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Khonsari S, Johnston B, Patterson H, Mayland C. Mechanisms of end-of-life communication contributing to optimal care at the end of life: a review of reviews. BMJ Support Palliat Care 2024:spcare-2024-004904. [PMID: 38955461 DOI: 10.1136/spcare-2024-004904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND End-of-life communication is an essential component of high-quality care, but its potential mechanisms for improving care are not well understood. OBJECTIVES To summarise the potential mechanisms by which end-of-life communication may contribute to enhanced end-of-life care in any setting. DESIGN An overview of systematic reviews, with a narrative synthesis of results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was assessed using the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. DATA SOURCES CINAHL, MEDLINE, Cochrane, SSCI and PsycINFO databases, were searched from inception to January 2024. Manual searches were also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews (published in English) related to end-of-life communication, where the target population was adult patients in their last year of life, relatives, caregivers and/or healthcare professionals involved in communicating with dying patients. RESULTS We reviewed 35 eligible studies. The reviews suggest potential mechanisms of effective end-of-life communication including collaborative decision-making, tailoring communication to individuals, using effective communication strategies and incorporating communication skills into practice. The reviews also highlighted barriers related to patients, professionals and organisations. CONCLUSION This review highlights a nuanced understanding of potential mechanisms of end-of-life communication, emphasising the need for tailored training, policy enhancements and interprofessional collaboration. It calls on healthcare professionals to reflect on their practices, advocating for co-designing a person-centred communication model that addresses patient preferences at the end of life. Importantly, in culturally diverse contexts, there is a need for a communication paradigm that embraces diversity to provide truly empathetic and effective end-of-life care. This concise roadmap may foster compassionate, dignified and effective end-of-life communication. TRIAL REGISTRATION NUMBER Protocol registered with PROSPERO (CRD42022271433, 29 March 2022).
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Affiliation(s)
| | - Bridget Johnston
- University of Glasgow, Glasgow, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
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Antonides MF, van Wijngaarden E. "It's like crystal gazing": The Lived Experience of Anticipating End-of-Life Choices in Older Adults and Their Close Ones. THE GERONTOLOGIST 2024; 64:gnae061. [PMID: 38832567 PMCID: PMC11192859 DOI: 10.1093/geront/gnae061] [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: 11/16/2023] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Nowadays people increasingly try to take control over the end of their lives by anticipating end-of-life choices. Explication of these choices is encouraged using advance care planning (ACP). We aim to deepen our understanding of how choice-making processes are lived in real life, exploring the experience of community-dwelling older adults and their close ones over time. RESEARCH DESIGN AND METHODS A multiperspective and longitudinal approach grounded in phenomenology was chosen. Ten triads consisting of an older adult (75+) and 2 close ones (n = 30) were interviewed, twice individually and once as a group, over 20 months (=70 interviews). Data were thematically analyzed both longitudinally and from all 3 perspectives. RESULTS The essential meaning of anticipatory choice-making processes was described as a dynamic and relationally entangled decisional process, to navigate between paradoxical choices for an opaque future. Three fields of tension were created due to ambivalence in these choice-making processes: navigation between having and losing control, between taking away and burdening with responsibility, and between expressing and holding back oneself. DISCUSSION AND IMPLICATIONS Anticipation of choices for hypothetical end-of-life scenarios turned out to be complex and ambivalent. Most older adults resisted ambivalence and ignored complexity in an attempt to stay in control over their end of life. The burdening impact of choices on close ones illuminated the relationality of choice-making processes. These aspects of end-of-life choice-making processes should be integrated into ACP in order to better understand and care for people and their close ones faced with these choices.
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Affiliation(s)
- Marte Fleur Antonides
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Els van Wijngaarden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Wu WD, Wang Y, Fu XY, Zhang JH, Zhang CY, Mao XL, Li SW. Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses. BMC Nurs 2024; 23:431. [PMID: 38918784 PMCID: PMC11201785 DOI: 10.1186/s12912-024-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To explore the perception of good death of patients with end-stage cancer by nurses in the oncology department. METHOD In the study we used a phenomenological approach and semi-structured interviews. A total of 11 nurses from the oncology department of a Grade A hospital in Taizhou were interviewed on the cognition of good death from July 1 to September 30, 2022. Colaizzi's analysis method was used to analyse the interview data. This study followed the consolidated criteria for reporting qualitative research (COREQ). RESULT Four themes were identified: a strong sense of responsibility and mission; To sustain hope and faith; The important role of family members; Improve patients' quality of life. CONCLUSION The nurses in the department of oncology have a low level of knowledge about the "good death", and the correct understanding and view of the "good death" is the premise of the realization of " good death". The ability of nursing staff to improve the "good death", attention, and meet the needs and wishes of individuals and families, is the guarantee of the realization of "good death".
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Affiliation(s)
- Wei-Dan Wu
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Yi Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Xin-Yu Fu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Jin-Hua Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Chen-Yang Zhang
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
| | - Shao-Wei Li
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
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Videon TM, Rosati RJ, Finn S. The Importance of Providing Training to Informal Caregivers of Hospice Patients: Caregiver Experience With Hospice Care Based on Consumer Assessment of Healthcare Providers & Systems Surveys. Am J Hosp Palliat Care 2024:10499091241262804. [PMID: 38901845 DOI: 10.1177/10499091241262804] [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: 06/22/2024] Open
Abstract
BACKGROUND Informal caregivers aid hospice patients at the end of life. Little is known of their preparation and confidence in providing care, and how this relates to experiences of hospice care. OBJECTIVE Examine factors associated with informal caregivers' rating of home hospice care. METHODS Data come from 828 completed CAHPS® surveys mailed between January 2022 and December 2023 from a single non-profit Hospice organization. Multivariate logistic regression analyses examined the independent influence of various aspects of hospice care on ratings of hospice. RESULTS Nine of every 10 respondents rated hospice care high (9 or 10). Most aspects of hospice care were rated favorably. Nearly all respondents felt the patient was treated with dignity and respect (96%). The measure with the greatest room for improvement was getting help as soon as needed (82% "always"). Multivariate analyses revealed 6 factors that independently predicted overall rating of hospice care. The strongest predictor was always getting help as soon as needed, followed by believing the hospice team cared about the patient. Three measures of caregiver training were significantly associated with higher ratings of hospice care being trained to: safely move the patient, what to do if patient became restless, and on pain medications. CONCLUSIONS When informal caregivers feel trained to assess and manage the symptoms, they rate hospice care more favorably. Greater attention to informal caregiver training and support are imperative to improving hospice care.
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Affiliation(s)
- Tami M Videon
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
| | - Robert J Rosati
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
| | - Stephanie Finn
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
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Sa'ari CZ, Chik H, Syed Muhsin SB, Zainuddin SI, Abdul Aziz NA, Mohammad Jodi KH, Saari CZ, Muhamad Shukri AS, Karman S, Surip AG. Needs Analysis for The Development of a Manual in Palliative Care for Malaysia: An Islamic Psychospiritual Approach. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02073-w. [PMID: 38874714 DOI: 10.1007/s10943-024-02073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
This study explicates an Islamic approach to palliative care based on the results of a needs analysis regarding the development of an Islamic psychospiritual manual of palliative care alongside related elements. This article represents the first phase of a three-phase study using the design and development research (DDR) approach developed by Richey and Klein to study for design and development of manual either needed or otherwise. This project is a quantitative study that uses purposive sampling through a questionnaire instrument to investigate 210 participants from the general population in Malaysia that have experience in taking care of terminally ill patients. The findings of the study indicated that the majority of participants agreed with the development of an Islamic psychospiritual manual with mean values (x̅) of 4.57 and 4.66. Concurrently, the findings showed that the hierarchy of emphasis in terms of the elements to be included in the manual starts with emotional support, which exhibited the highest mean rate (x̅), followed by faith in God, spiritual and religious support, self and physical management, trauma management and social support. The correlations indicated that all the elements to be included in the manual were significant.
