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Shibeshi AH, Mare KU, Kase BF, Wubshet BZ, Tebeje TM, Asgedom YS, Asmare ZA, Asebe HA, Lombebo AA, Sabo KG, Fente BM, Seifu BL. The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model. PLoS One 2024; 19:e0298647. [PMID: 38771790 PMCID: PMC11108208 DOI: 10.1371/journal.pone.0298647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. OBJECTIVE To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. METHODS The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. RESULTS The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. CONCLUSION Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.
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Affiliation(s)
- Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Betel Zelalem Wubshet
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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2
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Pollock K, Caswell G, Turner N, Wilson E. The ideal and the real: Patient and bereaved family caregiver perspectives on the significance of place of death. DEATH STUDIES 2023; 48:312-325. [PMID: 37338854 PMCID: PMC10860700 DOI: 10.1080/07481187.2023.2225042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Home has become established as the preferred place of death within health policy and practice in the UK and internationally. However, growing awareness of the structured inequalities underpinning end-of-life care and the challenges for family members undertaking care at home raise questions about the nature of patient and public preferences and priorities regarding place of death and the feasibility of home management of the complex care needs at the end-of-life. This paper presents findings from a qualitative study of 12 patients' and 34 bereaved family caregivers' perspectives and priorities regarding place of death. Participants expressed complex and nuanced accounts in which place of death was not afforded an overarching priority. The study findings point to public pragmatism and flexibility in relation to place of death, and the misalignment of current policy with public priorities that are predominantly for comfort and companionship at the end-of-life, regardless of place.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
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İşler AM, Yıldırım B. The Need for Hospice Care as a Preferred Environment of Death in Terminal Cancers: A Neglected Research Area in Turkey. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:53-83. [PMID: 35776763 DOI: 10.1080/15524256.2022.2094524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the context of end-of-life practices in Turkey, the researchers considered it important to reveal the need for hospice care in Turkey since the number of palliative care units is low and they do not meet the needs, hospice care services are absent, and intensive care units are misused in parallel with these deficiencies. The researchers addressed the subject with a phenomenological qualitative approach. The views of healthcare professionals and patient relatives who cared for terminal cancer patients. In the context of the environment of death preferences were of interest. The study was conducted in the city center of Manisa, one of the 30 metropolitan cities located in the western region of Turkey. Of the 23 participants, 18 were healthcare professionals working in the field of oncology, and five participants were primary caregivers who lost their loved ones with terminal cancer. The caregiver family members were the family members who provided care to the terminal cancer patient with their own means at home and accompanied the patient's treatment process, since there was no hospice care. A semi-structured interview guide was utilized for the in-depth interviews. Data were transcribed by the researchers and coded in MAXQDA 2020, subjected to thematic analysis, and divided into units of meaning. At the final stage of the study, the units of meaning were combined, and four basic themes were revealed: the conceptualization of the environment of death preferences, the problems caused by death in the hospital, the necessity of hospice care, and hospice care for caregivers. The study results demonstrated that hospice care was an essential need in Turkey, and the workload of hospitals would decrease, and hospital resources could be used efficiently in the presence of hospices. At the same time, it was understood that hospices were services making it easier for terminal cancer patients and their caregivers to face death with peaceful expectations.
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Affiliation(s)
- Ayşe Mine İşler
- Department of Social Work, Tekirdağ Namık Kemal University, Süleymanpaşa, Turkey
| | - Buğra Yıldırım
- Department of Social Work, Manisa Celal Bayar University, Manisa, Turkey
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Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study. BMJ Open 2022. [PMCID: PMC9362824 DOI: 10.1136/bmjopen-2021-057229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families. Methods and analysis The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights. Ethics and dissemination The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying. Trial registration number NCT04271085.
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Koyama T, Higashionna T, Maruo A, Ushio S, Zamami Y, Harada K, Hagiya H. Trends in places and causes of death among centenarians in Japan from 2006 to 2016. Geriatr Gerontol Int 2022; 22:675-680. [PMID: 35739616 DOI: 10.1111/ggi.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/19/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
AIM Amid the global aging, an establishment of healthcare policies for the aged population is a common issue to be addressed. However, few studies on centenarians have reported place and cause of death (PoD and CoD, respectively) as indicators of end-of-life care quality. This study aimed to analyze trends in PoD and CoD among centenarians in Japan. METHODS Data from death certificates from Japanese vital statistics were analyzed; 205 513 deaths occurred among centenarians (aged ≥100 years) in Japan during the period from 2006 to 2016. PoD prevalence was calculated for each CoD. Trends in PoD prevalence were analyzed using the Joinpoint regression model. Changing points, annual percentage changes, and average annual percentage changes (AAPCs) were calculated to examine trends. RESULTS The number of deaths more than doubled from 10 340 in 2006 to 26 427 in 2016. PoDs were composed of hospitals (52.7%), nursing homes (31.4%), own homes (13.6%) and others (2.2%). Dementia and old age increased rapidly as CoD. Proportions of hospital and home deaths decreased, with AAPCs of -2.3% (95% confidence interval [CI], -2.6 to -1.9) and -2.3% (95% CI, -3.2 to -1.4), respectively. Conversely, the proportion of deaths in nursing homes rapidly increased, with an AAPC of 6.8% (95% CI, 6.0-7.7). CONCLUSIONS The results revealed changes in PoD among centenarians in Japan. Understanding these transitions is indispensable for health policy in aging societies. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Toshihiro Koyama
- Department of Health Data Science, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | | | - Akinori Maruo
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Soichiro Ushio
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Yoshito Zamami
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Ko Harada
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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8
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Knight T, Lasserson D. Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population. J Intern Med 2022; 291:438-457. [PMID: 34816527 DOI: 10.1111/joim.13394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recent trends across Europe show a year-on-year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.
