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Bourmorck D, Pétré B, de Saint-Hubert M, De Brauwer I. Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission. BMC Health Serv Res 2024; 24:773. [PMID: 38956595 PMCID: PMC11218079 DOI: 10.1186/s12913-024-11242-2] [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: 01/24/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED's role in providing palliative care for this population. METHODS We designed a qualitative study based on 1) interviews - conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers - and 2) focus groups - conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. RESULTS Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients'(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED's role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile. CONCLUSIONS Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.
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Affiliation(s)
- Delphine Bourmorck
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Benoit Pétré
- Department of Public Health Sciences, Faculty of Medecine, University of Liège, Liège, Belgium
| | - Marie de Saint-Hubert
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- CHU-UCL Namur, Yvoir, Belgium
| | - Isabelle De Brauwer
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Iunius LA, Vilpert S, Meier C, Jox RJ, Borasio GD, Maurer J. Advance Care Planning: A Story of Trust Within the Family. J Appl Gerontol 2024; 43:349-362. [PMID: 37984553 PMCID: PMC10875907 DOI: 10.1177/07334648231214905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023] Open
Abstract
As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues-used as a proxy measure of family relationship quality-with individuals' engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55 years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland (n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.
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Affiliation(s)
- Lory A. Iunius
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
| | - Sarah Vilpert
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
- Swiss Centre of Expertise in the Social Sciences (FORS), Lausanne, Switzerland
| | - Clément Meier
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
- Swiss Centre of Expertise in the Social Sciences (FORS), Lausanne, Switzerland
| | - Ralf J. Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jürgen Maurer
- Faculty of Business and Economics (HEC), University of Lausanne, Switzerland
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3
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Demirkapu H, Van den Block L, De Maesschalck S, De Vleminck A, Colak FZ, Devroey D. Advance care planning among older adults in Belgium with Turkish backgrounds and palliative care needs: A qualitative interview study. Eur J Gen Pract 2023; 29:2271661. [PMID: 37870049 PMCID: PMC10990253 DOI: 10.1080/13814788.2023.2271661] [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: 02/10/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Data on advance care planning (ACP) among migrants in Europe is lacking. Research has shown that few older migrants in the United States perform ACP due to healthcare system distrust, collectivistic values and spirituality/religion. OBJECTIVES To explore the ACP knowledge and perspectives of older Turkish-origin adults in Belgium requiring palliative care. METHOD General practitioners (GPs) in Brussels and Antwerp recruited Turkish-origin participants aged ≥ 65 years with palliative care eligibility for this qualitative study. A GP conducted semi-structured interviews in Turkish in respondents' homes between May 2019 and February 2022 using a topic guide. Two researchers performed combined inductive/deductive thematic data analysis. RESULTS All 15 interviewees (average age, 79 years) lacked ACP awareness and information. Some had discussed specific end-of-life preferences (e.g. care location, burial place) with family. Still, many did not feel the need to discuss future healthcare preferences, due mainly to trust in God and family for caretaking and decision-making. Some respondents viewed ACP discussions as applicable, relieving the burden on family and enabling proactive addressing of 'what if' questions. Self-identified ACP barriers were fear of making wrong decisions, 'living in the moment' and difficulty discussing death. Facilitators were obtaining sufficient ACP information and recent family illness or death. CONCLUSION Our sample of Turkish-origin older adults in Belgium requiring palliative care lacked ACP knowledge. Our findings suggest that their lack of engagement in discussing end-of-life medical care planning was linked to their family dynamics and religion. The findings have implications for healthcare providers to ethnic-minority groups.
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Affiliation(s)
- Hakki Demirkapu
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels and Ghent, Belgium
| | | | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels and Ghent, Belgium
| | - F. Zehra Colak
- Department of Education, University of Utrecht, Utrecht, The Netherlands
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel [VUB], Brussels, Belgium
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Jang JE, Ryu JM, Heo MH, Kwon DE, Seo JY, Kim DY. Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment: A Focus on Deceased Patients with Hematologic Neoplasms. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2023; 26:69-79. [PMID: 37753507 PMCID: PMC10519723 DOI: 10.14475/jhpc.2023.26.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 09/28/2023]
Abstract
Purpose This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.
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Affiliation(s)
- Jae Eun Jang
- Hematology Intensive Care Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Jeong Moon Ryu
- Hematology Intensive Care Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Min Hee Heo
- Hematology Intensive Care Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Do Eun Kwon
- Hematology Intensive Care Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Ji Yeon Seo
- Hematology Intensive Care Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Dong Yeon Kim
- Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
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De Brauwer I, Henrard S, Baeyens H, Van Den Noortgate N, De Saint-Hubert M, Piers R. Palliative profile, one-year mortality and quality of life in older inpatients according to Be-PICT: a multicenter prospective cohort study. Acta Clin Belg 2023; 78:16-24. [PMID: 35293853 DOI: 10.1080/17843286.2022.2053812] [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: 01/18/2023]
Abstract
BACKGROUND A palliative care approach (PCA), including advanced care planning (ACP), should be considered for patients with limited life expectancy. The Belgian Palliative Care Indicators Tool (Be-PICT) has been released to help identify patients who may benefit from such approach. This study aimed at measuring 1-year mortality and describe the quality of life in older inpatients, according to baseline Be-PICT results. METHODS Prospective multicentre cohort study in older patients (≥ 75 years) admitted at geriatrics and cardiology wards of four Belgian hospitals. The palliative profile was defined as a positive Be-PICT.1, defined by the presence of its three criteria, i.e. a negative physician's answer to the surprise question 'would you be surprised if this patient dies in the 6-12 next months?', ≥ 1 poor health indicator and ≥ 1 life-limiting condition. RESULTS Of the 379 patients (50% aged ≥85 years; 51% female), 52 (14%) presented a palliative profile and 83 (23%) died within 1 year. Be-PICT.1 showed the following characteristics to predict 1-year mortality: sensitivity 0.54, specificity 0.83, positive and negative predictive values 0.48 and 0.86, positive and negative likelihood ratios 3.22 and 0.55. The patients with a palliative profile were at higher mortality risk (hazard ratio 4.79 p < 0.001) and 1-year mortality rate (45%). Not using the SQ allowed to improve sensitivity to include a larger number of patients who may benefit from ACP and PCA. CONCLUSIONS Be-PICT.1 is a simple case-finding tool to identify older inpatients being at high mortality risk and candidates for ACP and PCA.
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Affiliation(s)
- Isabelle De Brauwer
- Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Institute of Health and Society, UCLouvain, Bruxelles, Belgium
| | - Séverine Henrard
- Institute of Health and Society, UCLouvain, Bruxelles, Belgium.,Louvain Drug Research Institute, UCLouvain, Bruxelles, Belgium
| | - Hilde Baeyens
- Department of Geriatric Medicine, AZ Alma Campus Eeklo, Eeklo, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Marie De Saint-Hubert
- Institute of Health and Society, UCLouvain, Bruxelles, Belgium.,Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Namur, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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Preferred Place of End-of-Life Care Based on Clinical Scenario: A Cross-Sectional Study of a General Japanese Population. Healthcare (Basel) 2023; 11:healthcare11030406. [PMID: 36766981 PMCID: PMC9914905 DOI: 10.3390/healthcare11030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
In Japan, which has an aging society with many deaths, it is important that people discuss preferred place for end-of-life care in advance. This study aims to investigate whether the preferred place of end-of-life care differs by the assumed clinical scenario. This clinical scenario-based survey used data from a nationwide survey conducted in Japan in December 2017. Participants aged 20 years and older were randomly selected from the general population. The survey contained questions based on three scenarios: cancer, end-stage heart disease, and dementia. For each scenario, respondents were asked to choose the preferred place of end-of-life care among three options: home, nursing home, and medical facility. Eight hundred eighty-nine individuals participated in this study (effective response rate: 14.8%). The proportions of respondents choosing home, nursing home, and medical facility for the cancer scenario were 49.6%, 10.9%, and 39.5%, respectively; for the end-stage heart disease scenario, 30.5%, 18.9%, and 50.6%; and for the dementia scenario, 15.2%, 54.5%, and 30.3% (p < 0.0001, chi-square test). The preferred place of end-of-life care differed by the assumed clinical scenario. In clinical practice, concrete information about diseases and their status should be provided during discussions about preferred place for end-of-life care to reveal people's preferences more accurately.
