used to assess the achievement of good death. The short version of the Care Evaluation Scale (CES) version 2 was used to assess the quality of end-of-life care. The GDI and CES scores of MPM patients were compared with those of a Japanese cancer population from a previous study. Results: MPM patients failed to achieve good deaths. Only 12.5% of the MPM patients were free from physical pain. The GDI scores of most of the MPM patients were significantly lower than those of the Japanese cancer population. The CES scores indicated a significantly poorer quality of end-of-life care for the MPM patients than the Japanese cancer population. The total GDI and CES scores were correlated (r = 0.55). Conclusions: The quality of end-of-life care for MPM patients remains poor. Moreover, MPM patients do not achieve good deaths from the perspective of their bereaved family members.
Collapse
Affiliation(s)
- Yasuko Nagamatsu
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
- Correspondence: ; Tel./Fax: +81-3-5550-2262
| | - Yumi Sakyo
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
| | - Edward Barroga
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
| | - Riwa Koni
- St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan;
| | - Yuji Natori
- Hirano Kameido Himawari Clinic, 7-10-1 Kameido, Koto-ku, Tokyo 136-0071, Japan;
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai 980-8575, Japan;
| |
Collapse
|
24
|
Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
Collapse
Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
25
|
Translation and Cultural Adaptation into Portuguese of the Quality of Dying and Death Scale for Family Members of Patients in Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063614. [PMID: 35329301 PMCID: PMC8950919 DOI: 10.3390/ijerph19063614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
The translation and cultural adaptation of the Quality of Dying and Death in Brazil may provide a reliable and reproducible scale for collecting and analyzing data on the process of dying and death, given the absence of Brazilian studies that have produced or used scales in this topic. The purpose of this study was to perform the translation and cultural adaptation of the Quality of Dying and Death (QODD 3.2a) scale for intensive care patients' relatives into Portuguese (Brazil). This methodological study was carried out in a public university of the São Paulo State University (UNESP) medical school, São Paulo, Brazil, in three stages: translation and back-translation by two native-speaking independent professionals, analysis by a committee of specialists, and a pre-test phase. The final version was created by seven experts after making semantic, idiomatic, and cultural changes to 16 items. The results indicated a satisfactory content validation index (CVI ≥ 0.80). This version was applied on 32 relatives of patients who were hospitalized in a public hospital in the interior of São Paulo. No item was excluded from the instrument. The content and face validity were achieved to a satisfactory standard, in addition to reaching the minimum parameters recommended in the literature. The Portuguese version of QODD 3.2a for relatives of deceased patients in intensive care is appropriate and culturally adapted for use in Brazil.
Collapse
|
26
|
Rantanen P, Chochinov HM, Emanuel LL, Handzo G, Wilkie DJ, Yao Y, Fitchett G. Existential Quality of Life and Associated Factors in Cancer Patients Receiving Palliative Care. J Pain Symptom Manage 2022; 63:61-70. [PMID: 34332045 PMCID: PMC8766863 DOI: 10.1016/j.jpainsymman.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this. OBJECTIVES This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors. METHODS We used data from a multi-site study of 331 older cancer patients receiving palliative care. We examined levels of Preparation and Completion and their association with demographic, religious, and medical factors, and with the Patient Dignity Inventory. RESULTS Preparation and Completion scores were moderately high. In adjusted models, being 10 years older was associated with an increase of 0.77 in Preparation (P = 0.002). Non-white patients had higher Preparation (1.03, P = 0.01) and Completion (1.56, P = 0.02). Single patients reported Completion score 1.75 point lower than those married (P = 0.01). One-point increase in intrinsic religiousness was associated with a 0.86-point increase in Completion (P = 0.03). One-point increase in terminal illness awareness was associated with 0.75-point decrease in Preparation (P = 0.001). A 10-point increase in symptom burden was associated with a decrease of 0.55 in Preparation (P < 0.001) and a decrease of 1.0 in Completion (P < 0.001). The total Patient Dignity Inventory score and all of its subscales were negatively correlated with Preparation (r from -.26 to -.52, all P < 0.001) and Completion (r from -.18 to -.31, all P < 0.001). CONCLUSION While most patients reported moderate to high levels of existential QoL, a subgroup reported low existential QoL. Terminal illness awareness and symptom burden may be associated with lower existential QoL.