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Affiliation(s)
- Thomas Knight
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Foundation Trust, Birmingham, UK
| | - Daniel Lasserson
- Acute Hospital at Home, Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Jiang J, May P. Proportion of deaths in hospital in European countries: trends and associations from panel data (2005-2017). Eur J Public Health 2021; 31:1176-1183. [PMID: 34557918 DOI: 10.1093/eurpub/ckab169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time. METHODS We aimed to collate population-level data on place of death in Europe from 2005 to 2017, and to evaluate association with national characteristics and policy choices. We sought data on hospital as the place of death from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analyzed these cross-national panel data using linear regression with panel-corrected standard errors. RESULTS Our analytic dataset included 30 countries accounting for over 95% of Europe's population. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing rate in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths. CONCLUSIONS We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to reduce the proportion of dying in hospital.
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Affiliation(s)
- Jingjing Jiang
- School of Medicine, Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Peter May
- School of Medicine, Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,School of Medicine, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
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Yamout R, Hanna J, El Asmar R, Beydoun H, Rahm M, Osman H. Preferred place of death for patients with terminal illness: A literature review. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1961985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rana Yamout
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Janane Hanna
- Department of Anesthesia and Pain Management, AUBMC, Beirut, Lebanon
| | | | - Hanadi Beydoun
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Mira Rahm
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Hibah Osman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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11
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Fereidouni A, Rassouli M, Salesi M, Ashrafizadeh H, Vahedian-Azimi A, Barasteh S. Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:704590. [PMID: 34512460 PMCID: PMC8429937 DOI: 10.3389/fpsyg.2021.704590] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Identifying the preferred place of death is a key indicator of the quality of death in cancer patients and one of the most important issues for health service policymakers. This study was done to determine the preferred place of death and the factors affecting it for adult patients with cancer. Methods: In this systematic review and meta-analysis study four online databases (PubMed, Scopus, web of science, ProQuest) were searched by relevant keywords. Quality assessment of papers was conducted using Newcastle-Ottawa (NOS) criterion. Odds ratios, relative risks, and 95% confidence intervals were determined for each of the factors extracted from the investigations. Results: A total of 14,920 participants of 27 studies were included into the meta-analysis. Based on the results, 55% of cancer patients with a confidence interval [95% CI (41–49)] preferred home, 17% of patients with a confidence interval [95% CI (−12%) 23)] preferred hospital and 10% of patients with confidence interval [95% CI (13–18)] preferred hospices as their favored place to die. Effective factors were also reported in the form of demographic characteristics, disease-related factors and psychosocial factors. Conclusions: This study showed that more than half of cancer patients chose home as their preferred place of death. Therefore, guided policies need to ensure that the death of the patients in the preferred place should be considered with priority. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218680, identifier: CRD42020218680.
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Affiliation(s)
- Armin Fereidouni
- Medicine, Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Soosaipillai G, Wu A, Dettorre GM, Diamantis N, Chester J, Moss C, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Brunet J, Jones E, Mesia R, Jackson A, Mukherjee U, Sita-Lumsden A, Seguí E, Ottaviani D, Carbó A, Benafif S, Würstlein R, Carmona C, Chopra N, Cruz CA, Swallow J, Saoudi N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Wong YNS, Sureda A, Maluquer C, Ruiz-Camps I, Cabirta A, Prat A, Loizidou A, Gennari A, Ferrante D, Tabernero J, Russell B, Van Hemelrijck M, Dolly S, Hulbert-Williams NJ, Pinato DJ. Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective. Ther Adv Med Oncol 2021; 13:17588359211042224. [PMID: 34497669 PMCID: PMC8419540 DOI: 10.1177/17588359211042224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.
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Affiliation(s)
| | - Anjui Wu
- Cancer Division, University College London Hospitals, London, UK
- UCL Cancer Institute, Fitzrovia, London, UK
| | - Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC. Hospitalet de Llobregat, Spain
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Eleanor Jones
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sarah Benafif
- Cancer Division, University College London Hospitals, London, UK
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics, Breast Centre and Gynaecological Cancer Centre and CCC Munich, University Hospital Munich, Munich, Germany
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Judith Swallow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Haematology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Nicholas J Hulbert-Williams
- Professor of Behavioural Medicine, Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, Cheshire, CH1 4BJ, UK
| | - David J Pinato
- Department of Surgery and Cancer, Clinical Senior Lecturer and Consultant Medical Oncologist, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Malhotra C, Koh LE, Teo I, Ozdemir S, Chaudhry I, Finkelstein E. A Prospective Cohort Study of Stability in Preferred Place of Death Among Patients With Stage IV Cancer in Singapore. J Natl Compr Canc Netw 2021; 20:20-28. [PMID: 34359020 DOI: 10.6004/jnccn.2020.7795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advance care planning (ACP) involves documentation of patients' preferred place of death (PoD). This assumes that patients' preferred PoD will not change over time; yet, evidence for this is inconclusive. We aimed to assess the extent and correlates of change in patients' preferred PoD over time. MATERIALS AND METHODS Using data from a cohort study of patients with advanced cancer in Singapore, we analyzed preferred PoD (home vs institution including hospital, hospice, and nursing home vs unclear) among 466 patients every 6 months for a period of 2 years. At each time point, we assessed the proportion of patients who changed their preferred PoD from the previous time point. Using a multinomial logistic regression model, we assessed patient factors (demographics, understanding of disease stage, ACP, recent hospitalization, quality of life, symptom burden, psychologic distress, financial difficulty, prognosis) associated with change in their preferred PoD. RESULTS More than 25% of patients changed their preferred PoD every 6 months, with no clear trend in change toward home or institution. Patients psychologically distressed at the time of the survey had increased likelihood of changing their preferred PoD to home (relative risk ratio [RRR], 1.02; 95% CI, 1.00-1.05) and to an institution (RRR, 1.06; 95% CI, 1.02-1.10) relative to no change in preference. Patients hospitalized in the past 6 months were more likely to change their preferred PoD to home (RRR, 1.56; 95% CI, 1.07-2.29) and less likely to change to an institution (RRR, 0.50; 95% CI, 0.28-0.88) relative to no change in preference. CONCLUSIONS The present study provides evidence of instability in the preferred PoD of patients with advanced cancer. ACP documents need to be updated regularly to ensure they accurately reflect patients' current preference.