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7
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Polacsek M, Porter T. Facilitating advance care planning in the thriving retirement village setting. Australas J Ageing 2022. [DOI: 10.1111/ajag.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
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van der Plas AGM, Schellekens JEAP, Glaudemans JJ, Onwuteaka-Philipsen BD. The patient’s relationship with the General Practitioner before and after Advance Care Planning: pre/post-implementation study. BMC Geriatr 2022; 22:558. [PMID: 35790910 PMCID: PMC9254656 DOI: 10.1186/s12877-022-03256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background General Practitioners (GPs) are central in the care of Dutch older people and in a good position to have Advance Care Planning (ACP) conversations. Interview studies reveal that the doctor-patient relationship is important when initiating ACP conversations and can also be influenced by ACP conversations. We aimed to examine the association between having an ACP conversation and the patient feeling the GP knows him or her and the patient trusting the GP and vice versa. Methods Implementation of ACP in primary care was evaluated in a pre-and post design. Questionnaires before implementation of ACP and 14 months later were sent to patients aged 75 years or older within 10 GP-practices and 2 care homes. Multivariable logistic regression was used to model the relationship between ACP conversations during implementation and the patient-GP relationship before implementation. Odds ratios were adjusted for potential confounders. Generalized ordered logistic regression was used to model the relationship between the changes in patient-GP relationship before and after implementation and ACP conversations during implementation. Results Four hundred fifty-eight patients filled out the pre- and post-test questionnaire. There was no association between the GP knowing the patient and trust in the pre-test and having an ACP conversation during the implementation. For people who had had an ACP conversation at the end of the implementation period their trust remained more often the same or was higher after implementation (trust to provide good care OR 2.93; trust to follow their wishes OR 2.59), compared to patients who did not have an ACP conversation. A reduction in trust was less likely to happen to patients who had an ACP conversation compared to patients who did not have an ACP conversation. Conclusions Although we have not found evidence for trust as a prerequisite for ACP conversations, this paper shows that ACP conversations can be beneficial for the doctor—patient relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03256-4.
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Maniam R, Tan MP, Chong MC. End of life care preference among hemodialysis population: Revisit Q methodology. PATIENT EDUCATION AND COUNSELING 2022; 105:1495-1502. [PMID: 34625322 DOI: 10.1016/j.pec.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. METHODS The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. RESULTS Four-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. CONCLUSIONS End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. PRACTICE IMPLICATION Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.
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Affiliation(s)
- Radha Maniam
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Bekker YAC, Suntjens AF, Engels Y, Schers H, Westert GP, Groenewoud AS. Advance care planning in primary care: a retrospective medical record study among patients with different illness trajectories. BMC Palliat Care 2022; 21:21. [PMID: 35152892 PMCID: PMC8842525 DOI: 10.1186/s12904-022-00907-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Advance Care Planning (ACP) enables physicians to align healthcare with patients’ wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice.
Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice.
Methods
We chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and general practitioner (GP), and healthcare utilization in the last 2 years of life.
Results
In 65% of the records, one or more ACP items were registered by the GP. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death (inter-quartile range (IQR) 30–316). ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0.000). Patients with cancer had the most frequent (median 3 times, IQR 2–5) and extensive (median 5 items, IQR 2–7) ACP consultations.
Conclusion
Documentation of ACP items in medical records by GPs is present, however limited, especially in patients with multimorbidity or organ failure. We recommend more attention for – and documentation of – ACP in daily practice, in order to start anticipatory conversations in time and address the needs of all people living with advanced conditions in primary care.
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Ke LS, Hu WY, Dai YT, Chen CY. The Differences and Perspectives Between Elderly Individuals and Their Surrogates Regarding End-of-Life Care: A Mixed Methods Study. Am J Hosp Palliat Care 2022; 39:1061-1070. [PMID: 35139645 DOI: 10.1177/10499091211052853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Family members often take the place of decision-making for elderly individuals. Previous studies showed that family members could not predict elderly individuals' thoughts about end-of-life care. Objectives: The aims are to understand the differences and perspectives between elderly individuals and surrogates regarding end-of-life care. Design: A mixed methods study comprising a cross-sectional survey and field notes analysis. Setting: Two geriatric wards in a veterans hospital located in northern Taiwan. Subjects: Fifty-five pairs of elderly individuals and their surrogates. Measurements: Life support preferences questionnaire and field notes. Results: The quantitative data showed that the elderly individuals and their surrogates had proper consistency in cardiopulmonary resuscitation and surgery. However, their consistency was poor in antibiotics and nasogastric tube feeding. Four themes were identified in qualitative data: recognizing old age, struggling with hope and peace, worries and concerns, and control of life. Recognizing old age for both elderly individuals and their surrogates was critical. Elderly individuals and their surrogates may seek a ray of hope among aggressive treatments and struggle with hope and peace. A lot of worries and concerns were mentioned, including contextual concerns. Elderly individuals need to depend on their ability to control their life. Conclusions: The study highlights elderly individuals' and their surrogates' considerations for antibiotics and nasogastric tube feeding. Furthermore, elderly individuals expressed that it is different for making decisions for themselves or others; thus, future studies can further explore whether elderly individuals allow their surrogates leeway from their wishes.
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Affiliation(s)
- Li-Shan Ke
- School of Nursing, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Nursing, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine, 33561National Taiwan University, Taipei, Taiwan.,Department of Nursing, 38006National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tzu Dai
- School of Nursing, College of Medicine, 33561National Taiwan University, Taipei, Taiwan
| | - Ching-Yu Chen
- College of Medicine, 33561National Taiwan University, Taipei, Taiwan
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Kinley J, Flemming K. Understanding what is important to older people living with frailty in relation to advance care planning. Int J Palliat Nurs 2021; 27:471-480. [PMID: 34846935 DOI: 10.12968/ijpn.2021.27.9.471] [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: 11/11/2022]
Abstract
BACKGROUND Advance care planning (ACP) provides opportunities for people to make decisions about future care. Internationally, the approach to this varies. Older people living with frailty could considerably benefit from discussing and undertaking advance care planning. However, this has not traditionally been a particular focus of their care. AIM To provide recommendations to support nurses and health professionals to undertake ACP conversations with older people living with frailty through a review of contemporary literature. METHODS The following electronic databases were searched: CINAHL, British Nursing Index and the Cochrane Library. Information about the process and outcome of undertaking an ACP conversation with older people living with frailty was extracted and categorised in relation to care setting. FINDINGS A total of 69 papers were identified, of which eight met the inclusion criteria. The importance of preparation before starting an ACP conversation was highlighted, as well as key considerations when undertaking such a conversation. From these papers five clinical recommendations, one policy recommendation and two research recommendations are made. CONCLUSIONS Maintaining and improving wellness is important to older people living with frailty. In order that conversations about ACP are acceptable and meaningful to older people living with frailty, they should include: the opportunity to discuss both 'current' and 'future' care; be focused on their goals of care; and, to be offered routinely to the older person.