Collapse
Affiliation(s)
- Petra Rantanen
- University of Rochester School of Medicine and Dentistry (P.R.) Rochester, New York, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology (H.M.C.), Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada, USA
| | - Linda L Emanuel
- Buehler Center on Aging (L.L.E.), Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - George Handzo
- Health Services Research & Quality (G.H.), HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York, USA
| | - Diana J Wilkie
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA.
| |
Collapse
|
27
|
Paiva BSR, Valentino TCDO, Mingardi M, de Oliveira MA, Franco JO, Salerno MC, Palocci H, de Melo TC, Paiva CE. Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study. SAO PAULO MED J 2022; 141:e202285. [PMID: 36417658 PMCID: PMC10065093 DOI: 10.1590/1516-3180.2022.0085.r2.09082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Quality of Dying and Death Questionnaire (QoDD) may prove to be an important evaluation tool in the Brazilian context, and, therefore, can contribute to a more precise evaluation of the dying and death process, improving and guiding the end-of-life patient care. OBJECTIVE To translate and cross-culturally adapt the QoDD into Brazilian Portuguese and measure its validity (convergent and known-groups) and internal consistency. DESIGN AND SETTING A cross-sectional, methodological study was conducted at the Hospital de Câncer de Barretos, Brazil. METHODS A total of 78 family caregivers participated in this study. Semantic, cultural, and conceptual equivalences were evaluated using the content validity index. The construct validity was assessed through convergent validation and known groups analysis [presence of family members at the place of death; feel at peace with dying; and place of death (hospital versus home; hospital versus Palliative Care)]. Internal consistency was evaluated using Cronbach's alpha. RESULTS The questionnaire was translated into Brazilian Portuguese and presented evidence of a clear understanding of its content. Cronbach's alpha values were ≥ 0.70, except for the domains of treatment preference (α = 0.686) and general concerns (α = 0.599). The convergent validity confirmed a part of the previously hypothesized correlations between the Palliative Care Outcome Scale-Brazil (POS-Br) total scores and the QoDD domain scores. The QoDD-Br domains could distinguish the patients who died in palliative care and general wards. CONCLUSION The QoDD-Br is a culturally adapted valid instrument, and may be used to assess the quality of death of cancer patients.
Collapse
Affiliation(s)
- Bianca Sakamoto Ribeiro Paiva
- PhD. Researcher and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Talita Caroline de Oliveira Valentino
- MSc. Nurse and Doctoral Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Mirella Mingardi
- RN. Nurse and Master's Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Marco Antonio de Oliveira
- MSc. Biostatistics, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Julia Onishi Franco
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Michelle Couto Salerno
- RN. Research Nurse, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Helena Palocci
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Tais Cruz de Melo
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Carlos Eduardo Paiva
- PhD. Physician and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| |
Collapse
|
28
|
Wang Y, Liu M, Chan WCH, Zhou J, Chi I. Validation of the Quality of Dying and Death Questionnaire among the Chinese populations. Palliat Support Care 2021; 19:694-701. [PMID: 36942576 DOI: 10.1017/s1478951521001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study reports the evaluation of the original 31-item Quality of Dying and Death Questionnaire (QODD) using a sample of caregivers of recently deceased older adults in China, and the validation of a shortened version (QODD-C) derived from the original scale. METHODS The translation was performed using a forward and back method. The full scale was tested with 212 caregivers of decedents in four regions of China. Confirmatory factor analysis tested the model fit between the full Chinese version and the original conceptual model and generated the QODD-C. The psychometric analysis was performed to evaluate the QODD-C's internal consistency, content validity, construct validity, and discriminant validity. RESULTS A five-domain, 18-item QODD-C was identified with excellent internal consistency reliability (Cronbach's α = 0.933; split-half Pearson's value = 0.855). The QODD-C total score was significantly associated with constructs related to five domains. The caregiver's relationship with the decedent, the decedent's age at death, death reason, and death place was significantly associated with the QODD-C total score. SIGNIFICANCE OF RESULTS The QODD-C is a valid and reliable instrument for assessing the quality of dying and death among the Chinese populations.
Collapse
Affiliation(s)
- Ying Wang
- School of Philosophy and Sociology, Lanzhou University, Lanzhou, China
| | - Mandong Liu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Wallace Chi Ho Chan
- Department of Social Work, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Jing Zhou
- School of Law, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| |
Collapse
|
29
|
Chen C, Du L, Wu Q, Jin Y. Family caregivers' perceptions about patients' dying and death quality influence their grief intensity. Appl Nurs Res 2021; 62:151456. [PMID: 34814990 DOI: 10.1016/j.apnr.2021.151456] [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: 12/20/2020] [Revised: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES To understand the influence of family caregivers' perceptions about patients' dying and death quality on their grief intensity. BACKGROUND Dying patients and their family caregivers face life-limiting illness together, and they work jointly to negotiate shared understandings and mutual adaptation to losses. DESIGN Cross-sectional data were collected via an online survey. The manuscript followed the STROBE report guideline. METHODS Family caregivers of patients who had died within 8-365 days prior were recruited. The Quality of Dying and Death Questionnaire (QDDQ) (translated into Mandarin) and the Chinese Grief Reaction Assessment Form (GRAF) were used to measure the two key variables. Multivariate linear regression was performed to explore the links between the two variables while controlling for potential confounders. RESULTS Data were collected from 170 bereaved Chinese caregivers, and 150 cases were involved in the analysis. The four-factor structure of the QDDQ was appropriate for Chinese participants. After controlling whether end-of-life care was provided and families' satisfaction with physicians' and nurses' services, regressions revealed that more intense grief of the bereaved caregivers was associated with better symptom control for and worse transcendence of the deceased patient. Moreover, those who believed that the deceased had fulfilled his or her family duties before death experienced less intense grief, and the participant's relationship with the deceased also made a difference. CONCLUSION Two aspects of patients' dying and death quality perceived by family caregivers, namely symptom control and transcendence, have opposite influences on caregivers' grief intensity.