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Affiliation(s)
- Che Zarrina Sa'ari
- Department of Akidah and Islamic Thought, Academy of Islamic Studies, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Hasimah Chik
- Department of Akidah and Islamic Thought, Academy of Islamic Studies, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sharifah Basirah Syed Muhsin
- Department of Akidah and Islamic Thought, Academy of Islamic Studies, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nor Azah Abdul Aziz
- Faculty of Art, Computing and Creative Industries, Universiti Pendidikan Sultan Idris (UPSI), 35900, Tanjung Malim, Perak, Malaysia
| | | | - Che Zuhaida Saari
- Faculty of Syariah and Law, Universiti Sains Islam Malaysia, 71800, Nilai, Negeri Sembilan, Malaysia
| | - Abdul Salam Muhamad Shukri
- Kulliyyah Of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia (IIUM), 50728, Kuala Lumpur, Malaysia
| | - Salmah Karman
- Department of Biomedical Engineering Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Abdul Ghafar Surip
- Division of Research, Department of Islamic Development Malaysia (JAKIM), Kompleks Islam Putrajaya, Presint 3, 62100, Putrajaya, Malaysia
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Luck G, Eggenberger TL, Bautista A, Peters D, Mellman RT, Keller KB, Jacomino M. Fearing Pain at the End of Life: A Review of Advance Directives. Am J Hosp Palliat Care 2024; 41:824-830. [PMID: 37491203 DOI: 10.1177/10499091231190063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Patients, caregivers, and healthcare professionals often describe a "good death" as a pain-free process. However, many patients experience pain during their last weeks of life. Advance directives (ADs) are legally binding documents that allow individuals to express their wishes for end-of-life care which should include management of their pain. METHODS An interprofessional team conducted a comprehensive analysis of ADs from all 50 states and the District of Columbia to assess the inclusion of language that reflects patients' wishes for pain relief at the end of life. RESULTS Thirty-seven (73%) of the 51 entities examined reflected the prototypical directive, containing explicit instructions for withholding or withdrawing interventions that may prolong suffering rather than options for treating pain. Of these, 12 (24%) did not include the word "pain". Only 14 states (27%) provided clear guidance for managing pain. Unexpectantly, researchers found that 13 (25%) addressed the common fears of patients, caregivers, and healthcare teams when using opioids to relieve suffering, such as addiction, sedation, appetite, or respiratory suppression, and hastening death. CONCLUSION The majority of ADs reviewed lacked clear and comprehensive measures for addressing pain relief. This deficiency may contribute to the undertreatment of pain and amplify the anxiety felt by patients, families, and healthcare providers when making end-of-life decisions. The results highlight the need for improvements in ADs to help ensure that patients' wishes regarding pain management are adequately addressed, documented and respected.
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Affiliation(s)
- George Luck
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Adriana Bautista
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Darian Peters
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ross T Mellman
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Kathryn B Keller
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Mario Jacomino
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Ma J, Bai X, Li J, Wen B. Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis. J Adv Nurs 2024. [PMID: 38787364 DOI: 10.1111/jan.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
AIMS The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. METHODS In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. RESULTS Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. CONCLUSIONS Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. IMPLICATIONS FOR PAEDIATRIC CANCER CARE This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Jing Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Binbin Wen
- Xiangya School of Nursing, Central South University, Changsha, China
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Kgadima PN, Leburu GE. COVID-19 Ruptures And Disruptions on Grieving And Mourning Within an African Context: Lessons For Social Work Practice. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:191-206. [PMID: 35103534 PMCID: PMC8814609 DOI: 10.1177/00302228211070149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Losing a significant other through death is a tragic experience worsened by the novel coronavirus disease 2019 (COVID-19). To curb this massive increase of deaths, the South African government introduced various rules to regulate the burial process. However, these COVID-19 regulations have caused major ruptures and disruptions on how bereaved families observe and practice cultural rites and customs following death within an African context. Consequently, many bereaved family members, particularly Black Africans, struggle with adhering to the regulations and funerals have been coined 'super spreaders' of the virus. The concerns raised in this article are twofold, namely, the impact of the Covid-19 regulations on how Black Africans grieve and mourn, as well as the involvement of social workers in formulating regulations that ought to be adhered to. This article explores the fissures and bricolages brought about by COVID-19, ultimately suggesting possible ways of dealing the losses ascribed to the pandemic.
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Affiliation(s)
- Phuti N. Kgadima
- Department of Social Work, School of Social Sciences, University of South Africa, Pretoria, South Africa
| | - Goitseone E. Leburu
- Department of Social Work, School of Social Sciences, University of South Africa, Pretoria, South Africa
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Sennfält S, Hedman C, Fürst CJ. Associations between the spread of COVID-19 and end-of-life circumstances in the non-infected population of Sweden. Scand J Public Health 2024; 52:290-298. [PMID: 38153142 PMCID: PMC11067408 DOI: 10.1177/14034948231216197] [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: 02/26/2023] [Revised: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
AIMS Since its outbreak in 2020, the COVID-19 pandemic has directly caused the premature death of millions. However, indirect consequences, such as social restrictions, have affected a far greater number. We explored the association between the spread of COVID-19 and end-of-life circumstances in the infected and non-infected population in Sweden. METHODS In this descriptive, population-based, observational study, we primarily used data from the Swedish National Registry of Palliative Care, which covers about 60% of all deaths in Sweden. We explored the association between the spread of COVID-19 and place of death, people present at death and end-of-life symptoms using regression analyses. RESULTS The study included 190,291 individuals who died in any region of Sweden from 1 January 2019 to 30 June 2022, of which 10,646 were COVID-19 cases. Correlated to the temporal and geographical spread of COVID-19, there was a greater proportion of individuals dying without the presence of their next-of-kin, and consequently more people dying alone, both in those with and without COVID-19. There was a similar pattern of a greater proportion of deaths taking place in nursing homes and in the individual's own home. However, we did not find substantial associations to reported symptoms, such as anxiety or confusion. CONCLUSIONS This study shows the profound effects of the COVID-19 pandemic on end-of-life circumstances in both the infected and non-infected population in Sweden. As we prepare for future pandemics, there is a need to develop strategies to minimise the impact on non-infected individuals.
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Affiliation(s)
- Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Christel Hedman
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Sweden
| | - Carl Johan Fürst
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
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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.
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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
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Pamuk Cebeci S, Bilgiç Ş. Perception of Good Death and Level of Perceived Stress in Relatives of Palliative Care Patients. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241237838. [PMID: 38656222 DOI: 10.1177/00302228241237838] [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: 04/26/2024]
Abstract
This study aimed to examine the perception of a good death and the level of perceived stress in relatives of palliative care patients. Relatives of 110 patients hospitalized in a palliative care center constituted the research sample. A personal information form, the "Good Death Scale," and the "Perceived Stress Scale" were used for data collection. The patients' relatives defined good death as being with family members and living this process without suffering. The mean total Good Death Scale score of the relatives of palliative care patients was 54.86 ± 7.78, and their mean total Perceived Stress Scale score was 31.11 ± 10.10. These findings showed that patients' relatives had high perceptions of good death and that their stress levels were above average. To expand the scope of nursing care, it is important to know how patients' relatives are affected by this process. It is recommended that more studies be conducted on this subject.
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Affiliation(s)
- Sevil Pamuk Cebeci
- Fundamentals of Nursing Department, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Şebnem Bilgiç
- Fundamentals of Nursing Department, Faculty of Health Science, Trakya University, Edirne, Turkey
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12
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Swearinger H, Lapham JL, Martinson ML, Berridge C. Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England. J Aging Health 2024:8982643241245249. [PMID: 38613317 DOI: 10.1177/08982643241245249] [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: 04/14/2024]
Abstract
Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.