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Affiliation(s)
- Julie Kinley
- Research and Clinical Innovation Project Lead, Hospice UK
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Factors associated with willingness to complete advance directives in older adults. Geriatr Nurs 2021; 42:1042-1047. [PMID: 34256154 DOI: 10.1016/j.gerinurse.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
This study aimed to examine the factors associated with willingness to complete advance directives (ADs) in community-dwelling older adults. In total, 121 community-dwelling older adults in Korea completed the questionnaires inquiring about their willingness and perceptions in completing ADs (susceptibility, severity, benefits, barriers, and cues to action), which were based on the Health Belief Model. The mean score for willingness to complete ADs was 6.2 (SD = 3.6). A multiple linear regression analysis showed that higher scores of perceived severity (β = 0.199, p = 0.021), perceived benefits (β = 0.221, p = 0.016), and cues to action (β = 0.159, p = 0.030) were associated with a greater willingness to complete ADs. However, higher scores of perceived barriers (β = -0.409, p < 0.001) were likely to lower the willingness to complete ADs. This study highlights that future interventions aimed at increasing AD completion rates in older adults should consider improving perceived severity, benefits, and cues to action and minimizing perceived barriers.
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Lin LH, Cheng HC, Chen YC, Chien LY. Effectiveness of a video-based advance care planning intervention in hospitalized elderly patients: A randomized controlled trial. Geriatr Gerontol Int 2021; 21:478-484. [PMID: 33860972 DOI: 10.1111/ggi.14158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to develop a video-based advance care planning intervention, and examine the effectiveness of the intervention on knowledge, behavioral intentions and advance directive signing among older patients admitted to a geriatric unit in Taiwan. METHODS This randomized controlled trial was carried out in two geriatric wards of a medical center in northern Taiwan, between June 2014 and June 2015. The participants were randomly assigned to the intervention (n = 39) or control (n = 43) group. Participants in the intervention group watched a 5-min video regarding advance care planning. The control group received usual care. Structured questionnaires on advance care planning knowledge and behavioral intentions were administered to both groups before and after the intervention. Advance directive signing was carried out until 2 weeks after hospital discharge through a chart review. RESULTS The intervention group showed a significantly higher advance care planning knowledge score and behavioral intention score than the control group post-intervention. The rate of advance directive signing was 33.3% in the intervention group and 9.3% in the control group (P = 0.01). CONCLUSIONS This study showed the effectiveness of video-based interventions in increasing advance care planning knowledge, behavioral intention and advance directive signing among hospitalized older patients. Geriatric wards could use our model to promote advance care planning among older patients. Geriatr Gerontol Int 2021; 21: 478-484.
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Affiliation(s)
- Li-Hwa Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chuan Cheng
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Chih Chen
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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15
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Ke LS, Hu WY, Chen CY, Liu CY, Chiu TY. A quasi-experimental evaluation of advance care planning improves consistency between elderly individuals and their surrogates regarding end-of-life care preferences: Development and application of a decision aid with cartoon pictures. PATIENT EDUCATION AND COUNSELING 2021; 104:815-825. [PMID: 33010998 DOI: 10.1016/j.pec.2020.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study sought to develop a decision aid with cartoon pictures and evaluate its effectiveness in increasing consistency between elderly individuals and their surrogates regarding end-of-life care. METHODS A pre-post quasi-experimental design was adopted using the Life Support Preferences Questionnaire. The intervention had two components: (1) increasing participants' knowledge of medical treatments related to end-of-life care, and (2) sharing their end-of-life wishes. The experimental group received an intervention, whereas the control group received usual care. RESULTS A total of 110 participants in 55 pairs of elderly individuals with average aged 86.4 and their surrogates (27 in the experimental group, 28 in the control group) were recruited from a veterans hospital in northern Taiwan. Nearly 90 % of elderly individuals were male. The multiple linear regression showed that the inconsistent gap between elderly individuals and their surrogates in the experimental group decreased 12 points than the control group after controlling the covariances (B = -12.116, p = 0.032). CONCLUSION The intervention improved the consistency between elderly individuals and their surrogates regarding end-of-life care. PRACTICE IMPLICATIONS A decision aid with cartoon pictures may support the discussion of end-of-life care in older Asian populations.
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Affiliation(s)
- Li-Shan Ke
- National Taipei University of Nursing and Health Sciences, School of Nursing, Taipei, Taiwan; Taipei Veterans General Hospital, Department of Nursing, Taipei, Taiwan; National Taiwan University, College of Medicine, School of Nursing, Taipei, Taiwan.
| | - Wen-Yu Hu
- National Taiwan University, College of Medicine, School of Nursing, Taipei, Taiwan; National Taiwan University Hospital, Department of Nursing, Taipei, Taiwan
| | - Ching-Yu Chen
- National Taiwan University, College of Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Family Medicine, Taipei, Taiwan
| | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences, Department of Speech Language Pathology and Audiology, Taipei, Taiwan
| | - Tai-Yuan Chiu
- National Taiwan University, College of Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Family Medicine, Taipei, Taiwan
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16
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Hickman SE, Torke AM, Sachs GA, Sudore RL, Tang Q, Bakoyannis G, Heim Smith N, Myers AL, Hammes BJ. Factors associated with concordance between POLST orders and current treatment preferences. J Am Geriatr Soc 2021; 69:1865-1876. [PMID: 33760241 DOI: 10.1111/jgs.17095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance. OBJECTIVES To describe POLST preference concordance and identify factors associated with concordance. DESIGN Chart reviews to document existing POLST orders and interviews to elicit current treatment preferences. SETTING POLST-using nursing facilities (n = 29) in Indiana. PARTICIPANTS Nursing facility residents (n = 123) and surrogates of residents without decisional capacity (n = 152). MEASUREMENTS Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition. RESULTS Overall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n = 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p < 0.001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01-1.07, p < 0.01), better cognitive functioning (OR 1.07, 95% CI 1.02-1.13, p < 0.01), surrogate as the decision-maker (OR 2.87, OR 1.73-4.75, p < 0.001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29-11.00, p < 0.01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59-10.73, p < 0.01). CONCLUSIONS Less than half of all POLST forms were concordant with current preferences, but POLST was over five times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.
