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Boven C, Dillen L, Van Humbeeck L, Van Den Block L, Piers R, Van Den Noortgate N. Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study. J Clin Nurs 2024; 33:3259-3272. [PMID: 38661114 DOI: 10.1111/jocn.17185] [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: 04/13/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION Relatives of deceased cancer patients were involved in the conduct of the study.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Brussels, Belgium
- End-of-Life Care Research Group, Ghent University, Campus Ghent University Hospital, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Saarinen J, Mishina K, Soikkeli-Jalonen A, Haavisto E. Family members' participation in palliative inpatient care: An integrative review. Scand J Caring Sci 2023; 37:897-908. [PMID: 34958141 DOI: 10.1111/scs.13062] [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] [Received: 08/25/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
AIM To analyse how family members participate in hospital inpatient palliative care, and how their participation could be supported. METHODS This review followed a methodology outlined in the literature for integrative reviews. A literature search supplemented by a manual search was conducted on four electronic databases during 2020 to 2021: PubMed, CINAHL, PsycINFO, and Cochrane Library. A critical appraisal of the included studies was performed, and data were analysed using inductive content analysis. RESULTS The literature search resulted in 4990 articles, of which 14 articles were included in this review. Four main categories were identified concerning the participation of family members in hospital inpatient palliative care: participation in the physical care, provision of emotional support, promoting good patient care, and support provided by healthcare professionals for family members' participation. Family members' participation can be supported in different ways, including active communication and adequate information. CONCLUSION Family members' participation in hospital inpatient palliative care has been an important part of palliative care in hospital settings. Family members should be offered the opportunity to participate in patient care, and their presence in the hospital should be accommodated. Research on the topic is still scarce, and future research is needed from different perspectives, including intervention research.
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Affiliation(s)
- Johanna Saarinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Kaisa Mishina
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | | | - Elina Haavisto
- Deparment of Health Sciences, Tampere University, Tampere, Finland
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3
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Saarinen J, Mishina K, Soikkeli-Jalonen A, Konradsen H, Haavisto E. Participation in inpatient care from the perspective of family members of palliative care patients. Int J Palliat Nurs 2023; 29:446-454. [PMID: 37757806 DOI: 10.12968/ijpn.2023.29.9.446] [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: 09/29/2023]
Abstract
BACKGROUND The participation of family members in inpatient palliative care has been shown to be meaningful; it contributes to the wellbeing of the patient. Even so, little is known about the perspectives of family members regarding their participation in this type of care. AIM The aim of this study was to describe participation in inpatient care from the perspective of family members of palliative care patients. METHOD This study involved semi-structured individual interviews with family members (n=19) of patients receiving inpatient palliative care, as well as inductive thematic analysis. FINDINGS Four main themes describing the family members' perspectives of their participation in inpatient palliative care were identified: family members attending to everyday activities, importance of participation to family members, family members providing emotional support to patients and the role of family members in discussions and decision-making processes concerning patient care. CONCLUSION Family members participate in inpatient palliative care in different ways. Participation was experienced as important to patients and family members, and some family members felt that participation may have supported their coping process.
