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Mota-Romero E, Rodríguez-Landero O, Moya-Dieguez R, Cano-Garzón GM, Montoya-Juárez R, Puente-Fernández D. Information and Advance Care Directives for End-of-Life Residents with and without Dementia in Nursing Homes. Healthcare (Basel) 2023; 11:healthcare11030353. [PMID: 36766928 PMCID: PMC9914900 DOI: 10.3390/healthcare11030353] [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: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Communication and advance care directives may be affected by the presence of dementia. We sought to describe the information and end-of-life preferences provided to nursing homes residents and their families. METHODS Trained nurses collected information from 124 residents randomly selected with palliative care needs from eight nursing homes. RESULTS A total of 54.4% of the residents with dementia had been provided with information about their state of health, compared to 92.5% of the residents without dementia (p < 0.01); family members exhibited no differences regarding information (p = 0.658), regardless of whether the resident was cognitively impaired. Most advance care interventions remained unexplored, except for cases where a transfer to hospital (81.5%) or serotherapy (69.4%) was desired. Decisions regarding palliative sedation (p = 0.017) and blood transfusion (p = 0.019) were lower among residents with dementia. CONCLUSIONS Residents, especially residents with dementia, are provided with limited information and their preferences are inadequately explored.
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Affiliation(s)
- Emilio Mota-Romero
- Andalusian Health Service District Metropolitano Granada, Salvador Caballero Primary Care Centre, Institute for Biosanitary Research of Granada (IBS), University of Granada, 18014 Granada, Spain
| | | | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Institute for Biosanitary Research of Granada (IBS), University of Granada, 18014 Granada, Spain
| | - Daniel Puente-Fernández
- Department of Nursing, Institute for Biosanitary Research of Granada (IBS), University of Granada, 18014 Granada, Spain
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Zuniga-Villanueva G, Ramos-Guerrero JA, Osio-Saldaña M, Casas JA, Marston J, Okhuysen-Cawley R. Quality Indicators in Pediatric Palliative Care: Considerations for Latin America. CHILDREN (BASEL, SWITZERLAND) 2021; 8:250. [PMID: 33806896 PMCID: PMC8004984 DOI: 10.3390/children8030250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Pediatric palliative care is a growing field in which the currently available resources are still insufficient to meet the palliative care needs of children worldwide. Specifically, in Latin America, pediatric palliative care services have emerged unevenly and are still considered underdeveloped when compared to other regions of the world. A crucial step in developing pediatric palliative care (PPC) programs is delineating quality indicators; however, no consensus has been reached on the outcomes or how to measure the impact of PPC. Additionally, Latin America has unique sociocultural characteristics that impact the perception, acceptance, enrollment and implementation of palliative care services. To date, no defined set of quality indicators has been proposed for the region. This article explores the limitations of current available quality indicators and describes the Latin American context and how it affects PPC development. This information can help guide the creation of standards of care and quality indicators that meet local PPC needs while considering the sociocultural landscape of Latin America and its population.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey 64849, Mexico
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | | | - Monica Osio-Saldaña
- Department of Global Studies, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico;
| | - Jessica A. Casas
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
| | - Joan Marston
- Global Ambassador, International Children’s Palliative Care Network, Assagay 3624, South Africa;
| | - Regina Okhuysen-Cawley
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
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3
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Martínez Gimeno ML, Cámara Escribano C, Honrubia Fernández T, Olmo García MC, Tovar Benito DH, Bilbao-Goyoaga Arenas T, Rodríguez Almagro P. [Knowledge and attitudes of health care professionals in advance healthcare directives]. J Healthc Qual Res 2018; 33:270-277. [PMID: 30401422 DOI: 10.1016/j.jhqr.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The advanced healthcare directive is a new style of health care relationship, based on the respect of the patientś autonomous decisions: as well as a valuable tool that enables a proper management of the decisions made at the end of life. The objective of this study was to explore the knowledge and attitudes of the health care professionals regarding the advance directives, as well as the resources for advanced care planning in a municipality of Madrid during 2016-2017. MATERIAL AND METHODS A cross-sectional descriptive study was carried out on a population of Health care professionals of Primary and Specialised Care. The knowledge and attitudes questionnaire about the advance directives was used. Sociodemographic and knowledge variables related to resources for the advanced care planning. Statistical-descriptive analysis was performed. RESULTS A total of 431 professionals were included, with a mean age of 44.55 years (SD: 11.1). As regards knowledge about advance directives, the mean score was 5.08 (SD 2.4), with statistically significant differences being found between professional groups. A small percentage (4.6%) of the professionals had their document of Advance directives ready, and 42% of professionals did not know if they were regulated by the Community of Madrid. Less than half (41.5%) of the professionals knew the palliative resources of their institution. CONCLUSIONS The health care professional's knowledge about advance directives, as well as the resources for the advanced care planning, show deficiencies at training and information level. Almost half of the professionals did not know if these are regulated in the Community of Madrid. They also believe that it would be useful to plan, and very useful to have the Advance directives document ready.