Collapse
Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Lina Du
- Department of Propaganda and United Fronts, Jiangsu Province Hospital, Nanjing, China; School of Government, Nanjing University, Nanjing, China.
| | - Qinglu Wu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Yanyan Jin
- Office of Social Work, Jiangsu Province Hospital, Nanjing, China
| |
Collapse
|
30
|
Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
Collapse
Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
31
|
da Silva DF, Paiva CE, Paiva BSR. Cross-cultural adaptation and translation of the Pediatric Intensive Care Unit-Quality of Dying and Death into Brazilian Portuguese. Rev Bras Ter Intensiva 2021; 33:592-599. [PMID: 35081244 PMCID: PMC8889588 DOI: 10.5935/0103-507x.20210086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To translate and culturally adapt the Pediatric Intensive Care Unit-Quality of Dying and Death questionnaire into Brazilian Portuguese. METHODS This was a cross-cultural adaptation process including conceptual, cultural, and semantic equivalence steps comprising three stages. Stage 1 involved authorization to perform the translation and cultural adaptation. Stage 2 entailed independent translation from English into Brazilian Portuguese, a synthesis of the translation, back-translation, and an expert panel. Stage 3 involved a pretest conducted with family caregivers and a multidisciplinary team. RESULTS The evaluation by the expert panel resulted in an average agreement of 0.8 in relation to semantic, cultural, and conceptual equivalence. The pretests of both versions of the questionnaire showed that the participants had adequate comprehension regarding the ease of understanding the items and response options. CONCLUSION After going through the process of translation and cultural adaptation, the Pediatric Intensive Care Unit-Quality of Dying and Death caregiver and multidisciplinary team versions were considered culturally adapted, with both groups having a good understanding of the items. The questionnaires include relevant items to evaluate the process of death and dying in the intensive care setting, and suggest changes in care centered on patients and especially family caregivers, given the finitude of their children.
Collapse
Affiliation(s)
- Daiane Ferreira da Silva
- Research Group on Palliative Care and Health- Related
Quality of Life, Hospital de Câncer de Barretos - Barretos (SP), Brazil
| | - Carlos Eduardo Paiva
- Research Group on Palliative Care and Health- Related
Quality of Life, Hospital de Câncer de Barretos - Barretos (SP), Brazil
- Department of Clinical Oncology, Breast and Gynecology
Division, Hospital de Câncer de Barretos - Barretos (SP), Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Research Group on Palliative Care and Health- Related
Quality of Life, Hospital de Câncer de Barretos - Barretos (SP), Brazil
| |
Collapse
|
32
|
Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age. Support Care Cancer 2021; 30:1343-1353. [PMID: 34499215 PMCID: PMC8426162 DOI: 10.1007/s00520-021-06536-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022]
Abstract
Purpose We investigated relationships between domains of quality of dying and death in patients with advanced cancer and their caregivers’ bereavement outcomes and the moderating effect of patient age at death. Methods Bereaved caregivers of deceased patients with advanced cancer who had participated in an early palliative care trial completed measures of grief (Texas Revised Inventory of Grief [TRIG]), complicated grief (Prolonged Grief Inventory [PG-13]), and depression (Center for Epidemiologic Studies-Depression [CESD-10]). They also completed the Quality of Dying and Death measure (QODD), which assesses patients’ symptom control, preparation for death, connectedness with loved ones, and sense of peace with death. Results A total of 157 bereaved caregivers completed the study. When patient age × QODD subscale interactions were included, greater death preparation was related to less grief at patient death (past TRIG: β = − .25, p = .04), less current grief (present TRIG: β = − .26, p = .03), less complicated grief (PG-13: β = − .37, p = .001), and less depression (CESD-10: β = − .35, p = .005). Greater symptom control was related to less current grief (present TRIG: β = − .27, p = .02), less complicated grief (PG-13: β = − .24, p = .03), and less depression (CESD-10: β = − .29, p = .01). Significant patient age × connectedness interaction effects for current grief (present TRIG: β = .30, p = .02) and complicated grief (PG-13: β = .29, p = .007) indicated that, with less connectedness, younger patient age at death was associated with greater caregiver grief. Conclusion Better end-of-life death preparation and symptom control for patients with cancer may attenuate later caregiver grief and depression. Less connectedness between younger patients and their families may adversely affect caregiver grief.