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Affiliation(s)
- Johanna Saarinen
- Student, Department of Nursing Science, University of Turku, Turku, Finland
| | - Kaisa Mishina
- Senior researcher, Department of Nursing Science; Department of Child Psychiatry; INVEST Research Flagship Centre University of Turku, Turku, Finland
| | - Anu Soikkeli-Jalonen
- Doctoral researcher, Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
| | - Hanne Konradsen
- Professor, Herlev and Gentofte University Hospital, Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Elina Haavisto
- Professor, Department of Nursing Science, University of Turku, Turku, Finland, Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland Satakunta Central Hospital, Pori, Finland
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4
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van Esch HJ, Stoppelenburg A, van Zuylen L, van der Rijt CC, van der Heide A. When a dying patient is asked to participate in a double-blind, placebo-controlled clinical trial on symptom control: The decision-making process and experiences of relatives. Palliat Med 2022; 36:1552-1558. [PMID: 36503315 PMCID: PMC9749009 DOI: 10.1177/02692163221127557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Placebo-controlled trials can provide evidence to inform end-of-life care, but it is contested whether asking dying patients to participate in such trials is morally justifiable. To investigate the experiences of these patients is even more complex. Therefore, proxy assessments by relatives can be a good alternative. AIM To explore the experience of participating in a placebo-controlled trial at the end of life from the perspective of bereaved relatives. DESIGN Mixed-method study, including questionnaires and interviews. SETTING/PARTICIPANTS The SILENCE study was a randomized, double-blind, placebo-controlled trial on the efficacy of scopolamine butylbromide to prevent death rattle. The study was performed in six inpatient hospice facilities. Patients were asked to participate at admission in the hospice. Three months after the death of the patient, bereaved relatives were invited to fill in a questionnaire and to participate in an interview. One hundred four questionnaires were completed and 17 relatives were interviewed. RESULTS Fourteen percent of the relatives participating in the questionnaire study considered the participation of their loved one in research a bit burdensome and 10% considered it a bit stressful. Seventeen percent thought that it was a bit burdensome for the patient. Eighty-three percent considered participation in this type of research (very) valuable. The in-depth interviews showed that patients and relatives jointly decided about participation in this double-blind placebo-controlled medication trial. Relatives generally respected and felt proud about patients' decision to participate. CONCLUSION The large majority of bereaved relatives experienced the participation of their dying love one in this RCT as acceptable and valuable.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Laurens Cadenza, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Centrum Amsterdam, Amsterdam, The Netherlands
| | - Carin Cd van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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5
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van Esch HJ, Prins SD, van de Vathorst S, van der Rijt CCD, van der Heide A, van Zuylen L. Reflections on Including Patients in a Randomized Placebo-Controlled Multicentre Trial in the Dying Phase - the SILENCE Study. J Pain Symptom Manage 2022; 63:e545-e552. [PMID: 34954069 DOI: 10.1016/j.jpainsymman.2021.12.018] [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: 10/11/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
A need exists for studies investigating symptom relief at the end of life. Randomised controlled trials (RCTs) are the gold standard for demonstrating efficacy of medication, but they are difficult to perform at the end of life due to barriers such as the vulnerability of patients, and gatekeeping by healthcare professionals. We analyzed and reflected on recruitment, participation, and strategies used in an RCT at the end of life. The SILENCE study, performed in six inpatient hospice facilities, was a placebo-controlled trial to study the effect of ScopolamIne butyLbromidE giveN prophylactiCally for dEath rattle in dying patients. We addressed patients' vulnerability by using an advance consent procedure, and potential gatekeeping by extensive training of health care professionals and the appointment of hospice doctors as daily responsible researchers. In almost three years, 1097 patients were admitted of whom 626 were eligible at first assessment. Of these, 119 (19%) dropped out because of physical deterioration before they could be informed about the study (44) or sign informed consent (75). Twenty-five (4%) patients were not asked to participate. In 24 cases (4%), relatives advised against the patient participating. Overall, 229 patients (37%) gave informed consent to participate. The vulnerability of patients was the most important barrier in this medication study at the end of life. Gatekeeping by HCPs and relatives occurred in a small number of patients. The robust design and applied strategies to facilitate patient recruitment in this study resulted in a successful study with sufficient participants.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Laurens Cadenza, Oosterhagen 239, 3078 CL Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Sanne D Prins
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Suzanne van de Vathorst
- Department of Medical ethics,philosophy and history, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC, Amsterdam University Medical Centers, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands
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6
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Evaluating Organ Donation Decision in ICU Patients’ Families by Analytic Network Process Approach. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9969604. [PMID: 35463662 PMCID: PMC9033390 DOI: 10.1155/2022/9969604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
The imbalance between supply and demand for organs has been a global crisis, despite the efforts of transplant coordinators from healthcare institutions to promote donor registration. Because the patient's family has legal rights over the patient's remains, they can easily undermine any efforts spent on organ procurement by simply refusing the patient's consent before death in practice. Most related studies seldom mention the decision-making on organ donation from patients' families. The objectives of this study are to find what are the priorities of those factors acting as the pillars of organ donation by patients' families. This study applied the analytic network process (ANP) to the prioritization factors contributing toward the willingness of families to donate organs of intensive care unit patients. The purposive sampling method used structured questionnaires and ANP questionnaires to enroll 180 patients' families from five intensive care units who met the criteria in the regional teaching hospital of southern Taiwan. Through the ANP analysis, it was found that when family members made organ donation decisions, the weights of the four domains are as follows: psychology—47.6%, externality—20.3%, spirituality—19.7%, and physiology—12.3%. The main decision-making factors that influenced the weighting factors were “attitude” (31.5%), “physician's experience” (0.88%), “religion” (19.3%), and “organ selection” (31.9%). These results could assist organ donation teams to take the best strategies for persuading people to agree with organ donation and formulating an individual organ donation plan.