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Affiliation(s)
- Chetna Malhotra
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Ling En Koh
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Irene Teo
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and.,3Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Semra Ozdemir
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Isha Chaudhry
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Eric Finkelstein
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
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14
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Saurman E, Allingham S, Draper K, Edwards J, Moody J, Hooper D, Kneen K, Connolly J, Eagar K. Preferred Place of Death-A Study of 2 Specialist Community Palliative Care Services in Australia. J Palliat Care 2021; 37:26-33. [PMID: 34008453 DOI: 10.1177/08258597211018059] [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] [Indexed: 11/16/2022]
Abstract
Choice and preference are fundamental to person-centered care and supporting personal choice at the end of life should be a priority. This study analyzed the relationship between a person's preferred place of death and other individual variables that might influence their actual place of death by examining the activity of 2 specialist community palliative care services in Australia. This was a cross-sectional study of 2353 people who died between 01 August 2016-31 August 2018; 81% died in their preferred place. Sex, type of life-limiting illness, and length of time in care were the only variables significantly related to dying in one's preferred place. Women were more likely to die in their preferred place than men (84% v 78%) and people with a non-cancer diagnosis were 7% more likely to die in their preferred place than those with cancer, particularly when that place was their private residence (74% v 60%) or Residential Aged Care Facility (98% v 89%). Someone in care for 0-7 days had 4.2 times greater odds of dying in their preferred place (OR = 4.18, 2.20-7.94), and after 21 days in care, people had 4.6 greater odds of having a preference to die in a hospital (OR = 4.63, 3.58-5.99). Both community palliative care services have capacity and a model of care that is responsive to choice. These findings align with known referral patterns and disease trajectories and demonstrate that it is possible to support the majority of people in the care of community palliative care services to die in their preferred place.
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Affiliation(s)
- Emily Saurman
- Department of Rural Health, 4334University of Sydney, Broken Hill, New South Wales, Australia
| | - Sam Allingham
- Australian Health Services Research Institute, 8691University of Wollongong, New South Wales, Australia
| | - Kylie Draper
- 441015Eastern Palliative Care Association Incorporated, Mitcham, Victoria, Australia
| | - Julie Edwards
- Sydney Adventist Hospital Community, Palliative Care Service, Wahroonga, New South Wales, Australia
| | - Jeanette Moody
- 441015Eastern Palliative Care Association Incorporated, Mitcham, Victoria, Australia
| | - Dawn Hooper
- Sydney Adventist Hospital Community, Palliative Care Service, Wahroonga, New South Wales, Australia
| | - Kerrie Kneen
- Sydney Adventist Hospital Community, Palliative Care Service, Wahroonga, New South Wales, Australia
| | - Jane Connolly
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, 8691University of Wollongong, New South Wales, Australia
| | - Kathy Eagar
- Australian Health Services Research Institute, 8691University of Wollongong, New South Wales, Australia
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15
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Preferences of quality delivery of palliative care among cancer patients in low- and middle-income countries: A review. Palliat Support Care 2021; 20:275-282. [PMID: 33952378 DOI: 10.1017/s1478951521000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND All forms of cancer pose a tremendous and increasing problem globally. The prevalence of cancer across the globe is anticipated to double over the next two decades. About 50% of most cancer cases are expected to occur in low- and middle-income countries (LMICs), where there is a greater disproportionate level in mortality. Access to effective and timely care for cancer patients remains a challenge, especially in LMICs due to late disease diagnosis and detection, coupled with the limited availability of appropriate therapeutic options and delay in proper interventions. METHODOLOGY This study explored several mixed-method researches and randomized trials that addressed the preferences of quality delivery of palliative care among cancer patients in LMICs. A designated set of keywords such as Palliative Care; Preferences; Cancer patients; Psycho-social Support; End-of-life Care; Low and Middle-Income Countries were inserted on electronic databases to retrieve articles. The databases include PubMed, Scinapse, Medline, The Google Scholar, Academic search premier, SAGE, and EBSCO host. RESULTS Findings from this review discussed the socioeconomic and behavioral factors, which address the quality delivery of palliative care among cancer patients. These factors if measured with acceptance level in cancer patients could help to address areas that need improvement from the stage of disease diagnosis to the end-of-life. SIGNIFICANCE OF THE RESULTS Valuable collaborations among international and local health institutions are needed to build and implement a systematic framework for palliative care in LMICs. Policies and programs that are country and culturally specific, encompassing both theoretical and practical models of care in the milieu of existing quandaries should be developed.