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Affiliation(s)
- Susan E Hickman
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA.,Research in Palliative and End-of-Life Communication & Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA.,Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Alexia M Torke
- Research in Palliative and End-of-Life Communication & Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA.,Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Greg A Sachs
- Research in Palliative and End-of-Life Communication & Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA.,Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Rebecca L Sudore
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Qing Tang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Giorgos Bakoyannis
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Nicholette Heim Smith
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Anne L Myers
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Bernard J Hammes
- A Division of C-TAC Innovations, Respecting Choices, La Crosse, Wisconsin, USA
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17
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Frechman E, Dietrich MS, Walden RL, Maxwell CA. Exploring the Uptake of Advance Care Planning in Older Adults: An Integrative Review. J Pain Symptom Manage 2020; 60:1208-1222.e59. [PMID: 32645455 PMCID: PMC7342022 DOI: 10.1016/j.jpainsymman.2020.06.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Advance care planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older adults may identify barriers and facilitators. OBJECTIVE To conduct an integrative review of research on the uptake of ACP in older adults and create a conceptual model of the findings. METHODS Using Whittemore and Knafl's methodology, we systematically searched four electronic databases of ACP literature in older adults from 1996 through December 2019. Critical appraisal tools were used to assess study quality, and articles were categorized according to level of evidence. Statistical and thematic analysis was then undertaken. RESULTS Among 1081 studies, 78 met inclusion criteria. Statistical analysis evaluated ACP and variables within the domains of demographics, psychosocial, disability and functioning, and miscellaneous. Thematic analysis identified a central category of enhanced communication, followed by categories of 1) provider role and preparation; 2) patient/family relationship patterns; 3) standardized processes and structured approaches; 4) contextual influences; and 5) missed opportunities. A conceptual model depicted categories and relationships. CONCLUSIONS Enhanced communication and ACP facilitators improve uptake of ACP. Clinicians should be cognizant of these factors. This review provides a guide for clinicians who are considering implementation strategies to facilitate ACP in real-world settings.
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Affiliation(s)
- Erica Frechman
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA.
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee, USA
| | - Rachel Lane Walden
- Vanderbilt University Eskind Biomedical Library, Nashville, Tennessee, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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18
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Glaudemans JJ, Willems DL, Wind J, Onwuteaka Philipsen BD. Preventing unwanted situations and gaining trust: a qualitative study of older people and families' experiences with advance care planning in the daily practice of primary care. Fam Pract 2020; 37:519-524. [PMID: 31816034 PMCID: PMC7474529 DOI: 10.1093/fampra/cmz089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Using advance care planning (ACP) to anticipate future decisions can increase compliance with people's end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. OBJECTIVE To explore older people's and their families' experiences with ACP in primary care. METHODS We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40-79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. RESULTS We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners' (GPs') time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents' views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. CONCLUSIONS Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs' interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.
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Affiliation(s)
- Jolien J Glaudemans
- Section of Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jan Wind
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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19
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Dunleavy L, Walshe C, Machin L. Exploring the psychological impact of life-limiting illness using the Attitude to Health Change scales: A qualitative focus group study in a hospice palliative care setting. Eur J Cancer Care (Engl) 2020; 29:e13302. [PMID: 32881122 DOI: 10.1111/ecc.13302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Practitioners are often reluctant to engage in conversations that acknowledge patient's health concerns. This can affect patient and family carer psychological well-being. The Attitude to Health Change scales, adapted from the validated Adult Attitude to Grief scale, may have potential to address the psychological impact of illness and facilitate conversations in palliative care. To explore how health and social care professionals experience using the Attitude to Health Change Scales within hospice settings. METHODS Qualitative focus groups with practitioners currently using the Attitude to Health Change scales in three UK hospices. Two researchers conducted the interviews, developed the thematic framework and independently coded the transcripts using a framework analysis approach. RESULTS Three focus groups (n = 21 practitioners). The scale was used to assess and reassess levels of vulnerability and resilience to identify the need for support and to facilitate structured in-depth conversations. Factors that influenced scale implementation included the following: practitioner personal comfort and training; patient and family carer willingness to engage with the scales and having a practitioner "champion" within the organisation. CONCLUSION This exploratory work has identified the potential value of the scales for assessment and to facilitate conversations. Further research needs to incorporate the views of patients and family carers.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Linda Machin
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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20
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Kermel-Schiffman I, Werner P. Beliefs of Israeli Family Caregivers of People with Dementia toward Advance Care Planning. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:250-265. [PMID: 32251608 DOI: 10.1080/15524256.2020.1745729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Family caregivers of people with dementia often must make crucial medical decisions for them that may increase the burden of care experienced. Although undertaking Advance Care Planning (ACP) might reduce their decision-making burden, completion rates remain very low. The present study aimed to explore the common beliefs of family caregivers of people with dementia about undertaking ACP for themselves. A qualitative study was conducted, using a semi-structured questionnaire based on the Theory of Planned Behavior. Face-to-face interviews were conducted with a convenience sample of 20 family caregivers of people with dementia in Israel. The behavioral beliefs expressed by the participants referred to the dual benefits of ACP, for the person who will not be able to make medical decisions at the end of life and for themselves. Participants mentioned that family members and friends were the main persons with whom they would consult in making decisions regarding ACP. Personal characteristics and instrumental factors were mentioned as enablers and barriers to undertaking ACP. Findings from the study provide an important basis for expanding research and for developing interventions that can encourage undertaking ACP.
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Affiliation(s)
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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21
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Fleuren N, Depla MFIA, Janssen DJA, Huisman M, Hertogh CMPM. Underlying goals of advance care planning (ACP): a qualitative analysis of the literature. BMC Palliat Care 2020; 19:27. [PMID: 32143601 PMCID: PMC7059342 DOI: 10.1186/s12904-020-0535-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
Background Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. These studies show a heterogeneity in clinical endpoints, which reflects diversity of goals connected to ACP. This study aims to get insight in the range of underlying goals that comprise the legitimacy of ACP. Methods Systematic literature search in PubMed, EMBASE, PsychInfo, CINAHL and Cochrane Library. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full text document analysis. Analysis stopped once saturation was reached. Results In total, 6497 unique articles were found of which 183 were included. Saturation was reached after document analysis of 55 articles (30%); this yielded 141 codes concerning goals of ACP and also 70 codes about objections against ACP, which shed light on the underlying goals of ACP as well. We identified five underlying goals: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, reducing overtreatment. Conclusions Five distinctive underlying goals of ACP were identified, each with corresponding objections that need to be considered. Specifying underlying goals of ACP may direct the debate on definitions, methods and preferred outcomes of ACP. This study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002.
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Affiliation(s)
- Nienke Fleuren
- General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Marja F I A Depla
- General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daisy J A Janssen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,CIRO, Research and Development, Horn, The Netherlands
| | - Martijn Huisman
- Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Vrije Universiteit Amsterdam, Faculty of Sociology, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Advance Care Planning to Improve End-of-Life Decision-Making Consistency between Older People and Their Surrogates in Taiwan. J Palliat Med 2020; 23:325-336. [DOI: 10.1089/jpm.2019.0277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Abstract
Introduction: Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce institutionalization. This article explores the preferences and wishes of patients in terms of advance care planning. Methods: CINAHL, Medline, Embase and Pubmed were searched. Key words included ‘elderly’, ‘advance care planning’, ‘advance directive’, ‘views’ and ‘opinions’. Results: A total of 64 abstracts were screened and 20 full text articles read; 11 articles were included in the final study. Individual and cultural differences influence the level of decision making that patients want. Most studies agreed that conversations should be carried out opportunistically by a trained health-care professional. Patients value honest and open conversations, without which they may make misinformed decisions. Conclusions: The level of shared decision making that individuals personally want should be established. Open and honest conversations should be initiated at the earliest opportunity.
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Affiliation(s)
- Lucy Owen
- Junior Clinical Fellow, Department of Elderly Medicine, Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet EN5 3DJ
| | - Anna Steel
- Registrar, Department of Elderly Medicine, North Middlesex University Hospital, London
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24
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de Vries K, Banister E, Dening KH, Ochieng B. Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy. Nurs Ethics 2019; 26:1946-1954. [PMID: 30943848 DOI: 10.1177/0969733019833130] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.