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Affiliation(s)
- Hazal Swearinger
- Department of Social Work, Cankiri Karatekin University, Çankırı, Turkey
| | | | | | - Clara Berridge
- Department of Social Work, University of Washington, Seattle, WA, USA
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13
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Yang L, Zhou Q, Hong T, Zhang L, Che H. Analysis on the willingness and influencing factors of choosing hospice care service institutions among among older people in Wuhu, China: a cross-sectional study. BMJ Open 2024; 14:e083400. [PMID: 38569717 PMCID: PMC11146404 DOI: 10.1136/bmjopen-2023-083400] [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: 12/21/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the inclination and determinants influencing the selection of hospice care service institutions among elderly individuals in China. DESIGN The study conducted has a cross-sectional design. SETTING The study was conducted at four urban community centres in Wuhu, Anhui Province, China. PARTICIPANTS The sample consisted of 642 older adults, with ages ranging from 60 to over (mean age=71.03 years, SD=7.18). METHOD This study, based on the Anderson model, developed a questionnaire after conducting a preliminary survey and engaging in several group discussions. The final questionnaire encompassed the basic information, health status, attitude towards hospice care, choice of hospice care institutions and reasons of the older people. A regional population study was conducted using the Logistic regression model to estimate the ORs (OR) of influencing factors selected by hospice services. RESULTS 38.5% of respondents expressed their willingness to receive hospice care, while 22.3% were unwilling and 39.3% felt ambivalent towards it. The acceptance rate of older people in hospice care increases with higher levels of education and monthly income. 47.0% of older people opted for hospice care in a general hospital ward, indicating that demand for hospice services among older people in Wuhu City is primarily focused on such wards. The univariate analysis revealed significant differences in the willingness of older individuals to accept hospice care services based on gender, age, educational attainment and income levels. Regardless of the location of hospice care, older men had a lower likelihood of being willing to use hospice services compared with older women. The proportion of older women choosing a hospice ward or general hospital was 53.8%, which was higher than that of older men at 42.0%. The proportion of older men choosing a community health service institution was 31.6%, higher than 23.3% of women. The educational level differences significantly influence the older people's inclination towards receiving hospice care. CONCLUSION With the ageing population of Wuhu City on the rise, there is an increasing demand for hospice services. In their final journey, older individuals require multilevel hospice care services, which necessitates equipping general hospitals with hospice wards and using community health service centres to meet their specific needs.
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Affiliation(s)
- Liu Yang
- School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Quan Zhou
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Ting Hong
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Lin Zhang
- School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Hengying Che
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
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14
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Sweeny AL, Alsaba N, Grealish L, Denny K, Lukin B, Broadbent A, Huang YL, Ranse J, Ranse K, May K, Crilly J. The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand. Age Ageing 2024; 53:afae067. [PMID: 38594928 PMCID: PMC11004355 DOI: 10.1093/ageing/afae067] [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: 07/24/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. OBJECTIVES To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. METHODS We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. RESULTS From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31-6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65-74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. CONCLUSIONS Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens.
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Affiliation(s)
- Amy L Sweeny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Nemat Alsaba
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Education & Research Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Kerina Denny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Department of Intensive Care Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Bill Lukin
- Faculty of Health and Behavioural Sciences, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Andrew Broadbent
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Supportive and Specialist Palliative Care, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Kristen Ranse
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Katya May
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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15
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Masel EK, Baer J, Wenzel C. Integrating Palliative Care Into the Management of Genitourinary Malignancies. Am Soc Clin Oncol Educ Book 2024; 44:e438644. [PMID: 38662976 DOI: 10.1200/edbk_438644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Palliative care (PC) plays a critical role in managing the difficulties associated with genitourinary malignancies. Its primary aim is to improve the overall health of patients, provide support to both patients and their caregivers, and help individuals to navigate the complex decisions about treatment and end-of-life care. PC takes a holistic approach to patient care, recognizing that genitourinary malignancies affect multiple aspects of a person's life. By addressing physical, emotional, social, and spiritual needs, PC aims to provide comprehensive support that is consistent with the patient's values and preferences. The goal is to optimize comfort, minimize distress, and enhance the patient's quality of life throughout the course of the illness. PC is not a one-off intervention, but an ongoing source of support. This article aims to provide a thorough overview of the critical elements involved in addressing the challenges posed by genitourinary cancers, emphasizing the importance of palliative interventions. We will highlight the multifaceted aspects of care and explore strategies to optimize the overall well-being of patients throughout the course of treatment for genitourinary malignancies.
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Affiliation(s)
- Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Joachim Baer
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Wenzel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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16
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Ma J, Zhou S, Bai X, Lei J, Wang H. Transition readiness of adolescents with cancer: A cross-sectional study based on self-determination theory. Eur J Oncol Nurs 2024; 69:102521. [PMID: 38387132 DOI: 10.1016/j.ejon.2024.102521] [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: 12/11/2023] [Revised: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE This study aimed to assess the transition readiness of adolescents with cancer in central China and to explore the paths associated with transition readiness based on self-determination theory (SDT). METHODS Self-management and transition to adulthood with Rx = treatment questionnaire, patient activation measure, perceived social support scale and general self-efficacy scale were used to measure transition readiness as well as constructs pertaining to SDT (competence, relatedness and autonomy). The factors influencing transition readiness were evaluated using multiple linear regression. Models 4 and 6 in PROCESS Macro 3.3 were used to test the mediating effects and chain mediating effects, respectively. RESULTS A total of 217 adolescents with cancer were included; their mean transition readiness score was 59.95 (11.34). Age (t = 6.086, p < 0.000), duration of diagnosis (t = 2.218, p = 0.028), completion of treatment (t = -2.036, p = 0.043), insurance, and competence (t = 11.149, p < 0.000) were significantly associated with transition readiness. The direct effects of self-efficacy and perceived social support on transition readiness were not significant. However, two chain mediating paths were observed: perceived social support - self-efficacy - patient activation - transition readiness and self-efficacy - perceived social support - patient activation - transition readiness; the effect values of these paths were 0.0678 and 0.0703, respectively. CONCLUSIONS The findings of this study add to the evidence supporting the use of SDT-related constructs to promote transition readiness among adolescents with cancer, highlight the importance of encouraging patient activation, and clarify the ancillary roles of social support and self-efficacy in patient activation development during transitional period.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Siqi Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Jun Lei
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, China.
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17
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Sirivarawuth T, Utriyaprasit K, Ratinthorn A, Tankumpuan T, Viwatwongkasem C. The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241238388. [PMID: 38456767 DOI: 10.1177/00302228241238388] [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: 03/09/2024]
Abstract
Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.
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Affiliation(s)
| | - Ketsarin Utriyaprasit
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Ameporn Ratinthorn
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Thitipong Tankumpuan
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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18
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Walker W, Jones J, Astley M. In-hospital end-of-life care: an appreciative analysis of bereaved family feedback. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:126-131. [PMID: 38335107 DOI: 10.12968/bjon.2024.33.3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices.
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Affiliation(s)
- Wendy Walker
- Reader in Nursing (End-of-life Care and Bereavement), The Royal Wolverhampton NHS Trust
| | - Jennifer Jones
- Specialist Nurse-Bereavement/Lead Medical Examiner Officer, The Royal Wolverhampton NHS Trust
| | - Melanie Astley
- Clinical Nurse Specialist-Palliative Care, The Royal Wolverhampton NHS Trust
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19
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Uzunkaya Oztoprak P, Terzioglu F. Attitudes of Oncology Nurses Towards Care of Dying Patients and the Principles of Dying with Dignity and Their Views on Good Death. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:961-976. [PMID: 34870522 DOI: 10.1177/00302228211057743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study investigated oncology nurses' attitudes toward caring for dying patients, their principles of dying with dignity, and their views on good death. This descriptive study included 257 oncology nurses working at two university hospitals, an educational research hospital and a state hospital in Turkey. Data were collected using the descriptive characteristics information form, the Frommelt Attitudes toward Care of the Dying scale, the Assessment Scale of Attitudes toward the Principles of Dying with Dignity, and the Good Death Scale. The nurses obtained mean scores of 99.53 ± 7.76 on the Frommelt Attitudes toward Care of the Dying scale, 26.84 ± 12.45 on the Assessment Scale of Attitudes toward the Principles of Dying with Dignity, and 57.23 ± 7.48 on the Good Death Scale. The nurses' personal and professional characteristics influenced their attitudes toward caring for dying patients, the principles of dying with dignity, and their views on good death.
