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Warner G, Baird LG, McCormack B, Urquhart R, Lawson B, Tschupruk C, Christian E, Weeks L, Kumanan K, Sampalli T. Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis. BMC Palliat Care 2021; 20:114. [PMID: 34271897 PMCID: PMC8285870 DOI: 10.1186/s12904-021-00781-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. METHODS A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. RESULTS Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. CONCLUSIONS Primary care practitioners' use of tools to assess patients/families' needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families' outcomes.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI, C1A 4P3, Canada
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, Scotland
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Cheryl Tschupruk
- Palliative Care Integration, Nova Scotia Health Authority, 530C Bethune Building, 1276 South Park st, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care Implementation, Nova Scotia Health Authority, 6960 Mumford Road, Suite 2068, Halifax, NS, B3L 4P1, Canada
| | - Lori Weeks
- School of Nursing, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kothai Kumanan
- Palliative Care Integration, Nova Scotia Health Authority, Room 522 Bethune Building, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
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Cheraghi MA, Bahramnezhad F, Mehrdad N. Review of Ordering Don't Resuscitate in Iranian Dying Patients. JOURNAL OF RELIGION AND HEALTH 2018; 57:951-959. [PMID: 28861812 DOI: 10.1007/s10943-017-0472-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Making decision on not to resuscitate is a confusing, conflicting and complex issue and depends on each country's culture and customs. Therefore, each country needs to take action in accordance with its cultural, ethical, religious and legal contexts to develop guidelines in this regard. Since the majority of Iran's people are Muslims, and in Islam, the human life is considered sacred, based on the values of the community, an Iranian Islamic agenda needs to be developed not taking measures about resuscitation of dying patients. It is necessary to develop an Iranian Islamic guidelines package in order to don't resuscitate in dying patients.
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Affiliation(s)
- Mohammad Ali Cheraghi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, East Nosrat St, Tohid Sq, Tehran, 1419733171, Iran
| | - Fatemeh Bahramnezhad
- School of Nursing and Midwifery, Tehran University of Medical Sciences, East Nosrat St, Tohid Sq, Tehran, 1419733171, Iran.
| | - Neda Mehrdad
- School of Nursing and Midwifery, Tehran University of Medical Sciences, East Nosrat St, Tohid Sq, Tehran, 1419733171, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sawatzky R, Porterfield P, Roberts D, Lee J, Liang L, Reimer-Kirkham S, Pesut B, Schalkwyk T, Stajduhar K, Tayler C, Baumbusch J, Thorne S. Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis. ANS Adv Nurs Sci 2016; 40:261-277. [PMID: 27930401 PMCID: PMC5555976 DOI: 10.1097/ans.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Pat Porterfield
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Della Roberts
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Leah Liang
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Barb Pesut
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Tilly Schalkwyk
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Carolyn Tayler
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sally Thorne
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
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Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, Roberts D, Tayler C, Voth J, Stajduhar K. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care 2016; 15:5. [PMID: 26772180 PMCID: PMC4715271 DOI: 10.1186/s12904-016-0076-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
| | - Pat Porterfield
- School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Duncan Dixon
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Kathleen Lounsbury
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Della Roberts
- Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada
| | - Carolyn Tayler
- Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - James Voth
- Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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