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16
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Ikeda T, Tsuboya T. Place of Death and Density of Homecare Resources: A Nationwide Study in Japan. Ann Geriatr Med Res 2021; 25:25-32. [PMID: 33794586 PMCID: PMC8024167 DOI: 10.4235/agmr.21.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
Background Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan. Methods We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home. Results Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities. Conclusion Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Department of Community Health, Public Health Institute, Shiwa, Japan
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17
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Sheridan R, Roman E, Smith AG, Turner A, Garry AC, Patmore R, Howard MR, Howell DA. Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network. BMJ Support Palliat Care 2021; 11:7-16. [PMID: 32393531 PMCID: PMC7907576 DOI: 10.1136/bmjspcare-2019-002097] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/18/2020] [Accepted: 04/04/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Hospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions. METHODS Set within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004-2012 who died 2011-2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion. RESULTS Of 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion. CONCLUSION Challenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.
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Affiliation(s)
- Rebecca Sheridan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Alex G Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Andrew Turner
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Anne C Garry
- Department of Palliative Care, York Hospital, York, YO31 8HE, UK
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull, HU16 5JQ, UK
| | - Martin R Howard
- Department of Haematology, York Hospital, York, YO31 8HE, UK
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
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18
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Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health 2021; 18:10. [PMID: 33461593 PMCID: PMC7812564 DOI: 10.1186/s12978-021-01070-6] [Citation(s) in RCA: 338] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. Methods A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. Results The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Conclusion Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. Plain English summary The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.
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Affiliation(s)
- Bethany Kotlar
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily Gerson
- George Washington University, Washington, DC, USA
| | | | - Ana Langer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henning Tiemeier
- Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.
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19
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Kern H, Corani G, Huber D, Vermes N, Zaffalon M, Varini M, Wenzel C, Fringer A. Impact on place of death in cancer patients: a causal exploration in southern Switzerland. BMC Palliat Care 2020; 19:160. [PMID: 33059636 PMCID: PMC7566155 DOI: 10.1186/s12904-020-00664-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/30/2020] [Indexed: 09/07/2023] Open
Abstract
Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.
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Affiliation(s)
- Heidi Kern
- Triangolo Association, In Sceresòra 4, CH-6528, Camorino, Switzerland.
| | - Giorgio Corani
- IDSIA, Dalle Molle Institute for Artificial Intelligence, Galleria 2, Via Cantonale 2c, CH-6928, Manno, Switzerland
| | - David Huber
- IDSIA, Dalle Molle Institute for Artificial Intelligence, Galleria 2, Via Cantonale 2c, CH-6928, Manno, Switzerland
| | - Nicola Vermes
- IDSIA, Dalle Molle Institute for Artificial Intelligence, Galleria 2, Via Cantonale 2c, CH-6928, Manno, Switzerland
| | - Marco Zaffalon
- IDSIA, Dalle Molle Institute for Artificial Intelligence, Galleria 2, Via Cantonale 2c, CH-6928, Manno, Switzerland
| | - Marco Varini
- Triangolo Association, In Sceresòra 4, CH-6528, Camorino, Switzerland
| | - Claudia Wenzel
- Department Health Sciences (Institute for Therapeutic Sciences), KREMS, IMC University of Applied Sciences, Piaristengasse 1, A-3500, Krems, Austria
| | - André Fringer
- Department Health, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Katharina-Sulzer-Platz 9, Postfach, CH-8401, Winterthur, Switzerland
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20
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Cohen-Mansfield J, Brill S. After providing end of life care to relatives, what care options do family caregivers prefer for themselves? PLoS One 2020; 15:e0239423. [PMID: 32977327 PMCID: PMC7518928 DOI: 10.1371/journal.pone.0239423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives We examined how caregivers who had cared for a relative at end of life (EoL) wished to be cared for in the event that they experienced advanced dementia or physical disability in the future, and what factors influenced their preferences for EoL care. Methods In this mixed-methods study, 83 participants, recruited from multiple sources in Israel, were interviewed concerning socio-demographic factors, health status, past experience with EoL, preference for extension of life vs. quality of life (QoL), willingness to be dependent on others, and preferences for EoL care. Results In case of advanced dementia, 58% preferred euthanasia or suicide; around a third chose those for physical disability. Care by family members was the least desired form of care in the advanced dementia scenario, although more desirable than institutional care in the physical disability scenario. QoL was rated as the highest factor impacting preferences for EoL care. Men demonstrated a higher preference than women for extension of life over QoL. Conclusion Our study points to the need for society to consider solutions to the request of participants to reject the type of EoL experienced by their relatives. Those solutions include investing in improving the quality of life at the end of life, and offering alternatives such as euthanasia, which a large proportion of our participants found ethically and medically appropriate within the current system of care in the event of severe physical disability, and more so in the event of advanced dementia.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Shai Brill
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
- Beit Rivka Medical Center, Petah Tikva, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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21
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Portorani A, Dehghan M, Mangolian Shahrbabaki P. Death at home: Iranian nurses', cancer patients', and family caregivers' attitudes. DEATH STUDIES 2020; 46:1123-1127. [PMID: 32713329 DOI: 10.1080/07481187.2020.1795748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is important to facilitate death at a place that is in accord with dying patients' preferences. To see if nurses and family members agreed with patients themselves, we asked about attitudes toward death at home of 96 nurses working in oncology departments, 274 cancer patients, and 278 family caregivers in southeastern Iran. Most of the participants saw death at home as a good way of dying and preferred patients to spend their end-of-life days at home. This study supports the argument that providing hospice home care services for terminally ill patients with cancer may facilitate a preference of home death.