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Affiliation(s)
- Pinar Uzunkaya Oztoprak
- Faculty of Nursing, Department of Obstetrics and Gynecologic Nursing, Hacettepe University, Ankara, Turkey
| | - Fusun Terzioglu
- Nursing, Department, Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
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20
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Zhang Y, Li J, Zhang Y, Chen C, Guan C, Zhou L, Zhang S, Chen X, Hu X. Mediating effect of social support between caregiver burden and quality of life among family caregivers of cancer patients in palliative care units. Eur J Oncol Nurs 2024; 68:102509. [PMID: 38310666 DOI: 10.1016/j.ejon.2024.102509] [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: 04/13/2023] [Revised: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE To identify factors influencing the quality of life of family caregivers with terminal cancer in Chinese palliative wards and to test whether social support mediates the relationship between caregiver burden and caregiver quality of life. METHODS A cross-sectional study design was used. Sociodemographic data were collected and the Quality of Life Scale, the Caregiver Burden Scale, and the Social Support Rating Scale were administered to Chinese family caregivers from December 2021 to December 2022. The factors influencing quality of life and caregiver burden were examined using the Mann‒Whitney U test and the Kruskal‒Wallis H test. The mediating role of social support was assessed using the bootstrap method. RESULTS Family caregivers' quality of life in Chinese terminal cancer palliative units was related to caregivers' daily care time, the caregiver-patient relationship, and patient age. Caregiver quality of life was negatively associated with caregiver burden and positively associated with social support. In addition, social support mediated the relationship between caregiver burden and caregiver quality of life. CONCLUSION Social support mediated the impact of caregiver burden on caregiver quality of life. Family, society, and palliative care institutions should be integrated to take actions to reduce family caregiver burden, increase social support, and transfer the positive aspects of specific cultural contexts to the culture of palliative care in general to collaboratively cope with various problems related to end-stage cancer.
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Affiliation(s)
- Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Chongcheng Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chendu, Sichuan, PR China
| | - Chang Guan
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chendu, Sichuan, PR China; Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, PR China.
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21
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Liu Q, Zhang M, Guo X, Zhang Y, Qin T, Wang Y, Gai Y. The Chinese Version of the Palliative Nursing Care Quality Scale: Translation, Cross-Cultural Adaptation, and Validity. J Palliat Care 2024; 39:47-57. [PMID: 37828752 DOI: 10.1177/08258597231204593] [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: 10/14/2023]
Abstract
BACKGROUND Nurses play an important role in palliative care, and high-quality assessment tools can help standardize palliative-related nursing behaviors, but there are no such tools in China. OBJECTIVE This study aimed to revise, cross-culturally adapt, and validate the Palliative Nursing Care Quality Scale (PNCQS) to provide an effective tool that can help nurses in mainland China assess the quality of palliative care. METHODS This study involved a 2-steps process. First, the PNCQS was translated, back-translated, and cross-cultural adapted using Brislin's translation model. Second, a cross-sectional study was used to evaluate the reliability and validity of the revised scale. From January to February 2023, 367 nurses engaged in palliative care-related nursing from 3 tertiary A general hospitals were surveyed with the revised scale. The evaluation methods used in this study included item analysis, test-retest reliability, internal consistency, criterion-related validity, content validity, and construct validity. RESULTS The PNCQS-Chinese included 20 items. In this study, the item-total correlation coefficients ranged from 0.67 to 0.83 (P < .01), and the critical ratio value of the items was 12.10 to 23.34 (P < .01). The scale-level content validity index was 0.98, and the item-level content validity ranged from 0.86 to 1.00. The total Cronbach's α and test-retest reliability of the scale were 0.96 and 0.79, respectively. Factor analysis of 20 items extracted 1 factor, and the contribution rate of cumulative variance was 60.03%. CONCLUSIONS PNCQS-Chinese shows acceptable validity and reliability for assessing the quality of palliative care-related nursing in mainland China.
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Affiliation(s)
- Qingwei Liu
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojing Guo
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuchen Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tong Qin
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Wang
- Department of Oncology, Qingdao MUnicipal Hospital, Qingdao, China
| | - Yubiao Gai
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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22
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Zaman M, Andoniou E, Wind K, Gibson J, Upshur R, Rojas G, Jadad-Garcia T, Jadad AR. A good death: non-negotiable personal conditions for clinicians, healthcare administrators and support staff. BMJ Support Palliat Care 2023; 13:434-437. [PMID: 33846127 DOI: 10.1136/bmjspcare-2020-002878] [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: 12/31/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To ask all clinical, administrative and support staff affiliated with a large network of healthcare facilities to identify the conditions that they consider as non-negotiable for their own deaths to be regarded as good. METHODS All 3495 staff of a healthcare network were asked to rank 10 conditions according to how non-negotiable they would be for themselves during their final 3 months or few hours for their own deaths to be considered as good. They were also asked about whether they had thought about their own death in the last 3 months, if they had a will, believed in God, and in the possibility of a good death, and the intensity of their fear of death. RESULTS 2971 (85%) completed the survey. Most were female (79%) and clinical staff (65%). 93% believed in God, 60% had thought about their death recently, 33% had an intense fear of death, and 4% had a will. 64% considered a good death possible. Participants ranked dying at a preferred place, emotional support from family and friends and relief from physical symptoms as their top priorities. The lowest ranked conditions were (from the bottom) relief from psychological distress, performance of rituals and the right to terminate life. There were no statistically significant differences across genders or individual occupational groups. CONCLUSION Most of conditions for a good death of interest to healthcare professionals could be provided without sophisticated medical infrastructure or specialised knowledge, opening the door for new support services to make it possible for everyone, anywhere.
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Affiliation(s)
| | | | - Keiwan Wind
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ross Upshur
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Alejandro R Jadad
- University of Toronto, Toronto, Ontario, Canada
- Beati Inc, Toronto, Ontario, Canada
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23
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Li X, Che SL, Zhu M, Ng WI. What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China. Palliat Support Care 2023:1-9. [PMID: 38031427 DOI: 10.1017/s1478951523001657] [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: 12/01/2023]
Abstract
OBJECTIVES This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. METHODS A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. RESULTS A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI. SIGNIFICANCE OF RESULTS This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
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Affiliation(s)
- Xiang Li
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
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24
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Cagle JG, Zhang P, Clem S. Estimating the Impact of Hospice Care on Key Patient-Family Care Outcomes Using a Nationwide U.S. Probability Sample. Am J Hosp Palliat Care 2023:10499091231218261. [PMID: 37989148 DOI: 10.1177/10499091231218261] [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: 11/23/2023] Open
Abstract
Hospice is touted as an exemplary model for end-of-life care. However, there is little generalizable evidence estimating benefits of hospice at the national level. Using a national population-based probability sample of U.S. adults with weights applied (data collected Spring/Summer 2015), we conducted six logistic regression models to evaluate linkages between hospice involvement and end-of-life outcomes (pain, home death, presence of family, access to life-prolonging care, respect for spiritual/religious beliefs, financial burden) from N = 235 informal caregivers of decedents prior to death. Respondents were M = 55 years old (SD = 17), 55% female, 77% White, 91% non-Hispanic, and 71% had cared for a hospice recipient. In fully adjusted analyses, hospice users had better reported outcomes observed in two models: (a.) presence of family/friends at death (OR = 2.82, SE = .48, P < .05), and (b.) respect for spiritual/religious beliefs (OR = 9.52, SE = .73, P < .01). Hospice utilization was not statistically significant (P > .05) in all other adjusted models. Although more research is needed, findings support claims that hospice remains a high quality option for end-of-life care in the U.S.
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Affiliation(s)
- John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Sarah Clem
- University of Maryland School of Social Work, Baltimore, MD, USA
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Donaldson T. Human flourishing, the goals of medicine and integration of palliative care considerations into intensive care decision-making. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109299. [PMID: 37945337 DOI: 10.1136/jme-2023-109299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Aristotle's ethical system was guided by his vision of human flourishing (also, but potentially misleadingly, translated as happiness). For Aristotle, human flourishing was a rich holistic concept about a life lived well until its ending. Both living a long life and dying well were integral to the Aristotelian ideal of human flourishing. Using Aristotle's concept of human flourishing to inform the goals of medicine has the potential to provide guidance to clinical decision-makers regarding the provision of burdensome treatments, such as intensive care treatment, where pursuing a chance of survival must be balanced against the risk of exposing patients to a negative dying experience. By conceptually uniting potentially competing goals of medicine, such as prolonging life and the promotion of peaceful deaths, Aristotle's understanding of human flourishing creates an argument for the integration of palliative care considerations into intensive care decision-making and for advanced care planning with healthy patients.