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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8
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de Voogd X, Willems DL, Torensma M, Onwuteaka-Philipsen BD, Suurmond JL. Dignity of informal caregivers of migrant patients in the last phase of life: a qualitative study. BMC Palliat Care 2021; 20:26. [PMID: 33541334 PMCID: PMC7863486 DOI: 10.1186/s12904-021-00721-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background A key aim of palliative care is to improve the quality of life of patients and their families. To help ensure quality of life for the families of patients with migrant backgrounds, this study sought insights into the dignity of informal caregivers in migrant communities. This could improve understanding of family-centered care for migrant patients. Methods Twenty semi-structured interviews with informal caregivers of Turkish, Moroccan, or Surinamese background living in the Netherlands were analyzed thematically. Results The dignity of the patient and that of their informal caregivers were found to be strongly interrelated. Most important for the dignity of caregivers was ensuring good care for their patients and preserving the patients’ dignity. Ensuring good care involved advocating for good and dignified care and for satisfaction of a patient’s wishes. For many informal caregivers, it also included delivering care to the patient by themselves or together with other family members, despite having to give up part of their own lives. Providing care themselves was part of maintaining a good relationship with the patient; the care was to cater to the patient’s preferences and help preserve the patient’s dignity, and it could be accompanied by valuable aspects such as times for good conversations. Positive interaction between an informal caregiver and a patient positively influenced the informal caregiver’s dignity. Informal caregiver and patient dignity were often compromised simultaneously; when informal caregivers felt healthcare professionals were undermining a patient’s dignity, their own dignity suffered. According to informal caregivers, healthcare professionals can help them preserve dignity by taking seriously their advice about the patient, keeping them informed about the prognosis of the disease and of the patient, and dealing respectfully with differences in values at the end of life. Conclusion The dignity of migrant patients’ informal caregivers in the last phase of a patient’s life is closely entwined with ensuring good care and dignity for the patient. Healthcare professionals can strengthen the dignity of informal caregivers by supporting their caregiving role. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00721-6.
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Affiliation(s)
- X de Voogd
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. .,Amsterdam Public Health Research Institute, Van Boechorstraat 7, Postbus 7057, 1007 MB, Amsterdam, Netherlands.
| | - D L Willems
- Amsterdam Public Health Research Institute, Van Boechorstraat 7, Postbus 7057, 1007 MB, Amsterdam, Netherlands.,Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,Expertise Centre for Palliative Care, Amsterdam UMC, Boelelaan 1117, Postbus 7057, 1007 MB, Amsterdam, Netherlands
| | - M Torensma
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Van Boechorstraat 7, Postbus 7057, 1007 MB, Amsterdam, Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Van Boechorstraat 7, Postbus 7057, 1007 MB, Amsterdam, Netherlands.,Expertise Centre for Palliative Care, Amsterdam UMC, Boelelaan 1117, Postbus 7057, 1007 MB, Amsterdam, Netherlands
| | - J L Suurmond
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Van Boechorstraat 7, Postbus 7057, 1007 MB, Amsterdam, Netherlands
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9
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Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway. BMC Palliat Care 2020; 19:98. [PMID: 32635903 PMCID: PMC7341649 DOI: 10.1186/s12904-020-00609-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background The ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives’ point of view, as expressed in free text comments. Methods 194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6–8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation. Results Of the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation. Conclusions Our findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives’ coping.
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10
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Gómez-Vírseda C, de Maeseneer Y, Gastmans C. Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Med Ethics 2020; 21:50. [PMID: 32605569 PMCID: PMC7325052 DOI: 10.1186/s12910-020-00495-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Respect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized. Main body Here, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis. Conclusion This article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices.