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Groebe B, Rietz C, Voltz R, Strupp J. How to Talk About Attitudes Toward the End of Life: A Qualitative Study. Am J Hosp Palliat Care 2019; 36:697-704. [PMID: 30871338 DOI: 10.1177/1049909119836238] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To individually plan end-of-life care, open communication about a person's preferences and attitudes toward the end of life can facilitate dignity and quality of life in patients and relatives. To improve communication, structured guiding tools might be used as door openers. However, most tools focus on care preferences and decisions without assessing the person's underlying attitudes in detail. This study aims to get insights into specific requirements and conditions for communication about the end of life in various end-of-life care settings. Four focus groups were conducted with volunteers and professionals from nursing and psychosocial care (16 females, 2 males) working in hospice and palliative care and long-term care settings in Germany. A semistructured interview guideline on experiences and aspects associated with end-of-life conversations was used. Interviews were audiotaped, transcribed verbatim, and analyzed by a content analytic approach. Having end-of-life discussions primarily depended on a pleasant atmosphere, trusting bonds between conversation partners, and professional attitudes of staff members. Nursing home staff felt obligated to initiate conversations, but some reported insecurities doing so. Starting "early," including relatives, and having continuous discussions seemed beneficial for end-of-life conversations. Implementing conversations into existing care structures and using low-threshold impulses to start conversations were helpful. Individualized approaches should be preferred. Each staff member can be a partner in detailed conversations about end-of-life attitudes, but some felt unprepared doing so. Further skill training concerning end-of-life discussions is needed. Communication might be facilitated by open-format tools using low-threshold impulses when conditions of the care setting are considered.
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Affiliation(s)
- Bernadette Groebe
- 1 Doctoral Programme "Gerontological Research on Well-Being," University of Cologne, Köln, Germany.,2 Department of Palliative Medicine, Medical Faculty of the University of Cologne, Köln, Germany
| | - Christian Rietz
- 3 Department of Educational Science, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- 2 Department of Palliative Medicine, Medical Faculty of the University of Cologne, Köln, Germany.,4 Centre for Health Services Research Cologne, Faculty of Human Sciences and Medical Faculty of the University of Cologne, Köln, Germany.,5 Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty of the University of Cologne, Köln, Germany.,6 Clinical Trials Centre Cologne, Medical Faculty of the University of Cologne, Köln, Germany
| | - Julia Strupp
- 2 Department of Palliative Medicine, Medical Faculty of the University of Cologne, Köln, Germany
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26
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Rahemi Z, Dunphy LM, Newman D. Preferences Regarding and Communication About End-of-Life Care Among Older Iranian-American Adults. West J Nurs Res 2019; 41:1499-1516. [DOI: 10.1177/0193945919832304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using a cross-sectional study, this article addresses end-of-life (EOL) care for older Iranian-American adults. The purposes are twofold: (a) to explore participants’ preferences for home or hospital care in the event they face EOL conditions and (b) to learn how participants prefer to communicate these preferences. Results showed that about half of the 130 participants had communicated their EOL care preferences through written documents and/or verbal discussions. A set of factors predicted the preferences (χ2(9) = 17.42, p < .042) and communications (χ2(9) = 19.54, p = .021). Regression models indicated that higher scores of social support ( p = .013) and greater numbers of cohabitants ( p = .021) were associated with a preference for home care, and experience of a loved one’s death was associated with participants being willing to communicate their preferences for type of care ( p = .015). This study can bridge the gap between culturally diverse older adults’ preferences and types of EOL care they ultimately receive.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, Greenville, SC, USA
| | | | - David Newman
- Florida Atlantic University, Boca Raton, FL, USA
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27
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Nakazato K, Wakui T, Hirayama R, Shimada C. [Factors related to parent-child communication about end-of-life care -A survey of adult children with an elderly parent]. Nihon Ronen Igakkai Zasshi 2018; 55:378-385. [PMID: 30122704 DOI: 10.3143/geriatrics.55.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In Japan, because adult children are expected to perform a key role in decision-making on end-of-life care for older adults, conversing with parents on their wished-for end-of-life care can help these children to become prepared for this filial responsibility. Our aim in this study was to explore how likely Japanese adult children were to discuss end-of-life care with their parents as well as correlates of such discussions. METHODS We conducted an online survey using a sample of 1,590 adult children with at least one living parent aged 65 or older. We analyzed data from 1,010 children who responded during three consecutive days in October, 2015. RESULTS A small portion of our participants (22.8%) had discussed end-of-life care with their parents. Logistic regression analysis revealed that such discussions were likely in son-mother (Odds Ratio 〈OR〉 = 3.01) and daughter-mother (OR = 3.15) dyads compared with son-father ones as the reference. Occurrence of such discussions was also associated with having older parents (OR = 1.03), parental experience of severe diseases (OR = 1.47), parent-child coresiding (OR = 2.08), a higher level of perceived necessity for (OR = 1.36) and a lower level of emotional avoidance of (OR = 0.68) end-of-life communication. CONCLUSION Generally, adult children rarely discuss end-of-life care with their aging parents, suggesting the need to promote such familial communication while considering both children's and parents' circumstances.
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Menon S, Kars MC, Malhotra C, Campbell AV, van Delden JJM. Advance Care Planning in a Multicultural Family Centric Community: A Qualitative Study of Health Care Professionals', Patients', and Caregivers' Perspectives. J Pain Symptom Manage 2018; 56:213-221.e4. [PMID: 29775694 DOI: 10.1016/j.jpainsymman.2018.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Advance care planning (ACP) has been shown to improve end-of-life care, but it was developed in the U.S., and most research has been conducted in western communities. OBJECTIVES We aimed to study the attitudes and perceptions of patients with life-limiting illnesses, informal caregivers, doctors, nurses, and medical social workers regarding ACP in a multicultural family centric community. METHODS We conducted an explorative qualitative study, using focus groups and individual in-depth interviews. We used purposive sampling techniques to recruit 61 adults (15 doctors, 13 nurses, 5 medical social workers, 15 patients, and 13 caregivers) from multiple health care settings across the country. RESULTS The participants are genuinely anxious about the implementation of ACP. They had positive and negative expectations of ACP. Many were confused about the legal framework for health care decision-making and expected ACP to be of limited value because family members, rather than the patient, were usually the key decision makers. CONCLUSION A nuanced approach to ACP that considers the family network is required in multicultural family centric communities. Policies should be reconciled to create a more consistent message that respects patients, the family, and is legally coherent. Further research could focus on adaptations of ACP to promote its acceptance in such communities.