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Affiliation(s)
- Thomas Donaldson
- Centre for Social Ethics and Policy, School of Social Sciences, The University of Manchester, Manchester, UK
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Chary AN, Cameron-Comasco L, Shankar KN, Samuels-Kalow ME. Diversity, Equity, and Inclusion: Considerations in the Geriatric Emergency Department Patient. Clin Geriatr Med 2023; 39:673-686. [PMID: 37798072 PMCID: PMC10775156 DOI: 10.1016/j.cger.2023.04.009] [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: 10/07/2023]
Abstract
This article introduces core topics in health equity scholarship and provides examples of how diversity, equity, and inclusion impact the aging population and emergency care of older adults. It offers strategies for promoting diversity, equity, and inclusion to both strengthen the patient-clinician therapeutic relationship and to address operations and systems that impact care of the geriatric emergency department patient.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA.
| | - Lauren Cameron-Comasco
- Department of Emergency Medicine, Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA
| | - Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 9206, Boston, MA 02114, USA
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Otto RB, Fields NL, Bennett M, Anderson KA. Positive Aging and Death or Dying: A Scoping Review. THE GERONTOLOGIST 2023; 63:1497-1509. [PMID: 36744720 DOI: 10.1093/geront/gnad006] [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: 10/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying. RESEARCH DESIGN AND METHODS An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models. RESULTS The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models. DISCUSSION AND IMPLICATIONS The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.
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Affiliation(s)
- Robin Brown Otto
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Noelle L Fields
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Michael Bennett
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Keith A Anderson
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
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Mamun MR, Hirakawa Y, Saif-Ur-Rahman KM, Hong YJ, Song Z, Yoshida Y, Yatsuya H. Good death for people living with dementia: a qualitative study. BMC Geriatr 2023; 23:665. [PMID: 37845634 PMCID: PMC10580641 DOI: 10.1186/s12877-023-04395-y] [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: 12/19/2022] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia. METHODS This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data. FINDINGS Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event. CONCLUSION This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.
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Affiliation(s)
- Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Zean Song
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Kyota A, Kanda K, Senuma M, Tsukagoshi N, Futawatari T, Kondo Y. The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research. Eur J Oncol Nurs 2023; 66:102354. [PMID: 37586291 DOI: 10.1016/j.ejon.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review. METHODS The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods. RESULTS Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact. CONCLUSIONS An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.
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Affiliation(s)
- Ayumi Kyota
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Kiyoko Kanda
- Niigata College of Nursing, 240 Shinnan-cho, Joetsu, Niigata, 943-0147, Japan.
| | - Maiko Senuma
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Noriko Tsukagoshi
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Tamae Futawatari
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Yuka Kondo
- Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
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Chiu AF, Huang CH, Chiu CF, Hsieh CM. Attitudes toward End-of-Life Resuscitation: A Psychometric Evaluation of a Novel Attitude Scale. Healthcare (Basel) 2023; 11:2618. [PMID: 37830655 PMCID: PMC10572246 DOI: 10.3390/healthcare11192618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation's attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. METHOD Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical-surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. RESULTS After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named 'stress, avoidance, and ignorance', 'a peaceful death', and 'self-determination and ambivalence'. The Cronbach's alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. CONCLUSIONS A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required.
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Affiliation(s)
- Aih-Fung Chiu
- Department of Nursing, Meiho University, Pingtung 91202, Taiwan; (A.-F.C.); (C.-H.H.)
| | - Chin-Hua Huang
- Department of Nursing, Meiho University, Pingtung 91202, Taiwan; (A.-F.C.); (C.-H.H.)
| | - Chun-Fung Chiu
- Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Chun-Man Hsieh
- Department of Nursing, Tajen University, Pingtung 907101, Taiwan
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Kelly BC, Hanson HA, Utz RL, Hollingshaus MS, Meeks H, Tay DL, Ellington L, Stephens CE, Ornstein KA, Smith KR. Disparities and determinants of place of death: Insights from the Utah Population Database. DEATH STUDIES 2023; 48:663-675. [PMID: 37676820 PMCID: PMC11119959 DOI: 10.1080/07481187.2023.2255864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
To better understand determinants and potential disparities in end of life, we model decedents' place of death with explanatory variables describing familial, social, and economic resources. A retrospective cohort of 204,041 decedents and their family members are drawn from the Utah Population Database family caregiving dataset. Using multinomial regression, we model place of death, categorized as at home, in a hospital, in another location, or unknown. The model includes family relationship variables, sex, race and ethnicity, and a socioeconomic status score, with control variables for age at death and death year. We identified the effect of a family network of multiple caregivers, with 3+ daughters decreasing odds of a hospital death by 17 percent (OR: 0.83 [0.79, 0.87], p < 0.001). Place of death also varies significantly by race and ethnicity, with most nonwhite groups more likely to die in a hospital. These determinants may contribute to disparities in end of life.
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Affiliation(s)
- Brenna C Kelly
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heidi A Hanson
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rebecca L Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Mike S Hollingshaus
- Kem C. Gardner Policy Institute, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA
| | - Huong Meeks
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Ken R Smith
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Roshan HM, Ebadi A, Karimi L, Barasteh S. Translation and psychometric evaluation of the Persian version of "good death inventory- short Form" from the perspective of family-members of cancer patients. BMC Psychol 2023; 11:261. [PMID: 37660187 PMCID: PMC10475178 DOI: 10.1186/s40359-023-01305-0] [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: 02/20/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION Achieving good death is among the objectives of palliative care in patients with cancer. There should be an instrument for evaluating the quality of palliative care provided by family members at the end of life. This study was done to assess the psychometric properties of good death inventory- short form according to the perspective of family of patients with cancer. METHOD This methodological study was done in 2022 at two hospitals in Tehran. The translation was done via forward-backward method. Face validity was examined through cognitive interviewing with 10 family members. The content validation, were used by assessment the opinions of 10 palliative care specialists. The construct validity was explored through exploratory factor analysis and examination of convergent validation with care evaluation scale 2.0, as well as inspection of correlation by answering two general questions of satisfaction with treatment and end of life quality of life. The scale's reliability, internal consistency was calculated using Cronbach's alpha coefficient and stability via test-retest. RESULTS Overall, 204 family members of patients with cancer were included. In the exploratory factor analysis, three factors of peace, hope, and value as well as quality of care were extracted with cumulative variance of 41.8%.A significant and suitable correlation between the total scores of the participants Good death inventory-short form and care evaluation scale2.0 (r = 0.459, P < 0.001) and general satisfaction with end-of-life care (r = 0.423, p < 0.001) as well as the patient's general quality of life (r = 0.539, p < 0.001). The Cronbach's alpha coefficient for the questionnaire was found 0.842, and the stability was confirmed with Intra cluster correlation coefficient = 0.851. CONCLUSION the Persian version of good death inventory-short form is a valid and reliable questionnaire which can investigate the factors associated with good death according to patients' family members' perspective.