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Affiliation(s)
| | - Mahlagha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
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22
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Stephens SJ, Chino F, Williamson H, Niedzwiecki D, Chino J, Mowery YM. Evaluating for disparities in place of death for head and neck cancer patients in the United States utilizing the CDC WONDER database. Oral Oncol 2020; 102:104555. [PMID: 32006782 DOI: 10.1016/j.oraloncology.2019.104555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. MATERIALS/METHODS Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (MLR) were performed to evaluate for disparities in place of death. RESULTS We obtained aggregate data for 101,963 people who died of HNC between 1999 and 2017 (25.9% oral cavity, 24.6% oropharynx/pharynx, 0.4% nasopharynx, and 49.1% larynx/hypopharynx). Most were Caucasian (92.7%) and male (87.0%). Deaths at home or hospice increased over the study period (R2 = 0.96, p < 0.05) from 29.2% in 1999 to 61.2% in 2017. On MLR of patient-level data from 2015, those who were single (ref), ages 85+ (OR 0.78; 95% CI: 0.68, 0.90), African American (OR 0.73; 95% CI: 0.65, 0.82), or Asian/Pacific Islanders (OR 0.66; 95% CI: 0.54, 0.81) were less likely to die at home or hospice. On MLR of the aggregate data (1999-2017), those who were female (OR 0.87; 95% CI: 0.83, 0.91) or ages 75-84 (OR 0.79; 95% CI: 0.76, 0.82) were also less likely to die at home or hospice. In both analyses, those who died from larynx/hypopharynx cancers were less likely to die at home or hospice. CONCLUSIONS HNC-related deaths at home or hospice increased between 1999 and 2017. Those who were single, female, African American, Asian/Pacific Islander, older (ages 75+), or those with larynx/hypopharynx cancers were less likely to die at home or hospice.
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Affiliation(s)
- Sarah J Stephens
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Hannah Williamson
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Donna Niedzwiecki
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
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23
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Minamiguchi Y. Decision-Making about the Place of Death for Cancer Patients: A Concept Analysis. Asia Pac J Oncol Nurs 2019; 7:103-112. [PMID: 31879691 PMCID: PMC6927160 DOI: 10.4103/apjon.apjon_38_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/08/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of the study was to conduct a concept analysis of “decision-making about the place of death for cancer patients” to develop a theoretical definition of the concept and identify its attributes, antecedents, and outcomes. Methods: The Rodgers' evolutionary model of concept analysis was used. A literature search for papers published from 2000 to 2017 was conducted using the keywords: “cancer,” “place,” “death,” and “decision-making” for the search of the electronic databases. Results: Thirty articles were selected for this analysis. As a result, five attributes, six antecedents, and five consequences were extracted. [options to choose as a place of death], [wishes of the patients themselves], [consideration of the burden on the family], [open discussions with other persons concerned], and [best choice according to circumstances] are considered to be the characteristics in the decision-making about the place of death for cancer patients. Conclusions: This concept is defined as “The best choice according to circumstances of the cancer patients among different options for a place of death, resulting from a careful evaluation of the wishes of these patients and the burden on the family, as well as through open discussions with other persons concerned.” Nurses need to assist patients discuss deaths with important others, such as family members, in making decisions about the place of death. Further studies are necessary to elucidate the details of the categories and relationships shown in the attributes in this study, investigating the actual conditions of the patients and their families.
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Affiliation(s)
- Yoko Minamiguchi
- Department of Nursing Science, Graduate School of Nursing, Osaka Medical College, Takatsuki, Osaka, Japan
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24
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López-Valcárcel BG, Pinilla J, Barber P. Dying at home for terminal cancer patients: differences by level of education and municipality of residence in Spain. GACETA SANITARIA 2019; 33:568-574. [DOI: 10.1016/j.gaceta.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/04/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022]
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25
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Neergaard MA, Brogaard T, Vedsted P, Jensen AB. Asking terminally ill patients about their preferences concerning place of care and death. Int J Palliat Nurs 2019; 24:124-131. [PMID: 29608384 DOI: 10.12968/ijpn.2018.24.3.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Asking patients with palliative care needs about their end-of-life (EoL) preferences is widely acknowledged as an important aspect of EoL care. However, the issue of how to ask patients these questions has not been fully explored. Most prior studies in this area do not differentiate between patients' pragmatic preferences and ideal preferences, and between preferences concerning place of care (PoC) and place of death (PoD). AIM The aim of this study was to examine possible differences between pragmatic and ideal preferences of terminally ill patients, as well as differences between asking patients about preferences concerning PoC and PoD. METHODS Structured interviews were performed with terminally ill cancer patients at inclusion and a follow-up questionnaire was completed 1 month later. Answers were compared using kappa (k) statistics and Pearson's c2-test. RESULTS Among 96 cancer patients, agreement between pragmatic and ideal preferences was statistically significantly different (p=<0.001). Agreement between preferences for PoC and PoD was high (k:0.76-0.85). CONCLUSION Differences exist between pragmatic and ideal EoL preferences, whereas preferences for PoC and PoD were found to be similar. These findings highlight the importance of the phrasing of questions when uncovering patients' preferences for EoL care.