Collapse
|
33
|
Meinders MJ, Gentile G, Schrag AE, Konitsiotis S, Eggers C, Taba P, Lorenzl S, Odin P, Rosqvist K, Chaudhuri KR, Antonini A, Bloem BR, Groot MM. Advance Care Planning and Care Coordination for People With Parkinson's Disease and Their Family Caregivers-Study Protocol for a Multicentre, Randomized Controlled Trial. Front Neurol 2021; 12:673893. [PMID: 34434156 PMCID: PMC8382049 DOI: 10.3389/fneur.2021.673893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurodegenerative disease with motor- and non-motor symptoms. When the disease progresses, symptom burden increases. Consequently, additional care demands develop, the complexity of treatment increases, and the patient's quality of life is progressively threatened. To address these challenges, there is growing awareness of the potential benefits of palliative care for people with PD. This includes communication about end-of-life issues, such as Advance Care Planning (ACP), which helps to elicit patient's needs and preferences on issues related to future treatment and care. In this study, we will assess the impact and feasibility of a nurse-led palliative care intervention for people with PD across diverse European care settings. Methods: The intervention will be evaluated in a multicentre, open-label randomized controlled trial, with a parallel group design in seven European countries (Austria, Estonia, Germany, Greece, Italy, Sweden and United Kingdom). The “PD_Pal intervention” comprises (1) several consultations with a trained nurse who will perform ACP conversations and support care coordination and (2) use of a patient-directed “Parkinson Support Plan-workbook”. The primary endpoint is defined as the percentage of participants with documented ACP-decisions assessed at 6 months after baseline (t1). Secondary endpoints include patients' and family caregivers' quality of life, perceived care coordination, patients' symptom burden, and cost-effectiveness. In parallel, we will perform a process evaluation, to understand the feasibility of the intervention. Assessments are scheduled at baseline (t0), 6 months (t1), and 12 months (t2). Statistical analysis will be performed by means of Mantel–Haenszel methods and multilevel logistic regression models, correcting for multiple testing. Discussion: This study will contribute to the current knowledge gap on the application of palliative care interventions for people with Parkinson's disease aimed at ameliorating quality of life and managing end-of-life perspectives. Studying the impact and feasibility of the intervention in seven European countries, each with their own cultural and organisational characteristics, will allow us to create a broad perspective on palliative care interventions for people with Parkinson's disease across settings. Clinical Trial Registration:www.trialregister.nl, NL8180.
Collapse
Affiliation(s)
- Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Spiros Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Carsten Eggers
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Knappschaftskrankenhaus Bottrop GmbH, Department of Neurology, Bottrop, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology and Department of Palliative Care, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson's Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
34
|
Sousa SDS, Reis AD, Neto JOB, Garcia JBS. End-of-life experience and its toll on quality of life and spirituality: a cross-sectional study. Int J Palliat Nurs 2021; 27:263-273. [PMID: 34292769 DOI: 10.12968/ijpn.2021.27.5.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Breast and cervical/uterine cancer affect body parts that have symbolic meaning for women. Women with this diagnosis at the end-of-life often experience anxiety and depression that severely impacts their quality of life (QoL). AIMS This study aims to determine how the end-of-life experience impacts on the QoL and spirituality of women with advanced cancer. METHODS End-of-life patients and their caregivers were evaluated regarding religious and spiritual coping, depression and self-efficacy. Caregivers were interviewed regarding patients' QoL at the end-of-life. A spearman correlation test was used to evaluate correlation between variables. FINDINGS Several dimensions of positive religious and spiritual coping stood out for patients at the end of life. However, patients often experienced a negative revaluation of God. Patients reported experiencing low self-efficacy, depression and high levels of stress. The length of hospital stay, time spent in intensive care units and depression also correlated to the amount of worry and stress a patient experienced. CONCLUSIONS The end-of-life patients had a poor quality of life, and experienced depression, but also used spiritual beliefs and religion as a means of coping with their end-of-life experience.
Collapse
|
35
|
Scheinberg-Andrews C, Ganz FD. Israeli Nurses' Palliative Care Knowledge, Attitudes, Behaviors, and Practices. Oncol Nurs Forum 2021; 47:213-221. [PMID: 32078607 DOI: 10.1188/20.onf.213-221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe and compare self-perceived end-of-life (EOL) knowledge, attitudes, behaviors, and practices of intensive care unit (ICU) nurses compared to oncology nurses. SAMPLE & SETTING 126 Israeli nurses (79 oncology nurses and 47 ICU nurses) who were members of the Israel Association of Cardiology and Critical Care Nurses and the Israeli Oncology Nurses Organization. METHODS & VARIABLES This cross-sectional study used an online survey to gather demographic information, clinical setting, and study measures (EOL knowledge, attitudes, behaviors, and practices). RESULTS Oncology nurses and ICU nurses showed moderate levels of self-perceived knowledge and attitudes toward palliative care; however, their self-reported behaviors were low. Oncology nurses scored slightly higher than ICU nurses on knowledge and attitudes but not behaviors, although the difference was not statistically significant. IMPLICATIONS FOR NURSING Contrary to the current authors' expectations, oncology nurses and ICU nurses have similar levels of knowledge, attitudes, and behaviors regarding palliative care. Nurses in both settings need to be better trained and empowered to provide such care.
