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Agbodjavou MK, Mêliho PC, Akpi EA, Gandaho WM, Kpatchavi AC. 'We had to be there, Present to Help Him': Local Evidence on the Feeling of Safety in End-of-Life Care in Togo. Indian J Palliat Care 2024; 30:168-175. [PMID: 38846130 PMCID: PMC11152511 DOI: 10.25259/ijpc_66_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives For patients with diabetes and cancer at the end-of-life and their families, the safety sought in end-of-life care leads them to opt for home care. In developing countries where palliative care is not yet effectively integrated into public health policies, factors such as long distances to hospital referrals, lack of adequate infrastructure and shortage of specialised health professionals create a sense of insecurity for people seeking end-of-life care. The present study explored the factors that reinforce the feeling of security and insecurity of family members who have opted to accompany their relatives with diabetes and/or advanced cancer at the end-of-life at home in Togo. Materials and Methods This was an ethnographic approach based on observations and in-depth semi-structured interviews with people with the following characteristics: family members (bereaved or not) with experience of caring for a patient with diabetes and cancer at home at the end-of-life. The data were analysed using content and thematic analysis. This was done to identify categories and subcategories using the qualitative analysis software Nvivo12. Results The results show that of the ten relatives interviewed, eight had lived with the patient. Factors contributing to the feeling of security in the accompaniment of end-of-life care at home by the family members were, among others: 'Informal support from health-care professionals,' 'social support' from relatives and finally, attitudes and predispositions of the family members (presence and availability to the patient, predisposition to respect the patient's wishes at the place of end-of-life care and predisposition to talk about death with the dying person). Conclusion The 'informal support of health-care professionals', the 'perception of the home as a safe space for end-of-life care' and the 'social support' of family members contributed most to the feeling of safety among family members accompanying their diabetic and cancer patient family members at the end-of-life at home in Togo. Therefore, palliative and end-of-life care must be rethought in public health policies in Togo to orientate this care toward the home while providing families/caregivers with the knowledge and tools necessary to strengthen care.
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Affiliation(s)
- Mena Komi Agbodjavou
- Multidisciplinary Doctoral School Spaces, Cultures and Development, Abomey Calavi University, Abomey Calavi, Benin
| | - Pierre Codjo Mêliho
- Department of Livestock Systems Management and Operations, National School of Agriculture, Kétou, Benin
| | - Eric Ayédjo Akpi
- Department of Public Health, Faculty of Health Sciences, Abomey-Calavi University, Abomey-Calavi, Benin
| | - Wilisse Marlène Gandaho
- Department of Sexual and Reproductive Health, Regional Institute of Public Health - Comlan Alfred Quenum, Abomey-Calavi, Benin
| | - Adolphe Codjo Kpatchavi
- Multidisciplinary Doctoral School Spaces, Cultures and Development, Abomey Calavi University, Abomey Calavi, Benin
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Fujita J, Fukui S, Fujikawa A, Iwahara Y, Ishikawa T. Factors related to a sense of security with medical and long-term care services among community-dwelling middle-aged and older adults in Japan. Geriatr Gerontol Int 2022; 22:568-574. [PMID: 35711140 DOI: 10.1111/ggi.14417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to identify factors related to a sense of security with regard to medical and long-term care services among middle-aged and older adults. These are for consideration of strategies for the establishment of a community-based integrated care system. METHODS A cross-sectional survey was conducted in 2400 men and women aged ≥40 years in two cities. Survey items included a scale for sense of security for medical and long-term care, experience of medical and long-term care services, and social and demographic factors. Data were analyzed using univariate and multiple regression analyses. RESULTS In total, 945 respondents were included in the analysis. In multiple regression analysis, sense of security was significantly higher with ability to consult with medical professionals on medical and long-term care, availability of emotional and instrumental support, norm of reciprocity in the community, community attachment, economic comfort, higher age and male gender, and significantly lower with experience of bereavement at a hospital and depression. CONCLUSIONS These findings stress the importance of facilitating consultation with medical professionals, support for caregivers of terminally ill patients, and mutual support in the community in a community-based integrated care system. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Junko Fujita
- Faculty of Nursing, National College of Nursing, Tokyo, Japan
| | - Sakiko Fukui
- Department of Home Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Fujikawa
- Saitama Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Yuka Iwahara
- Faculty of Global Nursing, Iryo Sosei University, Iwaki, Japan
| | - Takako Ishikawa
- Department of Home Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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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.