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Affiliation(s)
- Mette Asbjoern Neergaard
- Associate Professor, Consultant in Palliative Medicine, Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Brogaard
- GP, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Peter Vedsted
- Professor and Research Director, Research Centre for Cancer Diagnosis, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | - Anders Bonde Jensen
- Professor, Consultant in Oncology, Department of Oncology, Aarhus University Hospital, Denmark
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26
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Miniotti M, Bassino S, Fanchini L, Ritorto G, Leombruni P. Supportive care needs, quality of life and psychological morbidity of advanced colorectal cancer patients. Eur J Oncol Nurs 2019; 43:101668. [PMID: 31593821 DOI: 10.1016/j.ejon.2019.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE This study describes the supportive care needs in a consecutive sample of Italian colorectal cancer (CRC) patients, evaluating their quality of life and psychological morbidity. METHODS This study used a cross-sectional design and self-assessment procedures and was conducted in an ambulatory setting. Demographics, basic clinical features, supportive care needs, quality of life and psychological morbidity of 203 CRC patients were gathered. RESULTS Approximately the 80% of the patients experienced one or more moderate- or high-level unmet need, notably regarding psychological concerns (approximately the 20% presented also signs of anxiety and depression). Functional roles and cognitive functioning were low. Symptoms of fatigue, nausea and vomiting and financial issues were frequent. The severity of anxiety, depression and quality of life impairment was significantly different across different levels of needs according to a unique linear relation. Patients with moderate or high needs had more severe anxiety and depression and a lower quality of life (i.e., lower level of functioning and more severe symptoms) than those with no needs or low needs. CONCLUSIONS The findings of this study suggest that meeting supportive care needs seems to improve psychological morbidity, functions and symptoms of CRC patients.
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Affiliation(s)
- M Miniotti
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy.
| | - S Bassino
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - L Fanchini
- ColoRectal Cancer Unit, Oncology Department, Città della Salute e della Scienza di Torino, Turin, Italy
| | - G Ritorto
- ColoRectal Cancer Unit, Oncology Department, Città della Salute e della Scienza di Torino, Turin, Italy
| | - P Leombruni
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
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27
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Cross J, Fischer A, Shotton D, Pollicino C, May A, Vora R, Dubrowin NB, Good P. Supporting choice: an innovative model of integrated palliative care funded by a private health insurer. Intern Med J 2019; 50:931-937. [PMID: 31424597 DOI: 10.1111/imj.14615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of Australians dying each year is predicted to double in the next 25 years and there is an urgent need to establish sustainable models for providing high quality end-of-life care. An innovative community care model (Bupa Palliative Care Choices Program or BPCCP) was developed and piloted with the purpose of supporting patients in achieving their choices surrounding end-of-life care. AIMS This study evaluates whether BPCCP patients were more likely to die in their place of choice compared with patients receiving standard care. Additional aims were evaluating patient and carer satisfaction and insurer cost. METHODS This prospective, comparative cohort study comprises a clinical chart audit and survey of patient and carer experience. RESULTS More BPCCP participants preferred to die at home (53% vs 31%). A lower proportion of BPCCP patients died in acute hospitals (10% vs 19%) and more of this cohort died at home (46% vs 26%). In both cohorts, nearly 90% of patients were able to die in their preferred location. Patient and carer satisfaction with the programme was very high in the small cohort who responded to the survey. There was a decrease in average claims spend per patient enrolled in the programme during the first 12-month period of implementation compared with historical claims spend for inpatients only. CONCLUSIONS This evaluation of an innovative community palliative care intervention indicates that the extra services available to patients support the choice of dying at home and the ability to do so while generating claims cost efficiencies.
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Affiliation(s)
- Jessica Cross
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Amanda Fischer
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Donna Shotton
- Program Development, Bupa HI Pty Ltd, Melbourne, Victoria, Australia
| | | | - Annabelle May
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Rohan Vora
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia.,Palliative and Supportive Care, Mater Misericordiae Health Services, Brisbane, Queensland, Australia
| | - Natalie B Dubrowin
- Health Partnership Models, Bupa HI Pty Ltd, Melbourne, Victoria, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia.,Palliative and Supportive Care, Mater Misericordiae Health Services, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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28
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Hoare S, Kelly MP, Barclay S. Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care. Br J Gen Pract 2019; 69:e561-e569. [PMID: 31208973 PMCID: PMC6582452 DOI: 10.3399/bjgp19x704561] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/24/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Enabling death at home remains an important priority in end-of-life care policy. However, hospital continues to be a more prevalent place of death than home in the UK, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment, associated with inadequate family care provision and insufficient professional care delivery. AIM To understand problems in professional and lay care provision that discourage death at home and lead to hospital admissions at the end of life. DESIGN AND SETTING A qualitative study of admission to a large English hospital of patients close to the end of their life. METHOD Retrospective in-depth semi-structured interviews with healthcare professionals (n = 30) and next-of-kin (n = 3) involved in an admission. Interviews addressed why older patients (>65 years) close to the end of life are admitted to hospital. Interviews were transcribed and analysed thematically. RESULTS Home-based end-of-life care appeared precarious. Hospital admission was considered by healthcare staff when there was insufficient nursing provision, or where family support, which was often extensive but under supported, was challenged. In these circumstances, home was not recognised to be a suitable place of care or death, justifying seeking care provision elsewhere. CONCLUSION Challenges in home care provision led to hospital admissions. Home end-of-life care depended on substantial input from family and professional carers, both of which were under-resourced. Where either care was insufficient to meet the needs of patients, home was no longer deemed to be desirable by healthcare staff and hospital care was sought.