Collapse
|
36
|
Glass DP, Wang SE, Minardi PM, Kanter MH. Concordance of End-of-Life Care With End-of-Life Wishes in an Integrated Health Care System. JAMA Netw Open 2021; 4:e213053. [PMID: 33822069 PMCID: PMC8025115 DOI: 10.1001/jamanetworkopen.2021.3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE There is widespread consensus on the challenges to meeting the end-of-life wishes of decedents in the US. However, there is broad but not always recognized success in meeting wishes among decedents 65 years and older. OBJECTIVE To assess how well end-of-life wishes of decedents 65 years and older are met in the last year of life. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study involved 3 planned samples of family members or informants identified as the primary contact in the medical record of Kaiser Permanente Southern California decedents. The first sample was 715 decedents, 65 years or older, who died between April 1 and May 31, 2017. The second was a high-cost sample of 332 decedents, 65 years or older, who died between June 1, 2016, and May 31, 2017, and whose costs in the last year of life were in the top 10% of the costs of all decedents. The third was a lower-cost sample with 655 decedents whose costs were not in the top 10%. The survey was fielded between December 19, 2017, and February 8, 2018. MAIN OUTCOMES AND MEASURES Meeting end-of-life wishes, discussions with next of kin and physicians, types of discordant care, and perceptions of amount of care received. RESULTS Surveys were completed by 715 of the 2281 next of kin in the all-decedent sample (mean [SD] decedent age, 80.9 [8.9] years; 361 [50.5%] male) for a 31% response rate; in 332 of the 1339 next of kin in the high-cost sample (mean [SD] decedent age, 75.5 [7.1] years; 194 [48.4%] male) for a 25% response rate; and in 659 of 2058 in the lower-cost sample (mean [SD] decedent age, 81.6 [8.8] years) for a 32% response rate. Respondents noted that high percentages of decedents received treatment that was concordant with their desires: 601 (88.9%) had their wishes met, 39 (5.9%) received a treatment they did not want, and 554 (84.1%) filled out an advance directive. A total of 509 respondents (82.5%) believed the amount of care was the right amount. Those with the highest costs had their wishes met at lower rates than those with lower costs (250 [80.1%] vs 553 [89.6%]). CONCLUSIONS AND RELEVANCE In this Kaiser Permanente Southern California cohort, a large proportion of decedents 65 years and older had end-of-life discussions and documentation, had their wishes met, and received the amount of care they thought appropriate.
Collapse
Affiliation(s)
- David P. Glass
- Department of Research and Evaluation, Kaiser Permanente Southern California
- Department of Health Systems Science, Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, California
| | - Susan E. Wang
- Life Care Planning and Serious Illness Care, Southern California Permanente Medical Group, Los Angeles
| | | | - Michael H. Kanter
- Department of Clinical Science, Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, California
| |
Collapse
|
37
|
Lamppu PJ, Pitkala KH. Staff Training Interventions to Improve End-of-Life Care of Nursing Home Residents: A Systematic Review. J Am Med Dir Assoc 2020; 22:268-278. [PMID: 33121871 DOI: 10.1016/j.jamda.2020.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim was to review evidence from all randomized controlled trials (RCTs) using palliative care education or staff training as an intervention to improve nursing home residents' quality of life (QOL) or quality of dying (QOD) or to reduce burdensome hospitalizations. DESIGN A systematic review with a narrative summary. SETTING AND PARTICIPANTS Residents in nursing homes and other long-term care facilities. METHODS We searched MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus, and Google Scholar, references of known articles, previous reviews, and recent volumes of key journals. RCTs were included in the review. Methodologic quality was assessed. RESULTS The search yielded 932 articles after removing the duplicates. Of them, 16 cluster RCTs fulfilled inclusion criteria for analysis. There was a great variety in the interventions with respect to learning methods, intensity, complexity, and length of staff training. Most interventions featured other elements besides staff training. In the 6 high-quality trials, only 1 showed a reduction in hospitalizations, whereas among 6 moderate-quality trials 2 suggested a reduction in hospitalizations. None of the high-quality trials showed effects on residents' QOL or QOD. Staff reported an improved QOD in 1 moderate-quality trial. CONCLUSIONS AND IMPLICATIONS Irrespective of the means of staff training, there were surprisingly few effects of education on residents' QOL, QOD, or burdensome hospitalizations. Further studies are needed to explore the reasons behind these findings.
Collapse
Affiliation(s)
- Pauli J Lamppu
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland.