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Affiliation(s)
- Sumytra Menon
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Alastair V Campbell
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, Steeman E, Dillen L, Vanden Berghe P, Van den Block L. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care 2018; 17:88. [PMID: 29933758 PMCID: PMC6014017 DOI: 10.1186/s12904-018-0332-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’s preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Methods Following the Belgian Centre for Evidence-Based Medicine’s procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Results Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. Conclusion No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Gwenda Albers
- Flanders Federation for Palliative Care, Vilvoorde, Belgium
| | - Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium.,Flemish Expertise Centre on Dementia Care, Antwerp, Belgium
| | - Wouter Van Mechelen
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Els Steeman
- Academic Centre for Nursing and Midwifery, KULeuven, Leuven, Belgium
| | - Let Dillen
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
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Groebe B, Strupp J, Eisenmann Y, Schmidt H, Schlomann A, Rietz C, Voltz R. Measuring attitudes towards the dying process: A systematic review of tools. Palliat Med 2018; 32:815-837. [PMID: 29323618 DOI: 10.1177/0269216317748889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND At the end of life, anxious attitudes concerning the dying process are common in patients in Palliative Care. Measurement tools can identify vulnerabilities, resources and the need for subsequent treatment to relieve suffering and support well-being. AIM To systematically review available tools measuring attitudes towards dying, their operationalization, the method of measurement and the methodological quality including generalizability to different contexts. DESIGN Systematic review according to the PRISMA Statement. Methodological quality of tools assessed by standardized review criteria. DATA SOURCES MEDLINE, PsycINFO, PsyndexTests and the Health and Psychosocial Instruments were searched from their inception to April 2017. RESULTS A total of 94 identified studies reported the development and/or validation of 44 tools. Of these, 37 were questionnaires and 7 alternative measurement methods (e.g. projective measures). In 34 of 37 questionnaires, the emotional evaluation (e.g. anxiety) towards dying is measured. Dying is operationalized in general items ( n = 20), in several specific aspects of dying ( n = 34) and as dying of others ( n = 14). Methodological quality of tools was reported inconsistently. Nine tools reported good internal consistency. Of 37 tools, 4 were validated in a clinical sample (e.g. terminal cancer; Huntington disease), indicating questionable generalizability to clinical contexts for most tools. CONCLUSION Many tools exist to measure attitudes towards the dying process using different endpoints. This overview can serve as decision framework on which tool to apply in which contexts. For clinical application, only few tools were available. Further validation of existing tools and potential alternative methods in various populations is needed.
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Affiliation(s)
- Bernadette Groebe
- 1 Doctoral Programme GROW 'Gerontological Research on Well-Being', University of Cologne, Cologne, Germany.,2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Julia Strupp
- 2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Yvonne Eisenmann
- 2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Schmidt
- 2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Schlomann
- 1 Doctoral Programme GROW 'Gerontological Research on Well-Being', University of Cologne, Cologne, Germany.,3 Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Christian Rietz
- 4 Department of Educational Science, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- 2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,5 Centre for Health Services Research of Cologne, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.,6 Centre for Integrated Oncology Cologne/Bonn (CIO), Faculty of Medicine, University of Cologne, Cologne, Germany.,7 Clinical Trials Centre Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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Discussing advance care planning: insights from older people living in nursing homes and from family members. Int Psychogeriatr 2018; 30:569-579. [PMID: 28988561 DOI: 10.1017/s1041610217001983] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP. METHODS This was a qualitative study using face-to-face interviews with 30 residents (age range 66-94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis. RESULTS Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents' concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives. CONCLUSIONS ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.
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de Vries K, Drury-Ruddlesden J. Advance care planning for people with dementia: Ordinary everyday conversations. DEMENTIA 2018; 18:3023-3035. [PMID: 29566541 DOI: 10.1177/1471301218764169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Advance care planning for people with dementia has become a focus of dementia care policies in developed countries. In New Zealand, the framework for dementia care relies on the person with dementia having a level of competence to enable them to participate in the planning process. For people with dementia, it may be too late to initiate these discussions in terms of decision-making capacity. Consequently, decisions about end-of-life care for people with dementia are typically made by a family member who acts as a surrogate decision maker on behalf of the person with dementia. An exploratory qualitative study of 23 people who had been carers or provided support for a family member with dementia who had died within five years of the interview was undertaken. The overarching theme, ‘ordinary everyday conversations’, describes how informal conversations and discussions within the family relating to preferences at the end of life had been embedded in interactions within the families over years. Sub-themes revealed three important components enabling adherence to the prior wishes of the person with dementia through these conversations: knowing the person and belief in ‘doing the right thing’; the importance of Wills and Enduring Power of Attorney; and negotiating unexpected encounters. There is potential for families to be well prepared for the time when they may need to make decisions for the person with dementia based on ordinary everyday conversation that take place within families and throughout life. This study also suggests that more innovative approaches to making a Will may provide an important vehicle for expressing advanced care wishes.
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Affiliation(s)
- Kay de Vries
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, De Montfort University, The Gateway, Leicester, UK
| | - Jenny Drury-Ruddlesden
- Faculty of Health, Graduate School of Nursing, Midwifery and Health, Victoria University Wellington, Wellington, New Zealand
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Etkind SN, Bone AE, Lovell N, Higginson IJ, Murtagh FEM. Influences on Care Preferences of Older People with Advanced Illness: A Systematic Review and Thematic Synthesis. J Am Geriatr Soc 2018; 66:1031-1039. [PMID: 29512147 PMCID: PMC6001783 DOI: 10.1111/jgs.15272] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives To determine and explore the influences on care preferences of older people with advanced illness and integrate our results into a model to guide practice and research. Design Systematic review using Medline, Embase, PsychINFO, Web of Science, and OpenGrey databases from inception to February 2017 and reference and citation list searching. Included articles investigated influences on care preference using qualitative or quantitative methodology. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were undertaken. Setting Hospital and community care settings. Participants Older adults with advanced illness, including people with specific illnesses and markers of advanced disease, populations identified as in the last year of life, or individuals receiving palliative care (N = 15,164). Measurements The QualSys criteria were used to assess study quality. Results Of 12,142 search results, 57 articles were included. Family and care context, illness, and individual factors interact to influence care preferences. Support from and burden on family and loved ones were prominent influences on care preferences. Mechanisms by which preferences are influenced include the process of trading‐off between competing priorities, making choices based on expected outcome, level of engagement, and individual ability to form and express preferences. Conclusion Family is particularly important as an influence on care preferences, which are influenced by complex interaction of family, individual, and illness factors. To support preferences, clinicians should consider older people with illnesses and their families together as a unit of care.
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Affiliation(s)
- Simon N Etkind
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Natasha Lovell
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Brohard C. Initial Efficacy Testing of an Autobiographical Memory Intervention on Advance Care Planning for Patients With Terminal Cancer. Oncol Nurs Forum 2017; 44:751-763. [DOI: 10.1188/17.onf.751-763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tripken JL, Elrod CS. Young Adults’ Perspectives on Advance Care Planning. Am J Hosp Palliat Care 2017; 35:627-634. [DOI: 10.1177/1049909117727456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jennifer L. Tripken
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Cathy S. Elrod
- Department of Physical Therapy, Marymount University, Arlington, VA, USA
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36
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De Bock R, Van Den Noortgate N, Piers R. Validation of the Supportive and Palliative Care Indicators Tool in a Geriatric Population. J Palliat Med 2017; 21:220-224. [PMID: 28792787 DOI: 10.1089/jpm.2017.0205] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Timely identification of patients in need of palliative care is especially challenging in a geriatric population because of prognostic uncertainty. The Supportive and Palliative Care Indicators Tool (SPICT™) aims at facilitating this identification, yet has not been validated in a geriatric population. OBJECTIVE This study validates the SPICT in a geriatric patient population admitted to the hospital. DESIGN This is a retrospective cohort study. SETTING Subject were patients admitted to the acute geriatric ward of a Belgian university hospital between January 1 and June 30, 2014. MEASUREMENTS Data including demographics, functional status, comorbidities, treatment limitation decision (TLD), and one-year mortality were collected. SPICT was measured retrospectively by an independent assessor. RESULTS Out of 435 included patients, 54.7% had a positive SPICT, using a cut-off value of 2 for the general indicators and a cut-off value of 1 for the clinical questions. SPICT-positive patients were older (p = 0.033), more frequently male (p = 0.028), and had more comorbidities (p = 0.015) than SPICT-negative patients. The overall one-year mortality was 32.2%, 48.7% in SPICT-positive patients, and 11.5% in SPICT-negative patients (p < 0.001). SPICT predicted one-year mortality with a sensitivity of 0.841 and a specificity of 0.579. The area under the curve of the general indicators (0.758) and the clinical indicators of SPICT (0.748) did not differ (p = 0.638). In 71.4% of SPICT-positive cases, a TLD was present versus 26.9% in SPICT-negative cases (p < 0.001). CONCLUSION SPICT seems to be valuable for identifying geriatric patients in need of palliative care as it demonstrates significant association with one-year mortality and with clinical survival predictions of experienced geriatricians, as reflected by TLDs given.