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Affiliation(s)
- Carlos Gómez-Vírseda
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35/3, 3000, Leuven, Belgium.
| | - Yves de Maeseneer
- Faculty of Theology and Religious Studies (Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 4 - box 3101, B-3000, Leuven, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 blok d - box 7001, 3000, Leuven, Belgium
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Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. The effectiveness of a nurse-led intervention to support family caregivers in end-of-life care: Study protocol for a cluster randomized controlled trial. J Adv Nurs 2020; 76:1266-1272. [PMID: 32048316 PMCID: PMC7187191 DOI: 10.1111/jan.14326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022]
Abstract
Aim To evaluate the feasibility of a structured nurse‐led supportive intervention and its effects on family caregivers in end‐of‐life care at home. Background Family caregivers are crucial in end‐of‐life care. They may experience burden due to the responsibilities associated with caregiving. Some family caregivers feel insufficiently prepared for their caregiver role. Nurses have a unique position to provide supportive interventions at home to reduce caregivers’ burden and improve preparedness. However, few nurse‐led interventions are available to support family caregivers in end‐of‐life care at home. Design We will perform a cluster randomized controlled trial. The clusters consist of twelve home care services, randomly assigned to the intervention group or the control group. Methods The study population consists of family caregivers of patients in the last phase of life. In the intervention group, nurses will systematically assess the supportive needs of family caregivers, using an assessment tool and the method of clinical reasoning. Family members of the control group receive care as usual. Primary outcome is burden measured by the Self‐Rated Burden Scale. Secondary outcomes are preparedness for caregiving, caregiving reactions and acute (hospital) admissions of the patient. In addition, the feasibility of the intervention will be evaluated. The study was funded in October 2016 and was ethically approved in April 2019. Impact Findings from this study will contribute to the scientific and practical knowledge of nursing interventions to support family caregivers in end‐of‐life care. Trial registration The Netherlands Trial Register (NL7702).
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Phillips G, Lifford K, Edwards A, Poolman M, Joseph-Williams N. Do published patient decision aids for end-of-life care address patients' decision-making needs? A systematic review and critical appraisal. Palliat Med 2019; 33:985-1002. [PMID: 31199197 DOI: 10.1177/0269216319854186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. AIMS AND DESIGN This systematic review aimed to (a) identify the range of patients' decision-making needs and (b) assess the extent to which patient decision aids address these needs. DATA SOURCES MEDLINE, PsycINFO and CINAHL electronic literature databases were searched (January 1990-January 2017), supplemented by hand-searching strategies. Eligible literature reported patient decision-making needs throughout end-of-life decision-making or were evaluations of patient decision aids. Identified decision aid content was mapped onto and assessed against all patient decision-making needs that were deemed 'addressable'. RESULTS Twenty-two studies described patient needs, and seven end-of-life patient decision aids were identified. Patient needs were categorised, resulting in 48 'addressable' needs. Mapping needs to patient decision aid content showed that 17 patient needs were insufficiently addressed by current patient decision aids. The most substantial gaps included inconsistent acknowledgement, elicitation and documentation of how patient needs varied individually for the level of information provided, the extent patients wanted to participate in decision-making, and the extent they wanted their families and associated healthcare professionals to participate. CONCLUSION Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life.
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Affiliation(s)
- Georgina Phillips
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Kate Lifford
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Marlise Poolman
- 2 Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
- 3 Department of Palliative Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Natalie Joseph-Williams
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
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Johnson S, Kelemen A, Grimes C, Stein S, Groninger H. A thematic analysis of in-hospital end-of-life care experiences of surviving family members. DEATH STUDIES 2019; 45:469-479. [PMID: 31397642 DOI: 10.1080/07481187.2019.1648341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
While end-of-life care (EoLC) priorities for patients dying in the hospital are well-documented, few data characterize needs and experiences of their family members. We conducted thematic analysis of audio recorded interviews of 18 bereaved family members to elucidate these experiences. Participants' memories were organized into two parent themes: those related to satisfaction with the care received and effective communication; those identifying shortcomings in patient care, hospital-family communication, hospital environment, and care burden on the part of family members. These findings provide insight to enhance services to patients and their families at end-of-life and improve postmortem and bereavement services.