| | - Kaisu H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
38
|
Strang P, Bergström J, Martinsson L, Lundström S. Dying From COVID-19: Loneliness, End-of-Life Discussions, and Support for Patients and Their Families in Nursing Homes and Hospitals. A National Register Study. J Pain Symptom Manage 2020; 60:e2-e13. [PMID: 32721500 PMCID: PMC7382350 DOI: 10.1016/j.jpainsymman.2020.07.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/27/2022]
Abstract
CONTEXT Preparation for an impending death through end-of-life (EOL) discussions and human presence when a person is dying is important for both patients and families. OBJECTIVES The aim was to study whether EOL discussions were offered and to what degree patients were alone at time of death when dying from coronavirus disease 2019 (COVID-19), comparing deaths in nursing homes and hospitals. METHODS The national Swedish Register of Palliative Care was used. All expected deaths from COVID-19 in nursing homes and hospitals were compared with, and contrasted to, deaths in a reference population (deaths in 2019). RESULTS A total of 1346 expected COVID-19 deaths in nursing homes (n = 908) and hospitals (n = 438) were analyzed. Those who died were of a more advanced age in nursing homes (mean 86.4 years) and of a lower age in hospitals (mean 80.7 years) (P < 0.0001). Fewer EOL discussions with patients were held compared with deaths in 2019 (74% vs. 79%, P < 0.001), and dying with someone present was much more uncommon (59% vs. 83%, P < 0.0001). In comparisons between nursing homes and hospital deaths, more patients dying in nursing homes were women (56% vs. 37%, P < 0.0001), and significantly fewer had a retained ability to express their will during the last week of life (54% vs. 89%, P < 0.0001). Relatives were present at time of death in only 13% and 24% of the cases in nursing homes and hospitals, respectively (P < 0.001). The corresponding figures for staff were 52% and 38% (P < 0.0001). CONCLUSION Dying from COVID-19 negatively affects the possibility of holding an EOL discussion and the chances of dying with someone present. This has considerable social and existential consequences for both patients and families.
Collapse
Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Jonas Bergström
- Palliative Care Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Staffan Lundström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| |
Collapse
|
39
|
Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
40
|
Seifart C, Koch M, Leppin N, Nagelschmidt K, Knorrenschild JR, Timmesfeld N, Rief W, von Blanckenburg P. Collaborative advance care planning in advanced cancer patients: col-ACP -study - study protocol of a randomised controlled trial. BMC Palliat Care 2020; 19:134. [PMID: 32838763 PMCID: PMC7445911 DOI: 10.1186/s12904-020-00629-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To assure patient-centred end-of-life care, palliative interventions need to account for patients' preferences. Advance care planning (ACP) is a structured approach that allows patients, relatives and physicians to discuss end-of-life decisions. Although ACP can improve several patient related outcomes, the implementation of ACP remains difficult. The col-ACP-study (collaborative advance care planning) will investigate a new ACP procedure (col-ACP-intervention (German: Hand-in-Hand Intervention)) in palliative cancer patients and their relatives that addresses individual values and targets barriers of communication before an ACP process. METHODS In a randomised controlled trial, 270 cancer patients without curative treatment options and their relatives will receive either 1) col-ACP 2) a supportive intervention (active control group) or 3) standard medical care (TAU). col-ACP comprises two steps: a) addressing various barriers of patients and relatives that discourage them from discussing end-of-life issues followed by b) a regular, structured ACP procedure. The col-ACP-intervention consists of 6 sessions. Primary endpoint is the patients' quality of life 16 weeks after randomisation. Secondary endpoints include measurements of distress; depression; communication barriers; caregivers' quality of life; existence of ACP or advance directives; the consistence of end of life care; and others. Patients will be followed up for 13 months. Multivariate analyses will be carried out. Qualitative evaluation of the intervention will be conducted. DISCUSSION Augmentation of a regular ACP program by a structured psycho-oncological intervention is an innovative approach to target barriers of communication about end-of-life issues. Study findings will help to understand the value of such a combined intervention in palliative care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03387436 (Date of registration: 01/02/2018, retrospectively registered.
Collapse
Affiliation(s)
- Carola Seifart
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Martin Koch
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division Hematology and Oncology, University Clinic of Gießen and Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| |
Collapse
|
41
|
Lee YH, Wang JS, Curtis R, Huang SJ, Chang SS, Chen YC. Palliative medicine family conferences and caregiver psychological distress during prolonged mechanical ventilation. BMJ Support Palliat Care 2020; 10:443-451. [PMID: 32461221 DOI: 10.1136/bmjspcare-2019-002103] [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: 11/06/2019] [Revised: 03/17/2020] [Accepted: 05/02/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Little is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers. METHODS A longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys. RESULTS In total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016-2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients' death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: -44.04% and 95% CIs -75.65 to -12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: -0.35% and 95% CI -0.58 to -0.11 on IES and coefficient: -0.22% and 95% CI -0.40 to -0.05 on CES-D) among caregivers following the patients' death. Caregivers' who accepted the concept of palliative care had fewer psychological symptoms after patients' death (coefficient: -3.29% and 95% CI -6.32 to -0.25 on IES and coefficient: -3.22% and 95% CI -5.24 to -1.20 on CES-D). CONCLUSIONS Palliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death.