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Affiliation(s)
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Leila Karimi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Yoong SQ, Porock D, Whitty D, Tam WWS, Zhang H. Performance of the Palliative Prognostic Index for cancer patients: A systematic review and meta-analysis. Palliat Med 2023; 37:1144-1167. [PMID: 37310019 DOI: 10.1177/02692163231180657] [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: 06/14/2023]
Abstract
BACKGROUND Clinician predicted survival for cancer patients is often inaccurate, and prognostic tools may be helpful, such as the Palliative Prognostic Index (PPI). The PPI development study reported that when PPI score is greater than 6, it predicted survival of less than 3 weeks with a sensitivity of 83% and specificity of 85%. When PPI score is greater than 4, it predicts survival of less than 6 weeks with a sensitivity of 79% and specificity of 77%. However, subsequent PPI validation studies have evaluated various thresholds and survival durations, and it is unclear which is most appropriate for use in clinical practice. With the development of numerous prognostic tools, it is also unclear which is most accurate and feasible for use in multiple care settings. AIM We evaluated PPI model performance in predicting survival of adult cancer patients based on different thresholds and survival durations and compared it to other prognostic tools. DESIGN This systematic review and meta-analysis was registered in PROSPERO (CRD42022302679). We calculated the pooled sensitivity and specificity of each threshold using bivariate random-effects meta-analysis and pooled diagnostic odds ratio of each survival duration using hierarchical summary receiver operating characteristic model. Meta-regression and subgroup analysis were used to compare PPI performance with clinician predicted survival and other prognostic tools. Findings which could not be included in meta-analyses were summarised narratively. DATA SOURCES PubMed, ScienceDirect, Web of Science, CINAHL, ProQuest and Google Scholar were searched for articles published from inception till 7 January 2022. Both retrospective and prospective observational studies evaluating PPI performance in predicting survival of adult cancer patients in any setting were included. The Prediction Model Risk of Bias Assessment Tool was used for quality appraisal. RESULTS Thirty-nine studies evaluating PPI performance in predicting survival of adult cancer patients were included (n = 19,714 patients). Across meta-analyses of 12 PPI score thresholds and survival durations, we found that PPI was most accurate for predicting survival of <3 weeks and <6 weeks. Survival prediction of <3 weeks was most accurate when PPI score>6 (pooled sensitivity = 0.68, 95% CI 0.60-0.75, specificity = 0.80, 95% CI 0.75-0.85). Survival prediction of <6 weeks was most accurate when PPI score>4 (pooled sensitivity = 0.72, 95% CI 0.65-0.78, specificity = 0.74, 95% CI 0.66-0.80). Comparative meta-analyses found that PPI performed similarly to Delirium-Palliative Prognostic Score and Palliative Prognostic Score in predicting <3-week survival, but less accurately in <30-day survival prediction. However, Delirium-Palliative Prognostic Score and Palliative Prognostic Score only provide <30-day survival probabilities, and it is uncertain how this would be helpful for patients and clinicians. PPI also performed similarly to clinician predicted survival in predicting <30-day survival. However, these findings should be interpreted with caution as limited studies were available for comparative meta-analyses. Risk of bias was high for all studies, mainly due to poor reporting of statistical analyses. while there were low applicability concerns for most (38/39) studies. CONCLUSIONS PPI score>6 should be used for <3-week survival prediction, and PPI score>4 for <6-week survival. PPI is easily scored and does not require invasive tests, and thus would be easily implemented in multiple care settings. Given the acceptable accuracy of PPI in predicting <3- and <6-week survival and its objective nature, it could be used to cross-check clinician predicted survival especially when clinicians have doubts about their own judgement, or when clinician estimates seem to be less reliable. Future studies should adhere to the reporting guidelines and provide comprehensive analyses of PPI model performance.
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Affiliation(s)
- Si Qi Yoong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Davina Porock
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Dee Whitty
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- St. Andrew's Community Hospital, Singapore
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [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: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Carter C, Giosa J, Rizzi K, Oikonen K, Stephenson B, Holyoke P. The Reflection Room ®: Moving from Death-Avoiding to Death-Discussing. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231192163. [PMID: 37515417 DOI: 10.1177/00302228231192163] [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: 07/30/2023]
Abstract
We developed, implemented, and evaluated a participatory arts-based storytelling initiative called the Reflection Room project. Our aim was to investigate if visiting a Reflection Room, (1) creates opportunities for disclosing emotions and processing thoughts, (2) increases comfort discussing dying and death, and (3) supports advance care planning (ACP), conversations. In the pilot phase of the Reflection Room project, a Reflection Room was installed in 25 sites across Canada from 2016-2017. Data collection included reflection cards (n = 463), and surveys completed by visitors upon exiting a room (n = 271) and 3 months later (n = 50). Analysis involved theoretically driven coding, inductive content analysis, and descriptive statistics. We found reflections contained both emotional disclosures and reflective processing. Survey data indicated visiting a Reflection Room increased comfort in thinking and talking about dying and death as well as the likelihood of engaging in ACP. In the future, we will explore the extent to which the project fosters social connections and well-being.
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Affiliation(s)
| | - Justine Giosa
- SE Research Centre, Markham, ON, Canada
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
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Vilpert S, Meier C, Berche J, Borasio GD, Jox RJ, Maurer J. Older adults' medical preferences for the end of life: a cross-sectional population-based survey in Switzerland. BMJ Open 2023; 13:e071444. [PMID: 37487679 PMCID: PMC10373667 DOI: 10.1136/bmjopen-2022-071444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Medical decision-making at the end of life is common and should be as patient-centred as possible. Our study investigates older adults' preferences towards three medical treatments that are frequently included in advance directive forms and their association with social, regional and health characteristics. SETTING A cross-sectional study using population-based data of wave 8 (2019/2020) of the Swiss component of the Survey of Health, Ageing and Retirement in Europe. PARTICIPANTS 1430 adults aged 58 years and older living in Switzerland. PRIMARY AND SECONDARY OUTCOME MEASURES Three questions on the preferences regarding cardiopulmonary resuscitation (CPR); life-prolonging treatment in case of high risk of permanent mental incapacity; reduced awareness (sedation) to relieve unbearable pain and symptoms. Their associations with individuals' social, regional and health characteristics. RESULTS Most older adults expressed a wish to receive CPR (58.6%) and to forgo life-prolonging treatment in case of permanent mental incapacity (92.2%). Most older adults also indicated that they would accept reduced awareness if necessary to receive effective treatment for pain and distressing symptoms (59.2%). Older adults' treatment preferences for CPR and life-prolonging treatment differed according to sex, age, partnership status, linguistic region and health status, while willingness to accept reduced awareness for effective symptom treatment was more similarly distributed across population groups. CONCLUSIONS Simultaneous preferences for CPR and refusal of life-prolonging treatment might appear to be conflicting treatment goals. Considering individuals' values and motivations can help clarify ambivalent treatment decisions. Structured advance care planning processes with trained professionals allows for exploring individuals' motivations and values and helps to identify congruent care and treatment goals.
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Affiliation(s)
- Sarah Vilpert
- Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Clément Meier
- Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jeanne Berche
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and 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
| | - Jürgen Maurer
- Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
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Wang G, Xiao J, Chen Z, Huang C, Deng Y, Tang S. Good death from cancer-the patient view: systematic review of qualitative studies. BMJ Support Palliat Care 2023:spcare-2022-004146. [PMID: 37353313 DOI: 10.1136/spcare-2022-004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND AND OBJECTIVE An in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer. METHODS This systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data. RESULTS A total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients' internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts. CONCLUSION A good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients' positive perspectives and behaviours are recommended to improve their quality of life and death.
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Affiliation(s)
- Guiyun Wang
- School of Nursing, Shandong Xiehe University, Jinan, Shandong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zhihan Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinghua Deng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Hsieh MH, Lin WC, Yeh TC, Liu CJ, Chen M, Liu CK. Bibliometric and Visualized Analysis of Good Death Research from 2001-2021. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231184301. [PMID: 37327405 DOI: 10.1177/00302228231184301] [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: 06/18/2023]
Abstract
Quantitative analysis via bibliometric field analyses is a recent, gradually emerging method. We conducted a bibliometric study to investigate the authors' scientific influence and contributions and evaluate trends and research foci in good death-related literature using the Web of Science (WOS) Core Collection. A total of 1,157 publications were selected for the analysis. There was a significant increase in annual publications per year (R2 = 0.79). The publication (317, 27.4%) and average citation (29.2) numbers were highest in the USA. Controlling for population number and GDP, the Netherlands had the highest number of articles per million persons (5.89) and US$ 1010 GDP (1.02). North American and Western European countries are leaders in the field, but some East Asian countries (Japan and Taiwan) perform well. Current research focuses on patient perspectives of good death and advance care planning among patients, families, and health care providers.