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Affiliation(s)
- Reine De Bock
- 1 Faculty of Medicine and Health Science, Ghent University , Ghent, Belgium
| | | | - Ruth Piers
- 2 Department of Geriatrics, Ghent University Hospital , Ghent, Belgium
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Read S, MacBride-Stewart S. The ‘good death’ and reduced capacity: a literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/13576275.2017.1339676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Simon Read
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Ke LS, Huang X, Hu WY, O'Connor M, Lee S. Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies. Palliat Med 2017; 31:394-405. [PMID: 27515975 DOI: 10.1177/0269216316663507] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. AIM To understand the experiences and perspectives of older people regarding advance care planning. DESIGN A systematic review of qualitative studies and meta-synthesis was conducted. DATA SOURCES CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. RESULTS A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. CONCLUSION Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.
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Affiliation(s)
- Li-Shan Ke
- 1 Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,2 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Xiaoyan Huang
- 3 School of Nursing, Fudan University, Shanghai, China.,4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia
| | - Wen-Yu Hu
- 2 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Margaret O'Connor
- 4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia.,5 Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan Lee
- 4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia
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Cohen JM, Blustein J, Weinstein BE, Dischinger H, Sherman S, Grudzen C, Chodosh J. Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review. J Am Geriatr Soc 2017; 65:1642-1649. [DOI: 10.1111/jgs.14860] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jamie M. Cohen
- State University of New York Upstate Medical University; Syracuse New York
| | - Jan Blustein
- Wagner Graduate School of Public Service, New York University; New York New York
- Department of Population Health; New York University School of Medicine; New York New York
| | - Barbara E. Weinstein
- Doctor of Audiology Program; The Graduate Center, City University of New York; New York New York
| | - Hannah Dischinger
- Oregon Health & Science University School of Medicine; Portland Oregon
| | - Scott Sherman
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
| | - Corita Grudzen
- Department of Emergency Medicine; New York University School of Medicine; New York New York
| | - Joshua Chodosh
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
- VA New York Harbor Heathcare System; New York New York
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Mignani V, Ingravallo F, Mariani E, Chattat R. Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis. Clin Interv Aging 2017; 12:475-484. [PMID: 28424546 PMCID: PMC5344428 DOI: 10.2147/cia.s128937] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. Methods The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. Results The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1) plans already made; 2) end-of-life care and decision-making; 3) opinions and attitudes toward ACP; and 4) how, when, about what, and with whom to do ACP. Conclusion Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. Practical implications In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities.
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Affiliation(s)
- Veronica Mignani
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, Bologna, Italy
| | - Elena Mariani
- Department of Psychology, University of Bologna, Viale Berti Pichat, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Viale Berti Pichat, Bologna, Italy
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Penders YWH, Albers G, Deliens L, Miccinesi G, Vega Alonso T, Miralles M, Moreels S, Van den Block L. End-of-life care for people dying with dementia in general practice in Belgium, Italy and Spain: A cross-sectional, retrospective study. Geriatr Gerontol Int 2017; 17:1667-1676. [PMID: 28060462 DOI: 10.1111/ggi.12948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
AIM To describe and compare end-of-life care for people with mild or severe dementia in general practice in Belgium, Italy and Spain, in terms of place of care, place of death, treatment aims, use of specialized palliative care and communication with general practitioners (GPs). METHODS Cross-sectional retrospective survey was carried out of nationwide networks of GPs in Belgium, Italy and Spain, including patients who died aged 65 years or older in 2009-2011 and were judged by the GP to have had dementia (n = 1623). RESULTS GPs reported a higher proportion of older people with severe dementia in Belgium (55%) than in Spain (46 %) and Italy (45 %), and a higher proportion of patients living in care homes (57% vs 18% and 13%, respectively). A palliative treatment aim was common in the last 3 months of life in all three countries. Specialized palliative care services were provided in 14% (Italy, severe dementia) to 38% (Belgium, severe dementia) of cases. Communication between GP and patient about illness-related topics occurred in between 50% (Italy) and 72% (Belgium) of cases of mild dementia, and 10% (Italy) to 32% (Belgium) of cases of severe dementia. Patient preferences for end-of-life care were known in a minority of cases. Few people (13-15 %) were transferred between care settings in the last week of life. CONCLUSIONS Although overall treatment aims at the end of life are often aligned with a palliative care approach and transfer rates are low, there is room for improvement in end-of-life care for people with dementia in all countries studied, especially regarding early patient-GP communication. Geriatr Gerontol Int 2017; 17: 1667-1676.
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Affiliation(s)
- Yolanda W H Penders
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Gwenda Albers
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy
| | - Tomás Vega Alonso
- Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consellería de Sanidad), Castile and Leon, Valladolid, Spain
| | - Maite Miralles
- Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Conselleria de Sanitat), Comunitat Valenciana, Valencia, Spain
| | - Sarah Moreels
- Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Tripken JL, Elrod C, Bills S. Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities. Am J Hosp Palliat Care 2016; 35:69-74. [PMID: 27852819 DOI: 10.1177/1049909116679140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. DESIGN A cross-sectional survey design was used. SETTING An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. PARTICIPANTS Individuals aged 55 years and older who resided in independent living. MEASUREMENTS A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. RESULTS Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. CONCLUSION Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.
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Affiliation(s)
- Jennifer L Tripken
- 1 Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Cathy Elrod
- 2 Department of Physical Therapy, Marymount University, Arlington, VA, USA
| | - Susan Bills
- 1 Department of Health and Human Performance, Marymount University, Arlington, VA, USA
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Groen-van de Ven L, Smits C, Oldewarris K, Span M, Jukema J, Eefsting J, Vernooij-Dassen M. Decision Trajectories in Dementia Care Networks: Decisions and Related Key Events. Res Aging 2016; 39:1039-1071. [PMID: 27401681 DOI: 10.1177/0164027516656741] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This prospective multiperspective study provides insight into the decision trajectories of people with dementia by studying the decisions made and related key events. This study includes three waves of interviews, conducted between July 2010 and July 2012, with 113 purposefully selected respondents (people with beginning to advanced stages of dementia and their informal and professional caregivers) completed in 12 months (285 interviews). Our multilayered qualitative analysis consists of content analysis, timeline methods, and constant comparison. Four decision themes emerged-managing daily life, arranging support, community living, and preparing for the future. Eight key events delineate the decision trajectories of people with dementia. Decisions and key events differ between people with dementia living alone and living with a caregiver. Our study clarifies that decisions relate not only to the disease but to living with the dementia. Individual differences in decision content and sequence may effect shared decision-making and advance care planning.