Collapse
Affiliation(s)
- Yi-Han Lee
- Headquarters, Taipei City Hospital, Taipei, Taiwan.,Department of Family Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
| | - Jiao-Syuan Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Randall Curtis
- Cambia Palliative Care Center of Excellence, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sheng-Jean Huang
- Headquarters, Taipei City Hospital, Taipei, Taiwan.,Surgical Department, Medical College, National Taiwan University, Taipei, Taiwan
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yang Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan .,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
42
|
Ouyang DJ, Lief L, Russell D, Xu J, Berlin DA, Gentzler E, Su A, Cooper ZR, Senglaub SS, Maciejewski PK, Prigerson HG. Timing is everything: Early do-not-resuscitate orders in the intensive care unit and patient outcomes. PLoS One 2020; 15:e0227971. [PMID: 32069306 PMCID: PMC7028295 DOI: 10.1371/journal.pone.0227971] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/04/2020] [Indexed: 12/21/2022] Open
Abstract
Background The use of Do-Not-Resuscitate (DNR) orders has increased but many are placed late in the dying process. This study is to determine the association between the timing of DNR order placement in the intensive care unit (ICU) and nurses’ perceptions of patients’ distress and quality of death. Methods 200 ICU patients and the nurses (n = 83) who took care of them during their last week of life were enrolled from the medical ICU and cardiac care unit of New York Presbyterian Hospital/Weill Cornell Medicine in Manhattan and the surgical ICU at the Brigham and Women’s Hospital in Boston. Nurses were interviewed about their perceptions of the patients’ quality of death using validated measures. Patients were divided into 3 groups—no DNR, early DNR, late DNR placement during the patient’s final ICU stay. Logistic regression analyses modeled perceived patient quality of life as a function of timing of DNR order placement. Patient’s comorbidities, length of ICU stay, and procedures were also included in the model. Results 59 patients (29.5%) had a DNR placed within 48 hours of ICU admission (early DNR), 110 (55%) placed after 48 hours of ICU admission (late DNR), and 31 (15.5%) had no DNR order placed. Compared to patients without DNR orders, those with an early but not late DNR order placement had significantly fewer non-beneficial procedures and lower odds of being rated by nurses as not being at peace (Adjusted Odds Ratio namely AOR = 0.30; [CI = 0.09–0.94]), and experiencing worst possible death (AOR = 0.31; [CI = 0.1–0.94]) before controlling for procedures; and consistent significance in severe suffering (AOR = 0.34; [CI = 0.12–0.96]), and experiencing a severe loss of dignity (AOR = 0.33; [CI = 0.12–0.94]), controlling for non-beneficial procedures. Conclusions Placement of DNR orders within the first 48 hours of the terminal ICU admission was associated with fewer non-beneficial procedures and less perceived suffering and loss of dignity, lower odds of being not at peace and of having the worst possible death.
Collapse
Affiliation(s)
- Daniel J. Ouyang
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
| | - Lindsay Lief
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America
| | - David Russell
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
- Department of Sociology, Appalachian State University, Boone, North Carolina, United State of America
| | - Jiehui Xu
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
| | - David A. Berlin
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America
| | - Eliza Gentzler
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
| | - Amanda Su
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
| | - Zara R. Cooper
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United State of America
| | - Steven S. Senglaub
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United State of America
| | - Paul K. Maciejewski
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America
- Department of Radiology, Weill Cornell Medicine, New York, New York, United State of America
| | - Holly G. Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America
- * E-mail:
| |
Collapse
|
43
|
Abstract
OBJECTIVE To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.
Collapse
Affiliation(s)
- Karen B Lasater
- Author Affiliations: Assistant Professor (Dr Lasater), Center for Health Outcomes and Policy Research, School of Nursing, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; and Predoctoral Fellow (Ms Schlak), Leonard Davis Institute of Health Economics and Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia; and Robert Wood Johnson Foundation Future of Nursing, Scholar, Princeton, NJ
| | | |
Collapse
|
44
|
Ghoshal A. Adapting and using the quality of dying and death questionnaire. Indian J Palliat Care 2020; 26:39-41. [PMID: 32132782 PMCID: PMC7017709 DOI: 10.4103/ijpc.ijpc_170_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/02/2019] [Indexed: 11/04/2022] Open
|
45
|
Abstract
RATIONALE Caring for patients at the end of life is emotionally taxing and may contribute to burnout. Nevertheless, little is known about the factors associated with emotional distress in intensive care unit (ICU) nurses. OBJECTIVES To identify patient and family factors associated with nurses' emotional distress in caring for dying patients in the ICU. METHODS One hundred nurses who cared for 200 deceased ICU patients at two large academic medical centers in the Northeast United States were interviewed about patients' psychological and physical symptoms, their reactions to those patient experiences (e.g., emotional distress), and perceived factors contributing to their emotional distress. Logistic regression analyses modeled nurses' emotional distress as a function of patient symptoms and care. RESULTS Patients' overall quality of death (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.31-7.25), suffering (OR, 2.34; CI, 1.03-5.29), and loss of dignity (OR, 2.95; CI, 1.19-7.29) were significantly associated with nurse emotional distress. Some 40.5% (79 of 195) of nurses identified families' fears of patient death, and 34.4% (67 of 195) identified families' unrealistic expectations as contributing to their own emotional distress. CONCLUSIONS Patients' emotional distress, physical distress, and perceived quality of death are associated with nurse emotional distress. Unrealistic family expectations for the patient may be a source of nurse emotional distress. Improving patients' quality of death, including enhancing their dignity, reducing their suffering, and promoting acceptance of an impending death among family members may improve the emotional health of nurses.