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Affiliation(s)
- Ming-Hsuan Hsieh
- Development and Planning Center, Taipei City Hospital, Taipei City, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Chih Lin
- Center for General Education, Taipei University of Marine Technology, New Taipei City, Taiwan
| | - Te-Chun Yeh
- Development and Planning Center, Taipei City Hospital, Taipei City, Taiwan
- University of Taipei, Taipei City, Taiwan
| | - Chia-Jen Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Center for General Education, Taipei University of Marine Technology, New Taipei City, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
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Suntai Z, Laha-Walsh K, Albright DL. Perspectives on a good death: A comparative study of veterans and civilians. DEATH STUDIES 2023; 48:276-285. [PMID: 37288754 DOI: 10.1080/07481187.2023.2219641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans (n = 241) and nonveterans (n = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | | | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Forster-Holt N, DeSanto-Madeya S, Davis J. The Mortality of Family Business Leaders: Using a Palliative Care Model to Re-imagine Letting Go. JOURNAL OF MANAGEMENT INQUIRY 2023. [DOI: 10.1177/10564926231159331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The succession literature frames a leader's reluctance to let go as the single largest deterrent to succession planning, and early literature pointed to the stronghold that mortality can have on letting go. The notion has not captured our continued curiosity, preventing a full understanding of the tensions and antecedents of family business succession. Most scholarship on letting go describes a quest for immortality and in this sense, ‘mortality’ has been misapplied and one dimensional. In an interdisciplinary boost to family business, we turn to palliative care, where it is believed that the acknowledgment of one's mortality will facilitate letting go. We develop four typologies of letting go by combining elements of mortality awareness and planning that offers nuance and insights into long-held beliefs about this most vital and finite ‘soft issue’. We discuss emotion governance tools that help change the mortality awareness trajectory and support family business succession.
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Affiliation(s)
- Nancy Forster-Holt
- College of Business Administration, University of Rhode Island, Kingston, RI, USA
| | | | - James Davis
- Huntsman School of Business, Utah State University, Logan, UT, USA
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Jewitt N, Rapoport A, Gupta A, Srikanthan A, Sutradhar R, Luo J, Widger K, Wolfe J, Earle CC, Gupta S, Kassam A. The Effect of Specialized Palliative Care on End-of-Life Care Intensity in AYAs with Cancer. J Pain Symptom Manage 2023; 65:222-232. [PMID: 36423804 DOI: 10.1016/j.jpainsymman.2022.11.013] [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: 09/08/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Many adolescents and young adults (AYAs; 15-39 years) with cancer receive high intensity (HI) care at the end of life (EOL). Palliative care (PC) involvement in this population is associated with lower risk of HI-EOL care. Whether this association differs by specialized vs. generalist PC (SPC, GPC) is unknown. OBJECTIVES (1) To evaluate whether SPC had an impact on the intensity of EOL care received by AYAs with cancer; (2) to determine which subpopulations are at highest risk for reduced access to SPC. METHODS A decedent cohort of AYAs with cancer who died between 2000-2017 in Ontario, Canada was identified using registry and population-based data. The primary composite measure of HI-EOL care included any of: intravenous chemotherapy <14 days from death; more than one ED visit, more than one hospitalization or any ICU admission <30 days from death. Physician's billing codes were used to define SPC and GPC involvement. RESULTS Of 7122 AYA decedents, 2140 (30%) received SPC and 943 (13%) received GPC. AYAs who died in earlier years, those with hematologic malignancies, males and rural AYAs were least likely to receive SPC. No PC involvement was associated with higher odds of receiving HI-EOL care (odds ratio (OR) 1.5; P < 0.0001). SPC involvement was associated with the lowest risk of HI-EOL care (OR SPC vs. GPC 0.8; P = 0.007) and decreased odds of ICU admission (OR 0.7; P = 0.006). CONCLUSION SPC involvement was associated with the lowest risk of HI-EOL care in AYAs with cancer. However, access to SPC remains a challenge.
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Affiliation(s)
- Natalie Jewitt
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada.
| | - Adam Rapoport
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Abha Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Amirrtha Srikanthan
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rinku Sutradhar
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Jin Luo
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Joanne Wolfe
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Craig C Earle
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Sumit Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Alisha Kassam
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Heijltjes MT, van Zuylen L, van Thiel GJ, van Delden JJ, van der Heide A. Symptom evolution in the dying. BMJ Support Palliat Care 2023; 13:121-124. [PMID: 36410945 PMCID: PMC9985713 DOI: 10.1136/spcare-2022-003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Provide insight in the prevalence of symptoms in patients who are in the last days of life. METHODS A retrospective descriptive analysis of data on patients who died between 2012 and 2019 at the age of 18 or older in 1 of 20 Dutch healthcare facilities, including hospitals, inpatient hospices and long-term care facilities. We analysed data from 4 hourly registrations in the Care Programme for the Dying Person, to assess for how many patients symptom-related goals of care were not achieved. We looked at the first 4 hours episode after the start of the Care Programme and the last 4 hours episode prior to death. RESULTS We analysed records of 2786 patients. In the first 4 hours episode, at least one symptom-related care goal was not achieved for 28.5%-42.8% of patients, depending on the care setting. In the last 4 hours episode, these percentages were 17.5%-26.9%. Care goals concerning pain and restlessness were most often not achieved: percentages varied from 7.3% to 20.9% for pain and from 9.3% to 21.9% for restlessness. CONCLUSIONS Symptom control at the end of life is not optimal in a substantial minority of patients. Systematic assessment and attention as well as further research on symptom management are of the essence.
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Affiliation(s)
- Madelon T Heijltjes
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ghislaine Jmw van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes Jm van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Lutier T, Morel V, Robert G. Patients considérés dans leur dernière année de vie par leur médecin traitant : quelles attentes concernant leur avenir ? MÉDECINE PALLIATIVE 2023. [DOI: 10.1016/j.medpal.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Hansen DM, Stephenson P, Lalani N, Shanholtzer J. Reflective Journaling as Preparation for Spiritual Care of Patients. J Hosp Palliat Nurs 2023; 25:45-50. [PMID: 36415043 DOI: 10.1097/njh.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Death is a human experience; however, an understanding of dying, grief, and loss continues to elude many cultures, even more elusive is the understanding of complicated grief for families and burnout for providers caring for the dying patient and their families. To prepare students taking care of dying patients and their families, the Catalyzing Relationships at the End of Life program included addressing perceptions of one's own death through journal reflection. The Catalyzing Relationships at the End of Life program utilized journals to ascertain student understanding of issues surrounding family communication at the end of life. Journal reflections were embedded in an online learning management system and utilized structured prompts as the journaling method. These prompts addressed what students desire for their own family relationships during their own death. Results from the qualitative descriptive analysis included 4 themes: meaning, beliefs, connections, and good death. Reflections about their own death were a powerful experience for student participants. Although questions about spirituality were not specifically asked, themes relating to spirituality emerged from the data.
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Nishimura M, Toyama M, Mori H, Sano M, Imura H, Kuriyama A, Nakayama T. Providing End-of-Life Care for Patients Dying of COVID-19 and Their Families in Isolated Death During the Pandemic in Japan: The Providing End-of-life Care for COVID-19 Project. Chest 2023; 163:383-395. [PMID: 36257473 PMCID: PMC9576251 DOI: 10.1016/j.chest.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Death resulting from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many health care providers (HCPs) have struggled with end-of-life (EOL) care for these patients, the various strategies across hospitals are not well known. RESEARCH QUESTION What EOL care did HCPs give patients dying of COVID-19 and their families in hospitals during the COVID-19 pandemic? What were the key themes in care? STUDY DESIGN AND METHODS This qualitative study used individual, semistructured, internet, and face-to-face interviews. We recruited HCPs who provided EOL care to patients with COVID-19 dying in hospitals and their families. Purposive sampling was used through the academic networks at the School of Public Health, Kyoto University. Anonymized verbatim transcripts were analyzed thematically. RESULTS Fifteen doctors and 18 nurses from 23 hospitals in 13 regions across Japan participated; 16 participants (48%) were women, with an age range of 20 to 59 years (most were 30-39 years of age). Participants described 51 strategies, including providing physical and psychological-spiritual care, making connections, providing death care, and arranging care environments and bereavement care for patients and their families. Four themes emerged as prominent efforts in COVID-19 EOL care: maintaining relationships with isolated patients, connecting patients and families, sharing decision-making in isolation, and creating humanistic episodes. INTERPRETATION Proper application and awareness of the four themes may help HCPs to implement better EOL care. To compensate for limited memories resulting from isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. EOL education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for EOL care.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University.
| | - Mayumi Toyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Hiroko Mori
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Section of Epidemiology, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Makiko Sano
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Nursing, School of Health Sciences, Bukkyo University
| | - Haruki Imura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto
| | - Akira Kuriyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
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Cevik Aktura S, Citlik Saritas S, Karakaş N. Student Nurses' Perception of Good Death and Religious Coping Styles. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231154678. [PMID: 36706235 DOI: 10.1177/00302228231154678] [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: 01/29/2023]
Abstract
This research aims to examine the perception of the good death and religious coping styles of student nurses. The research is a correlational descriptive study. The research was conducted with 358 nursing students at a state university in the east of Turkey. It was found in the study that students had a good perception of death (58.83 ± 6.12) and mostly used positive religious coping styles (positive/24.55 ± 3.71, negative/13.31 ± 4.21). As a result of the correlation analysis, a weakly significant positive relationship was determined between good death perception and positive religious coping (p < .001).This study observed that students' perceptions of good death increased along with their positive religious coping styles.