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Affiliation(s)
- M L Martínez Gimeno
- Unidad de Anestesia y Reanimación, Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España; Grupo de Investigación Salud, Bienestar y Sostenibilidad Sociosanitaria (SALBIS), Facultad de Ciencias de la Salud, Universidad de León, Campus de Ponferrada, Ponferrada, León, España. Departamento de Enfermería y Fisoterapia, Centro Universitario San Rafael-Nebrija, Madrid, España.
| | - C Cámara Escribano
- Atención Primaria, Móstoles,Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
| | - T Honrubia Fernández
- Unidad de Cuidados Intensivos,Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
| | - M C Olmo García
- Unidad de Anestesia y Reanimación, Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
| | - D H Tovar Benito
- Unidad de Anestesia y Reanimación, Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
| | - T Bilbao-Goyoaga Arenas
- Unidad de Neumología. Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
| | - P Rodríguez Almagro
- Atención Primaria, Móstoles,Comité de Ética Asistencial, Hospital Universitario de Móstoles, Madrid, España
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Deng RL, Duan JZ, Zhang JH, Miao JR, Chen LL, Lee DT. Advance care planning for frail older people in China: A discussion paper. Nurs Ethics 2018; 26:1696-1706. [PMID: 29895229 DOI: 10.1177/0969733018779177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness.
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Affiliation(s)
| | | | - Jiang-Hui Zhang
- The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Jia-Rui Miao
- Zhuhai Campus of Zunyi Medical University, China
| | - Liu-Liu Chen
- The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China
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Albayrak T, Şencan İ, Akça Ö, Koç EM, Aksoy H, Ünsal S, Bülbül İ, Bahadır A, Kasım İ, Kahveci R, Özkara A. The ideas about advanced life support and affecting factors at the end-stage of life in a hospital in Turkey. PLoS One 2017; 12:e0181456. [PMID: 28732071 PMCID: PMC5521791 DOI: 10.1371/journal.pone.0181456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/01/2017] [Indexed: 11/19/2022] Open
Abstract
Background The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. “Advanced directives” is one of the examples for the participation in decisions for the treatment. Aim We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions. Design and setting The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013. Method A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer’s Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations. Results The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided. Conclusion Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants’ desire should be evaluated in terms of practicability.
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Affiliation(s)
| | - İrfan Şencan
- Ankara Numune Training and Research Hospital, Department of Family Medicine, Ankara, Turkey
| | - Ömer Akça
- Kayseri Training and Research Hospital, Department of Internal Medicine, Kayseri, Turkey
| | - Esra Meltem Koç
- Izmır Katip Celebi University Medical Faculty, Department of Family Medicine, Izmir, Turkey
- * E-mail:
| | - Hilal Aksoy
- Pamukkale Pelitlibag Family Health Center, Denizli, Turkey
| | - Selim Ünsal
- Sefkat No 2 Family Health Center, Ankara, Turkey
| | | | - Adem Bahadır
- Kalkandere No 1 Family Health Center, Rize, Turkey
| | - İsmail Kasım
- Ankara Numune Training and Research Hospital, Department of Family Medicine, Ankara, Turkey
| | - Rabia Kahveci
- Ankara Numune Training and Research Hospital, Department of Family Medicine, Ankara, Turkey
| | - Adem Özkara
- Corum Hitit University Medical Faculty, Department of Family Medicine, Corum, Turkey
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Granero-Moya N, Frías-Osuna A, Barrio-Cantalejo IM, Ramos-Morcillo AJ. [Primary care nurses' difficulties in advance care planning processes: A qualitative study]. Aten Primaria 2016; 48:649-656. [PMID: 27083077 PMCID: PMC6876016 DOI: 10.1016/j.aprim.2016.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/15/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022] Open
Abstract
Objetivo Conocer las dificultades que encuentran las enfermeras de atención primaria para promover procesos de planificación anticipada de las decisiones con personas en el final de la vida. Diseño Estudio cualitativo fenomenológico. Emplazamiento Área de Gestión Sanitaria Norte de Jaén. Participantes Enfermeras de atención primaria. Método Muestreo intencional. Realización de 14 entrevistas en profundidad hasta la saturación de los discursos. Análisis de contenido en 4 etapas: transcripción de datos, codificación, obtención de resultados y verificación de conclusiones. Uso de N-Vivo como apoyo al análisis. Triangulación de resultados entre investigadores. Resultados Dificultades referidas a los profesionales: falta de conocimiento sobre el tema, falta de habilidades de comunicación o de experiencia y presencia de emociones negativas. En la institución sanitaria, la falta de tiempo y las interferencias con otros profesionales suponen una barrera. También la actitud del propio paciente o su familia es vista como una traba ya que pocos hablan sobre el final de la vida. Finalmente, nuestra sociedad evita las conversaciones abiertas sobre temas relacionados con la muerte. Conclusiones Es necesario el aprendizaje de los profesionales sobre planificación anticipada de decisiones, su entrenamiento en habilidades comunicativas y su educación afectiva. Los gestores sanitarios han de tener en cuenta el hecho de que las intervenciones para planificar anticipadamente decisiones sanitarias precisan formación, tiempo y atención continuada. En tanto no acontezca un cambio cultural, persistirá un modelo evasivo para afrontar el final de la vida.
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Affiliation(s)
| | | | | | - Antonio Jesús Ramos-Morcillo
- Centro de Salud Murcia Centro-San Juan, Área de Salud VI-Vega Media del Segura, Servicio Murciano de Salud, Murcia, España
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