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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
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Anezaki S, Sakka M, Noguchi-Watanabe M, Igarashi A, Inagaki A, Sumikawa Tsuno Y, Omori J, Ota A, Yamamoto-Mitani N. Association between participation in hospital-led community activities and sense of security in continued community living among older adults in a rural district of Japan: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e347-e356. [PMID: 33089582 DOI: 10.1111/hsc.13191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
For older adults to continue living in a community, they need to have a certain sense of security, especially in terms of the availability of healthcare in the community. The aim of this cross-sectional study was to explore important factors of the sense of security among older adults in their continued community living, with particular attention to hospital-led community activities. The participants comprised 252 randomly sampled older adults aged 65 years or older, living in a local community in western Japan, and ranging from being independent to physically and cognitively frail. Participants' sense of security in continued community living was assessed using a modified scale from past research on cancer care. Activities provided by local community organisations and hospitals were examined. The participants' mean age was 75.0 years, 144 (57.8%) were female and 32 (13.3%) were frail. Hospital-led groups (e.g. health lectures) and individual (e.g. health counselling) activities were used by 73 (30.5%) and 76 (31.9%) participants respectively. Among participants, 174 (73.4%) had participated in activities run by the local community, such as senior day celebrations or senior centre activities. A stronger sense of security was associated with participation in hospital-led individual activities (β = 0.171, p = .036), being a member of a neighbourhood association (β = 0.156, p = .020), frequency of contact with family members (β = 0.145, p = .034) and lower depression (β = -0.269, p < .001). Participation in community hospital-led individual activities may provide older adults opportunities to discuss their health-related concerns in a community setting, and thus might enhance their sense of security. In the aged society, the role of healthcare facilities may need to be expanded to facilitate outreach for older adults in the community to enhance their sense of security and actualise ageing in place.
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Affiliation(s)
- Saori Anezaki
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
| | - Asa Inagaki
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
| | - Yoko Sumikawa Tsuno
- Department of Public Health Nursing, Tohoku University Graduate School of Medicine, Sendai-city, Miyagi, Japan
- Department of Health Sciences, Saitama Prefectural University, Koshigaya-city, Saitama, Japan
| | - Junko Omori
- Department of Public Health Nursing, Tohoku University Graduate School of Medicine, Sendai-city, Miyagi, Japan
| | - Akiko Ota
- Brain Attack Center Ota Memorial Hospital, Fukuyama-city, Hiroshima, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
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Ivzori-Erel A, Bar-Sela G, Cohen M. Introducing the concept sense of place: A mediator between place of care and emotional distress of patients with cancer at the end of life. Psychooncology 2020; 29:1951-1958. [PMID: 32856351 DOI: 10.1002/pon.5530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND A sense of place (SOP) is defined as the emotional bonds, values, meaning, and symbols attached to a place. AIM To assess SOP of patients with cancer during end-of-life care at home (home-hospice service) versus at a hospital in relation to place of care, social support, and emotional distress. METHODS Participants were 150, stage IV, cancer patients with a life expectancy of less than 6 months, as defined by oncological staff, who were not receiving any life-prolonging care. Seventy-five patients received care at home (home-hospice), and the other 75 received care at the oncology department at the hospital, by palliative unit staff. Participants completed the Brief Symptom Inventory anxiety and depression subscales, questionnaires on perceived support and both questionnaires on home SOP and hospital SOP. RESULTS Mean scores of emotional distress were similar for patients in home-hospice and at the hospital. Home SOP among individuals receiving care at home was high, and hospital SOP was high among hospitalized individuals. The structural equation model had good fit indexes, showing that each of the SOP variables mediated the association between place of care and emotional distress. Perceived support was associated with lower distress only in the hospital setting. CONCLUSIONS The SOP concept is relevant to understanding emotional distress in relation to place of care at end of life. Strengthening SOP in relation to place of care should be considered. As newly introduced concept regarding place of care at the EoL, SOP warrants further research.