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Affiliation(s)
- Shannon Johnson
- The National Catholic School of Social Service,Catholic University of America, Washington, District of Columbia, USA
| | - Anne Kelemen
- Department of Medicine,Georgetown University Medical Center, Washington, District of Columbia, USA
- Department of Palliative Care, Section of Palliative Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Coleia Grimes
- The National Catholic School of Social Service,Catholic University of America, Washington, District of Columbia, USA
| | - Susannah Stein
- Department of Social Work, Children's National Medical Center, Washington, District of Columbia, USA
| | - Hunter Groninger
- Department of Medicine,Georgetown University Medical Center, Washington, District of Columbia, USA
- Department of Palliative Care, Section of Palliative Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Vermorgen M, De Vleminck A, Deliens L, Houttekier D, Spruytte N, Van Audenhove C, Cohen J, Chambaere K. Do physicians discuss end-of-life decisions with family members? A mortality follow-back study. PATIENT EDUCATION AND COUNSELING 2018; 101:1378-1384. [PMID: 29550293 DOI: 10.1016/j.pec.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/09/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs. METHODS A questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n = 6188) in Flanders. RESULTS In 72.3% of ELDs preceding death, family of the dying person were involved. Discussion of an ELD with family members was more likely when the decision was also discussed with the dying person, the ELD was made with the explicit intention to shorten life, specialized palliative care was provided or death occurred in an ICU. CONCLUSIONS Involving family in end-of-life decision making appears to be related to the type of formal care services involved, communication with the dying person and the motives behind the decision. PRACTICE IMPLICATIONS Our findings suggest a need to further expand a palliative care approach with a focus on both the dying person and their family within and across a variety of health care services.
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Affiliation(s)
- Maarten Vermorgen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Nele Spruytte
- LUCAS Center for Care Research and Consultancy, University of Leuven, Leuven, Belgium.
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy, University of Leuven, Leuven, Belgium.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
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15
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Larsson H, Edberg AK, Bolmsjö I, Rämgård M. Contrasts in older persons' experiences and significant others' perceptions of existential loneliness. Nurs Ethics 2018; 26:1623-1637. [PMID: 29772961 DOI: 10.1177/0969733018774828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. OBJECTIVE To contrast frail older (>75) persons' experiences with their significant others' perceptions of existential loneliness. METHODS A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. ETHICAL CONSIDERATIONS This study was conducted in accordance with the principles of research ethics. FINDINGS The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. DISCUSSION Knowledge about the tensions between older persons' and their significant others' views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. CONCLUSION It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person.
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Affiliation(s)
- Helena Larsson
- Malmö University, Sweden; Kristianstad University, Sweden
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Ullrich A, Ascherfeld L, Marx G, Bokemeyer C, Bergelt C, Oechsle K. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliat Care 2017; 16:31. [PMID: 28486962 PMCID: PMC5424283 DOI: 10.1186/s12904-017-0206-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/28/2017] [Indexed: 11/15/2022] Open
Abstract
Background This pilot study aimed to investigate quality of life, psychological burden, unmet needs, and care satisfaction in family caregivers of advanced cancer patients (FCs) during specialized inpatient palliative care (SIPC) and to test feasibility and acceptance of the questionnaire survey. Methods During a period of 12 weeks, FCs were recruited consecutively within 72 h after the patient’s admission. They completed validated scales on several outcomes: quality of life (SF-8), distress (DT), anxiety (GAD-7), depression (PHQ-9), supportive needs (FIN), palliative care outcome (POS), and satisfaction with care (FAMCARE-2). We used non-parametric tests, t-tests and correlation analyses to address our research questions. Results FCs showed high study commitment: 74 FCs were asked to participate whereof 54 (73%) agreed and 51 (69%) returned the questionnaire. Except for “bodily pain”, FCs’ quality of life (SF-8) was impaired in all subscales. Most FCs (96%) reported clinically significant own distress (DT), with sadness, sorrows and exhaustion being the most distressing problems (80–83%). Moderate to severe anxiety (GAD-7) and depression (PHQ-9) were prevalent in 43% and 41% of FCs, respectively. FCs scored a mean number of 16.3 of 20 needs (FIN) as very or extremely important (SD 3.3), 20% of needs were unmet in >50% of FCs. The mean POS score assessed by FCs was 16.6 (SD 5.0) and satisfaction (FAMCARE-2) was high (73.4; SD 8.3). Conclusions This pilot study demonstrated feasibility of the questionnaire survey and showed relevant psychosocial burden and unmet needs in FCs during SIPC. However, FCs’ satisfaction with SIPC seemed to be high. A current multicenter study evaluates these findings longitudinally in a large cohort of FCs.
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Affiliation(s)
- Anneke Ullrich
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lilian Ascherfeld
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gabriella Marx
- Department of Palliative Medicine, University Medical Center Göttingen, Von-Siebold-Str. 3, 37075, Göttingen, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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