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Affiliation(s)
| | | | - Neşe Karakaş
- Public Health, Malatya Turgut Özal University Medical School, Malatya, Turkey
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Yildirim G, Işık MT, Yalcin SO. Relationship Between Physician's and Nurses' Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231153712. [PMID: 36683558 DOI: 10.1177/00302228231153712] [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: 01/24/2023]
Abstract
We aimed to determine the relationship between the attitudes of healthcare professionals towards futile treatment and their approach to death and terminally ill patients. We collected the data from nurses-physicians working in the intensive care unit, using the Nurses' Attitudes towards Futile Treatment Scale (NAFTS) and Approach to Death and Dying Patients Attitude Scale (ADDPAS). Avoidant attitudes displayed towards death and terminally ill patients increase as futile treatment is administered more. Health workers who work in the intensive care unit and witness futile treatment more frequently in the clinic are of the opinion that futile treatment should not be performed.
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Affiliation(s)
- Gulay Yildirim
- Department of History and Ethics, Sivas Cumhuriyet Üniversty, Sivas, Turkey
| | - Meryem Türkan Işık
- Faculty of Nursing, Fundamental Nursing Department, Mersin University, Turkey
| | - Sibel Oner Yalcin
- Department of History of Medicine and Ethics, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Arora S, Bhatia S. Addressing Grief and Bereavement in Covid-19 Pandemic. ILLNESS, CRISES, AND LOSS 2023:10541373221145536. [PMCID: PMC9880143 DOI: 10.1177/10541373221145536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Losses that took place during the covid 19 pandemic are recognised as “bad deaths”. They are characterized by physical discomfort, difficulty breathing, social isolation, psychological distress and ineffective care. The experience of grief has been even more challenging during the covid times as compared to the usual grief prior to the pandemic due to the lack of resources that assist in coping. Lack of social support, uncertainty about the future, lack of routine, and absence of mourning rituals deny the bereaved with the basic opportunity to grieve adaptively. Enhancing advance care planning may help dying patients to receive effective care. Virtual funeral services, extending support through telephonic conversations, online psychotherapy and encouraging continuing bonds with the deceased assist individuals who experience grief and bereavement. The current chapter focuses on expanding awareness about the nature of grief during the pandemic and understanding effective measures to mitigate complicated grief across various subgroups of the society who experienced grief as a result of the covid-19 pandemic.
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Affiliation(s)
- Saachi Arora
- Department of Psychology,
University of Delhi, Delhi, India
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Paiva BSR, Lourenço BM, Prata HM, Valentino TCDO, Oliveira MAD, Santos Neto MFD, Bruera E, Paiva CE. Burial or cremation? Factors associated with preferences among patients with cancer in Brazil: a cross-sectional study. SAO PAULO MED J 2023; 141:e2022441. [PMID: 37194763 DOI: 10.1590/1516-3180.2022.0441.r1.13022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND People living with life-limiting illnesses and their family caregivers consistently emphasize the importance of preparing for imminent death, with planned funerals being a common aspect of this preparation. Few studies have described the funeral rituals or post-mortem preferences of patients with cancer. OBJECTIVE To evaluate the percentage of patients with cancer who wish to be cremated and to identify the factors associated with this preference. DESIGN AND SETTING Cross-sectional study conducted at Barretos Cancer Hospital. METHODS A total of 220 patients with cancer completed a Sociodemographic and Clinical Questionnaire, the Duke University Religiosity Index, and burial or cremation preferences. Binary Logistic Regression was performed to identify independent variables associated with cremation. RESULTS Of the 220 patients, 25.0% preferred cremation and 71.4% preferred burial. Talks about death with family or close friends in their daily life (odds ratio, OR = 2.89; P = 0.021), patients that answered "other" (unsure, tends not be true and not true) for religious beliefs are what really lie behind my whole approach to life (OR = 20.34; P = 0.005), and education 9 to 11 years (OR = 3.15; P = 0.019) or ≥ 12 years (OR = 3.18; P = 0.024) were associated with cremation preference. CONCLUSION Most patients with Cancer in Brazil prefer burial after death. Discussions about death, religious beliefs and involvement, and educational level seem to influence the preference for cremation. A deeper understanding of ritual funeral preferences and their associated factors may guide policies, services, and health teams in promoting the quality of dying and death.
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Affiliation(s)
- Bianca Sakamoto Ribeiro Paiva
- PhD. Nurse, Researcher and Professor, Oncology Graduate Program, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Bruna Minto Lourenço
- BM. Undergraduate Psychology Student, Oncology Graduate Program, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Henrique Moraes Prata
- PhD. Lawyer, Oncology Graduate Program, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Talita Caroline de Oliveira Valentino
- Doctoral Student and Nurse, Oncology Graduate Program, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Marco Antonio de Oliveira
- MSc. Biostatistics, Learning and Research Institute, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Martins Fideles Dos Santos Neto
- MSc. Librarian, Oncology Graduate Program, Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata (FACISB), Barretos (SP), Brazil; Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
| | - Eduardo Bruera
- MD. Physician, Department of Palliative, Rehabilitation, and Integrative Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston (TX), United States
| | - Carlos Eduardo Paiva
- PhD. Physician and Professor, Postgraduation, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Hospital de Câncer de Barretos, Barretos (SP), Brazil
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Agosta MT, Tang M, Carmack CL, Bruera E. Social isolation at the end of life: A case report of one person's journey navigating the medical landscape during the COVID-19 pandemic. Palliat Support Care 2022; 20:900-903. [PMID: 35587538 DOI: 10.1017/s1478951522000505] [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
BACKGROUND In addition to physical symptom burden, psychological suffering at end of life (EOL) is quite pervasive. As such, the interdisciplinary team in our Palliative and Supportive Care Unit strives to provide quality care sensitive to the physical and psychosocial needs of patients. Involving and allowing for the presence of family members is one way in which we afford our patients some additional comfort. Unfortunately, the current pandemic has placed limitations on this rather fundamental need for both patients and their family members. Here, we present a case illustrating the effects of visitor restrictions/isolation due to COVID-19 on the suffering of a patient at the EOL. CASE DESCRIPTION A male in his 20s with a refractory hematologic malignancy decided to pursue a comfort-based approach to care after a rapid clinical deterioration. Due to visitor restrictions, he had to face this decision with limited support at the bedside, which caused significant distress. He was forced to choose among several immediate family members who would be at his side through his hospitalization, to be his advocate, at times his voice, his confidant, and the person to relay all information to those on the outside. He expressed a wish to be married before he died, which occurred in our palliative care unit. This life goal was one we would normally encourage those he loved to gather around him, but this was not possible. He passed peacefully two days after he was married. CONCLUSION Although social limitations are necessary to help provide safety to the patients and staff in a hospital, they can have a direct impact on the suffering of patients and families at the EOL. Helping to maintain dignity, reflect on their life, and resolve any conflicts in the presence of family members is a benchmark for providing quality palliative care. Being barred from visitation due to isolation, threatens this care and lays the foundation for complicated grief among family members. Further research is needed to help balance the needs of those at the EOL with public safety. One such measure to help ease distress is to allow for more virtual visitation through electronic measures.
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Affiliation(s)
- Monica T Agosta
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Tang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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