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Affiliation(s)
- Leontine Groen-van de Ven
- 1 Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Carolien Smits
- 1 Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Karen Oldewarris
- 1 Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Marijke Span
- 1 Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Jan Jukema
- 1 Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Jan Eefsting
- 2 Department of Nursing Home Medicine and EMGO Institute for Health and Care Research, Free University Medical Centre, Amsterdam, The Netherlands.,3 Zonnehuisgroep IJssel-Vecht, Zwolle, The Netherlands
| | - Myrra Vernooij-Dassen
- 4 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,5 Radboud Alzheimer Centre, Nijmegen, The Netherlands
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Fleming J, Farquhar M, Brayne C, Barclay S. Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care--Qualitative Research within a Population-Based Cohort Study. PLoS One 2016; 11:e0150686. [PMID: 27045734 PMCID: PMC4821585 DOI: 10.1371/journal.pone.0150686] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/18/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Increasing longevity means more people will be dying in very old age, but little is known about the preferences of the 'oldest old' regarding their care at the end of life. AIMS To understand very old people's preferences regarding care towards the end of life and attitudes towards dying, to inform policy and practice. METHODS Qualitative data collection for n = 42 population-based cohort study participants aged 95-101 (88% women, 42% in long-term-care): topic-guided interviews with n = 33 participants and n = 39 proxy informants, most with both (n = 30: 4 jointly + separate interviews for 26 dyads). RESULTS Death was a part of life: these very old people mainly live day-to-day. Most were ready to die, reflecting their concerns regarding quality of life, being a nuisance, having nothing to live for and having lived long enough. Contrasting views were rare exceptions but voiced firmly. Most were not worried about death itself, but concerned more about the dying process and impacts on those left behind; a peaceful and pain-free death was a common ideal. Attitudes ranged from not wanting to think about death, through accepting its inevitable approach to longing for its release. Preferring to be made comfortable rather than have life-saving treatment if seriously ill, and wishing to avoid hospital, were commonly expressed views. There was little or no future planning, some consciously choosing not to. Uncertainty hampered end-of-life planning even when death was expected soon. Some stressed circumstances, such as severe dependency and others' likely decision-making roles, would influence choices. Carers found these issues harder to raise but felt they would know their older relatives' preferences, usually palliative care, although we found two discrepant views. CONCLUSIONS This study's rare data show ≥95-year-olds are willing to discuss dying and end-of-life care but seldom do. Formal documentation of wishes is extremely rare and may not be welcome. Although being "ready to die" and preferring a palliative approach predominated, these preferences cannot be assumed.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Morag Farquhar
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Garvelink MM, Ngangue PAG, Adekpedjou R, Diouf NT, Goh L, Blair L, Légaré F. A Synthesis Of Knowledge About Caregiver Decision Making Finds Gaps In Support For Those Who Care For Aging Loved Ones. Health Aff (Millwood) 2016; 35:619-26. [DOI: 10.1377/hlthaff.2015.1375] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mirjam M. Garvelink
- Mirjam M. Garvelink is a postdoctoral fellow in the Population Health and Practice-Changing Research Group of the Research Centre, CHU de Quebéc–Université Laval, in Québec City
| | - Patrice A. G. Ngangue
- Patrice A. G. Ngangue is a PhD candidate in community health in the Population Health and Practice-Changing Research Group of the Research Centre, CHU de Québec
| | - Rheda Adekpedjou
- Rheda Adekpedjou is a PhD candidate in epidemiology in the Population Health and Practice-Changing Research Group of the Research Centre, CHU de Québec
| | - Ndeye T. Diouf
- Ndeye T. Diouf is a PhD candidate in community health in the Population Health and Practice-Changing Research Group of the Research Centre, CHU de Québec
| | - Larissa Goh
- Larissa Goh is an undergraduate student at the University of British Columbia, in Vancouver
| | - Louisa Blair
- Louisa Blair is a caregiver representative in the Population Health and Practice-Changing Research Group of the Research Centre, CHU de Québec
| | - France Légaré
- France Légaré is a professor in the Department of Family Medicine and Emergency Medicine and the Canada Research Chair in Implementation of Shared Decision Making in Primary Care, both at Université Laval
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Street M, Ottmann G, Johnstone MJ, Considine J, Livingston PM. Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:513-522. [PMID: 25443161 DOI: 10.1111/hsc.12162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.
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Affiliation(s)
- Maryann Street
- Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Goetz Ottmann
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Uniting Care Community Options, Glen Waverley, Victoria, Australia
| | - Megan-Jane Johnstone
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Julie Considine
- Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia
| | - Patricia M Livingston
- Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Ampe S, Sevenants A, Coppens E, Spruytte N, Smets T, Declercq A, van Audenhove C. Study protocol for ‘we DECide’: implementation of advance care planning for nursing home residents with dementia. J Adv Nurs 2014; 71:1156-68. [DOI: 10.1111/jan.12601] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Ampe
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Aline Sevenants
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Evelien Coppens
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Nele Spruytte
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Tinne Smets
- Vrije Universiteit Brussel; End-of-life Care Research Group; Belgium
| | - Anja Declercq
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
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Lovell A, Yates P. Advance Care Planning in palliative care: a systematic literature review of the contextual factors influencing its uptake 2008-2012. Palliat Med 2014; 28:1026-35. [PMID: 24821708 DOI: 10.1177/0269216314531313] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advance Care Planning is an iterative process of discussion, decision-making and documentation about end-of-life care. Advance Care Planning is highly relevant in palliative care due to intersecting clinical needs. To enhance the implementation of Advance Care Planning, the contextual factors influencing its uptake need to be better understood. AIM To identify the contextual factors influencing the uptake of Advance Care Planning in palliative care as published between January 2008 and December 2012. METHODS Databases were systematically searched for studies about Advance Care Planning in palliative care published between January 2008 and December 2012. This yielded 27 eligible studies, which were appraised using National Institute of Health and Care Excellence Quality Appraisal Checklists. Iterative thematic synthesis was used to group results. RESULTS Factors associated with greater uptake included older age, a college degree, a diagnosis of cancer, greater functional impairment, being white, greater understanding of poor prognosis and receiving or working in specialist palliative care. Barriers included having non-malignant diagnoses, having dependent children, being African American, and uncertainty about Advance Care Planning and its legal status. Individuals' previous illness experiences, preferences and attitudes also influenced their participation. CONCLUSION Factors influencing the uptake of Advance Care Planning in palliative care are complex and multifaceted reflecting the diverse and often competing needs of patients, health professionals, legislature and health systems. Large population-based studies of palliative care patients are required to develop the sound theoretical and empirical foundation needed to improve uptake of Advance Care Planning in this setting.
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Affiliation(s)
- Allison Lovell
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia Specialist Palliative Care Service, Division of Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Verschuur EML, Groot MM, Sande RVD. Nurses’ perceptions of proactive palliative care: a Dutch focus group study. Int J Palliat Nurs 2014; 20:241-5. [DOI: 10.12968/ijpn.2014.20.5.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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50
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van Eechoud IJ, Piers RD, Van Camp S, Grypdonck M, Van Den Noortgate NJ, Deveugele M, Verbeke NC, Verhaeghe S. Perspectives of family members on planning end-of-life care for terminally ill and frail older people. J Pain Symptom Manage 2014; 47:876-86. [PMID: 24035067 DOI: 10.1016/j.jpainsymman.2013.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/31/2013] [Accepted: 06/14/2013] [Indexed: 11/28/2022]
Abstract
CONTEXT Advance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process. OBJECTIVES To gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process. METHODS This was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory. RESULTS Family members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns. CONCLUSION This study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns.
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Affiliation(s)
- Ineke J van Eechoud
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
| | - Ruth D Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Van Camp
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Mieke Grypdonck
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Myriam Deveugele
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Natacha C Verbeke
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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