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Affiliation(s)
- Sarah Hoare
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael P Kelly
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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29
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Gerber K, Hayes B, Bryant C. 'It all depends!': A qualitative study of preferences for place of care and place of death in terminally ill patients and their family caregivers. Palliat Med 2019; 33:802-811. [PMID: 31046580 DOI: 10.1177/0269216319845794] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is often suggested that terminally ill patients favour end-of-life care at home. Yet, it is unclear how these preferences are formed, if the process is similar for patients and family caregivers, and if there are discrepancies between preferences for place of care and place of death. Understanding these nuances is essential to support people in their decision-making and ultimately provide better care at the end-of-life. AIM To gain an in-depth understanding of how terminally ill patients and their family caregivers make decisions about preferred place of care and place of death. DESIGN Semi-structured interviews with patients and family caregivers, which were analysed thematically using qualitative description. SETTING/PARTICIPANTS A total of 17 participants (8 patients and 9 caregivers) recruited from an acute palliative care hospital ward, a sub-acute hospice unit, and a palliative homecare organisation in Melbourne, Australia. RESULTS The process of forming location preferences was shaped by uncertainty relating to the illness, the caregiver and the services. Patients and caregivers dealt with this uncertainty on a level of thoughts, emotions, and actions. At the end of this process, patients and caregivers expressed their choices as contextual, personal, relational, conditional and flexible preferences. CONCLUSIONS These findings suggest that in many cases end-of-life decision-making does not conclude with a clear and stable choice. Understanding the reasons for the malleability of preferences and the process of how they are formed has implications for both clinicians and researchers.
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Affiliation(s)
- Katrin Gerber
- 1 School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Barbara Hayes
- 2 Advance Care Planning Program, Northern Health, Bundoora, VIC, Australia.,3 Palliative & Supportive Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christina Bryant
- 1 School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
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30
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Ozen B, Ceyhan O, Büyükcelik A. Hope and perspective on death in patients with cancer. DEATH STUDIES 2019; 44:412-418. [PMID: 31204898 DOI: 10.1080/07481187.2019.1626942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study was conducted to determine the relationship between various attitudes and hope levels of cancer patients. The study was conducted in an observational and cross-sectional design with 106 cancer patients who were followed in the oncology clinic of a hospital. In the study, it was found that women had lower hope levels than men, and as age decreased, hope levels increased and as educational level increased, hope levels increased. It was found that the patients who said "I have fear/worry/anxiety and think about my family as they will be left behind" had lower total scores and subscale scores of hope. The results of the study showed that individuals with cancer had relatively higher hope levels. It was determined that the patients' thoughts about death affected their hope both directly and indirectly.
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Affiliation(s)
- Betül Ozen
- Department of Community Health Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Ozlem Ceyhan
- Department of Internal Diseases Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
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31
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Wales J, Kalia S, Moineddin R, Husain A. The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study. J Palliat Care 2019; 35:167-173. [PMID: 31204570 DOI: 10.1177/0825859719855020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. AIM Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. DESIGN This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. SETTING/PARTICIPANTS Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. RESULTS A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). CONCLUSIONS Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.
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Affiliation(s)
- Joshua Wales
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumeet Kalia
- University of Toronto Practice Based Research Network, North York General Hospital, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amna Husain
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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32
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Mcpherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Self-Perceived Burden to Others: Patient and Family Caregiver Correlates. J Palliat Care 2019. [DOI: 10.1177/082585970702300303] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To provide further evidence about the prevalence and correlates of the sense of “self-perceived burden” (SPB) to others, and to examine its association with caregiver reports of burden. Methods The participants were 65 patients with advanced cancer and their family caregivers. Patients completed measures of SPB and family members completed a caregiver burden scale. Results SPB was experienced at minimal to mild levels by 35% of patients, and at moderate to extreme levels by another 28%. It was correlated with some physical symptoms, but more frequently with psychological symptoms. The family members of patients who reported that SPB was a significant problem had higher scores on the caregiver burden scale than family members of other patients (p=0.048), although the overall correlation was modest. Conclusions SPB is a common and distressing concern for many patients receiving palliative care and is associated with a number of other distressing concerns.
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Affiliation(s)
| | | | | | - Susan Brajtman
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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33
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Tan WS, Bajpai R, Ho AHY, Low CK, Car J. Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country. BMJ Open 2019; 9:e024662. [PMID: 30782914 PMCID: PMC6367977 DOI: 10.1136/bmjopen-2018-024662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the end-of-life care preferences of individuals, and to examine the influence of age and gender on these preferences. DESIGN, SETTING AND PARTICIPANTS A retrospective cohort study was conducted. Participants included all adults (≥21 years old) (n=3380) who had completed a statement of their preferences as part of a national Advance Care Planning (ACP) programme in Singapore. Data were extracted from the national and Tan Tock Seng Hospital ACP database. MAIN MEASURES End-of-life care preferences were obtained from the ACP document and differentiated by health status (healthy, chronically ill or diagnosed with advanced illnesses). To analyse the data, descriptive statistics and logistic regression analysis were used. RESULTS Across healthy and chronically ill patients, the majority did not opt for cardiopulmonary resuscitation (CPR) or other life-sustaining measures. Among individuals with advanced illnesses, 94% preferred not to attempt CPR but 69% still preferred to receive some form of active medical treatment. Approximately 40% chose to be cared for, and to die at home. Age and sex significantly predict preferences in those with advanced illnesses. Older age (>=75 years) showed higher odds for home as preferred place of care (OR 1.52; 95% CI 1.23 to 1.89) and place of death (OR 1.29; 95% CI 1.03 to 1.61) and lower odds for CPR (OR 0.31; 95% CI 0.18 to 0.54) and full treatment (OR 0.32; 95% CI 0.17 to 0.62). Being female was associated with lower odds for home as preferred place of care (OR 0.69; 95% CI 0.57 to 0.84) and place of death (OR 0.70; 95% CI 0.57 to 0.85) and higher odds for full treatment (OR 2.35; 95% CI 1.18 to 4.68). CONCLUSION The majority preferred to not proceed with life-sustaining treatments, but there was still a strong preference to receive some form of limited treatment. Better understanding of end-of-life care preferences through ACP can better guide end-of-life care programme planning, and resource allocation decisions.
