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Costeira C, Dixe MA, Querido A, Rocha A, Vitorino J, Santos C, Laranjeira C. Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis. Healthcare (Basel) 2024; 12:188. [PMID: 38255076 PMCID: PMC10815185 DOI: 10.3390/healthcare12020188] [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: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.
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Affiliation(s)
- Cristina Costeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Ana Rocha
- Nursing School of Coimbra, Avenida Bissaya Barreto s/n, 3004-011 Coimbra, Portugal;
| | - Joel Vitorino
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, 3000-075 Coimbra, Portugal
| | - Cátia Santos
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Wen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psychooncology 2023. [PMID: 37114337 DOI: 10.1002/pon.6146] [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: 01/10/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND/OBJECTIVE Facilitating death preparedness is important for improving cancer patients' quality of death and dying. We aimed to identify factors associated with the four death-preparedness states (no-preparedness, cognitive-only, emotional-only, and sufficient-preparedness) focusing on modifiable factors. METHODS In this cohort study, we identified factors associated with 314 Taiwanese cancer patients' death-preparedness states from time-invariant socio-demographics and lagged time-varying modifiable variables, including disease burden, physician prognostic disclosure, patient-family communication on end-of-life (EOL) issues, and perceived social support using hierarchical generalized linear modeling. RESULTS Patients who were male, older, without financial hardship to make ends meet, and suffered lower symptom distress were more likely to be in the emotional-only and sufficient-preparedness states than the no-death-preparedness-state. Younger age (adjusted odds ratio [95% confidence interval] = 0.95 [0.91, 0.99] per year increase in age) and greater functional dependency (1.05 [1.00, 1.11]) were associated with being in the cognitive-only state. Physician prognostic disclosure increased the likelihood of being in the cognitive-only (51.51 [14.01, 189.36]) and sufficient-preparedness (47.42 [10.93, 205.79]) states, whereas higher patient-family communication on EOL issues reduced likelihood for the emotional-only state (0.38 [0.21, 0.69]). Higher perceived social support reduced the likelihood of cognitive-only (0.94 [0.91, 0.98]) but increased the chance of emotional-only (1.09 [1.05, 1.14]) state membership. CONCLUSIONS Death-preparedness states are associated with patients' socio-demographics, disease burden, physician prognostic disclosure, patient-family communication on EOL issues, and perceived social support. Providing accurate prognostic disclosure, adequately managing symptom distress, supporting those with higher functional dependence, promoting empathetic patient-family communication on EOL issues, and enhancing perceived social support may facilitate death preparedness.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, ROC
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC
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