Collapse
|
46
|
Joosse P, Loggers SAI, Van de Ree CLPM, Van Balen R, Steens J, Zuurmond RG, Gosens T, Van Helden SH, Polinder S, Willems HC, Van Lieshout EMM. The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study. BMC Geriatr 2019; 19:301. [PMID: 31703579 PMCID: PMC6839183 DOI: 10.1186/s12877-019-1324-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).
Collapse
Affiliation(s)
- Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands
| | - Sverre A I Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C L P Marc Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis (location Westfriesgasthuis), P.O. Box 600, 1620 AR, Hoorn, The Netherlands.,Department of Orthopaedic Surgery, Dijklanders Ziekenhuis (location Waterland Ziekenhuis), P.O. Box 250, 1440 AG, Purmerend, The Netherlands
| | - Rutger G Zuurmond
- Department of Orthopaedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Sven H Van Helden
- Department of Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hanna C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC location AMC, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | | |
Collapse
|
47
|
Liu WM, Koerner J, Lam L, Johnston N, Samara J, Chapman M, Forbat L. Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia. J Am Geriatr Soc 2019; 68:305-312. [PMID: 31681981 DOI: 10.1111/jgs.16192] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING Twelve Australian care homes in Canberra, Australia. PARTICIPANTS A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P < .01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P < .01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P < .01; 95% CI = 2.73-6.72). CONCLUSION The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305-312, 2020.
Collapse
Affiliation(s)
- Wai-Man Liu
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Koerner
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Nikki Johnston
- Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
| | - Juliane Samara
- Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
| | - Michael Chapman
- Australian National University, Canberra, Australian Capital Territory, Australia.,ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Liz Forbat
- Australian Catholic University, Canberra, Australian Capital Territory, Australia.,University of Stirling, Stirling, United Kingdom
| |
Collapse
|
48
|
Family ratings of ICU care. Is there concordance within families? J Crit Care 2019; 55:108-115. [PMID: 31715527 DOI: 10.1016/j.jcrc.2019.10.011] [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: 05/29/2019] [Revised: 09/09/2019] [Accepted: 10/23/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine heterogeneity of quality-of-care ratings within families and to examine possible predictors of concordance. MATERIALS AND METHODS We examined two aspects of agreement within families: response similarity and the amount of exact concordance in responses in a cohort of Danish ICU family members participating in a questionnaire survey (the European Quality Questionnaire: euroQ2). RESULTS Two hundred seventy-four family respondents representing 122 patients were included in the study. Identical ratings between family members occurred in 28%-59% of families, depending upon the specific survey item. In a smaller sample of 28 families whose patients died, between 39% and 86% gave identical responses to items rating end-of-life care. There was more response variance within than between families, yielding low estimates of intrafamily correlation. Statistics correcting for chance agreement also suggested modest within-family agreement. CONCLUSIONS The finding that variance is higher within than between families suggests the value of including multiple participants within a family in order to capture varying points of view.
Collapse
|
49
|
Chen C, Michaels J, Meeker MA. Family Outcomes and Perceptions of End-of-Life Care in the Intensive Care Unit: A Mixed-Methods Review. J Palliat Care 2019; 35:143-153. [PMID: 31543062 DOI: 10.1177/0825859719874767] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this review was to evaluate end-of-life care (EOLC) in the intensive care unit (ICU) from the perspective of family members. Sandelowski's segregated approach from Joanna Briggs Institute (JBI) Mixed-Methods Systematic Reviews guided this review. A search was conducted in PubMed, CINAHL, PsycINFO, EMBASE, and ProQuest databases and identified 50 papers (33 quantitative, 15 qualitative, and 2 mixed-methodology studies). Five synthesized themes (distressing emotions, shared decision-making, proactive communication, personalized end-of- life care, and valuing of nursing care) were identified. For quantitative results, study methodologies and interventions were heterogeneous and did not always improve family members' perceived quality of care and family members' psychological distress. Configuration of qualitative and quantitative data revealed ICU end-of-life interventions were ineffective because they were not guided by family members' reported needs and perceptions. To fulfill the family members' needs for the patients' EOLC in the ICU, researchers should develop a theory to explicitly explain how the family members experience ICU EOLC and implement a theory-based intervention to improve family psychological outcomes.
Collapse
Affiliation(s)
- Chiahui Chen
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Jacqueline Michaels
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA.,School of Nursing and Allied Health, SUNY Empire State College, Saratoga Springs, NY, USA
| | - Mary Ann Meeker
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA
| |
Collapse
|
50
|
Update and recommendations in decision making referred to limitation of advanced life support treatment. Med Intensiva 2019; 44:101-112. [PMID: 31472947 DOI: 10.1016/j.medin.2019.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/16/2019] [Accepted: 07/14/2019] [Indexed: 12/18/2022]
Abstract
The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients. The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit.
Collapse
|