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Affiliation(s)
- Adi Ivzori-Erel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Family Medicine, Clalit Health Services, Haifa, Israel
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
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Milberg A, Liljeroos M, Krevers B. Can a single question about family members' sense of security during palliative care predict their well-being during bereavement? A longitudinal study during ongoing care and one year after the patient's death. BMC Palliat Care 2019; 18:63. [PMID: 31345200 PMCID: PMC6657130 DOI: 10.1186/s12904-019-0446-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023] Open
Abstract
Background It has been recognised that more evidence about important aspects of family members’ sense of security during palliative care is needed. The objectives of the study was: i) to discover what variables are associated with family members feeling secure during palliative care; ii) to develop a model of family members’ sense of security during palliative care, and iii) to evaluate if family members’ sense of security during ongoing palliative care predicts well-being during bereavement. Methods Between September 2009 and October 2010, 227 family members (of patients admitted to six Swedish palliative home care units) participated in the study (participation rate 75%) during ongoing care and 158 participated also 1 year after the patient’s death (70%). They answered a single question regarding the family members’ sense of security during the palliative care period. The question was constructed and validated by the researchers. Data were also collected using other questions and validated instruments and analysed stepwise with Generalized Linear Models (ordinal multinomial distribution and logit link). Results Sixteen variables were positively related to family members’ sense of security during ongoing palliative care. The five variables with the highest importance were selected into the model (listed in decreasing importance): Family members’ mastery; nervousness and stress; self-efficacy; patient having gynaecological cancer; family members’ perceived quality of life. Moreover, the family members’ sense of security during ongoing palliative care predicted ten variables indicating their well-being 1 year after the patient’s death, e.g. psychological well-being, complicated grief symptoms, health related quality of life. Conclusions The findings reveal possibilities to identify family members at risk of negative adjustment to bereavement in clinical practice and may help to develop interventions to support family members during ongoing palliative care. Electronic supplementary material The online version of this article (10.1186/s12904-019-0446-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Milberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Advanced Home Care and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden
| | - Maria Liljeroos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden. .,Medical Department, Mälarsjukhuset Hospital, 631 88, Eskilstuna, Sweden.
| | - Barbro Krevers
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Chiba H, Ogata T, Ito M, Kaneko S. Identification of Topics Explained by Home Doctors to Family Caregivers with Cancer Patients Died at Home: A Quantitative Text Analysis of Actual Speech in All Visits. TOHOKU J EXP MED 2018; 245:251-261. [PMID: 30135327 DOI: 10.1620/tjem.245.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An important consideration in the quality of end-of-life care is whether the patient's place of death matches his or her hopes. We aimed to identify topics related to patients' home death by comparing the occurrence frequency of topics explained by doctors for family caregivers between the home death cases and the hospital death cases. The method of integrating qualitative and quantitative data was adopted in this study. Primary participants were 24 home doctors who specialized home medical care. Enrolled 18 patients received periodical medical care by cooperated doctors, understood their own health situation, and lived with family caregivers. Doctors recorded all their speech during every visit with voice-recorder until the patient died at home or was re-hospitalized. Doctors' speech was transcribed and converted to the number of occurrences based on number of visits. The occurrence frequency was compared with a χ2 test (Yates' correction). Speaking records of 227 visits to 18 patients by doctors were collected. Finally, 16 patients died at home and two died at hospital. We measured the occurrence frequency of topics during maximum 26 visits on 16 home death cases and maximum 13 visits on two hospital death cases. The topics of patients' death, helping daily burden using public insurance, and financial application were more frequently appeared with home death cases than hospital death cases. In conclusion, doctors should explain to family caregivers the topics of patients' death process and specific measures or procedures for reduction in care burden.
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Affiliation(s)
- Hiroki Chiba
- Department of Medical Education, Kitasato University School of Medicine
| | - Tomoaki Ogata
- Department of Medical Policy and Administration, Tohoku Medical and Pharmaceutical University
| | - Michiya Ito
- Department of Medical Policy and Administration, Tohoku Medical and Pharmaceutical University.,Tohoku University Graduate School of Medicine
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Sarmento VP, Gysels M, Higginson IJ, Gomes B. Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers. BMJ Support Palliat Care 2017; 7:0. [DOI: 10.1136/bmjspcare-2016-001141] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 12/14/2016] [Accepted: 01/30/2017] [Indexed: 11/04/2022]
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