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Affiliation(s)
- Woan Shin Tan
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Research Department, Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Barclay S, Moran E, Boase S, Johnson M, Lovick R, Graffy J, White PL, Deboys B, Harrison K, Swash B. Primary palliative care research: opportunities and challenges. BMJ Support Palliat Care 2019; 9:468-472. [PMID: 30755396 PMCID: PMC6923936 DOI: 10.1136/bmjspcare-2018-001653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/15/2018] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed. THE STUDY METHODS Using a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs. THE CHALLENGES ADDRESSED Considerable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.
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Affiliation(s)
- Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Emily Moran
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sue Boase
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Johnson
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Roberta Lovick
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Patrick L White
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Brenda Deboys
- Clinical Research Network Eastern; Primary Care, Cambridge, UK
| | - Katy Harrison
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Brooke Swash
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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The ageing and de-institutionalisation of death-Evidence from England and Wales. Health Policy 2019; 123:435-439. [PMID: 30739819 DOI: 10.1016/j.healthpol.2019.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/24/2022]
Abstract
Increasingly, age of death is postponed until very old age, and care of those who are dying is challenged by medical co-morbidities and the presence of dementia. Although most people would prefer to die at home, currently in England and Wales only about 20 per cent of those aged 65 years and over die at home, and this proportion falls to about 10 per cent among those aged over 85 years. To explore recent and likely future trends in age and place of death, mortality statistics from 2006 to 2013 were analysed and projected to 2050 using age- and gender-specific rates. Results confirmed recent increasing age at death and indicated a trend for increasing proportions of older people to die at home. Projections indicated large increases in home-based deaths, particularly for men aged 65 and over. Consistent with people's wishes, there may be a partial return to the view that dying at home is a normal experience. Resource allocations are likely to need to shift to support people dying at home and their formal and informal carers.
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Fukui S, Fujita J, Yoshiuchi K. Associations between Japanese People's Concern about Family Caregiver Burden and Preference for End-Of-Life Care Location. J Palliat Care 2018. [DOI: 10.1177/082585971302900104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Through a cross-sectional nationwide survey, this study identified the associations between Japanese people's choice of end-of-life care location and their sense of being a burden or a source of concern to their family members. A total of 1,042 people responded to the survey (a response rate of 55 percent). Of these, 44 percent said they would prefer to receive end-of-life care at home, 15 percent in hospital, 19 percent in a palliative care unit, 10 percent in a public nursing home, and 2 percent in a private nursing home. Multinomial logistic regression analysis revealed that those who thought it most important to relieve caregiver burden on family members tended to prefer a palliative care unit or a public nursing home to their own homes; those who were most concerned about the effect their death would have on their family members tended to prefer a hospital or a palliative care unit to their own homes. These findings may assist in the development of a more effective end-of-life care system in Japan and in other countries.
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Affiliation(s)
- Sakiko Fukui
- S Fukui (corresponding author) Department of Community Health Nursing, Graduate School of Nursing, Japanese Red Cross University, 4-1-3 Hiroo, Shibuya-ku, Tokyo 150-0012, Japan
| | - Junko Fujita
- Department of Community Health Nursing, Graduate School of Nursing, Japanese Red Cross University, Shibuya-ku, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Benson JJ, Schwarz B, Tofle RB, Parker Oliver D. The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/02763893.2018.1505460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jacquelyn J. Benson
- Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Benyamin Schwarz
- Department of Architectural Studies, University of Missouri, Columbia, Missouri, USA
| | - Ruth Brent Tofle
- Department of Architectural Studies, University of Missouri, Columbia, Missouri, USA
| | - Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
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Natsume M, Watanabe K, Matsumoto S, Naruge D, Hayashi K, Furuse J, Kawamura M, Jinno H, Sano K, Fukushima R, Osawa G, Aruga E, Hashiguchi Y, Tanaka A, Takikawa H, Seki N. Factors Influencing Cancer Patients' Choice of End-of-Life Care Place. J Palliat Med 2018; 21:751-765. [DOI: 10.1089/jpm.2017.0481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maika Natsume
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kiyotaka Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoko Matsumoto
- Department of Quality Improvement, NTT Medical Center Tokyo, Tokyo, Japan
| | - Daisuke Naruge
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiko Hayashi
- Department of Chemotherapy and Palliative Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiromitsu Jinno
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Gakuji Osawa
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Etsuko Aruga
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hajime Takikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiko Seki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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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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Carduff E, Johnston S, Winstanley C, Morrish J, Murray SA, Spiller J, Finucane A. What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings. BMC Palliat Care 2018; 17:12. [PMID: 29301524 PMCID: PMC5753489 DOI: 10.1186/s12904-017-0259-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. Methods Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings. Results The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care. Conclusions Complexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life. Electronic supplementary material The online version of this article (10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Carduff
- Marie Curie Hospice, 133 Balornock Road, Glasgow, G21 3US, UK. .,School of School of Medicine, Nursing and Healthcare, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK.
| | - Sarah Johnston
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Jamie Morrish
- Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Juliet Spiller
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Anne Finucane
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
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Robinson J, Gott M, Frey R, Gardiner C, Ingleton C. Predictors of patient-related benefit, burden and feeling safe in relation to hospital admissions in palliative care: A cross-sectional survey. Palliat Med 2018; 32:167-171. [PMID: 28952886 DOI: 10.1177/0269216317731991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research exploring patient experience of palliative care in the hospital setting has previously been limited to negative aspects of care. However, recent studies have shown that patients with palliative care needs experience benefits being in hospital. Little is known about how experiences of benefit and burden vary according to socio-demographic and illness-related factors and how these experiences influence patient preferences to return to hospital. AIM To identify factors influencing experiences of benefit and burden and the predictors associated with a preference to return to hospital in palliative care. DESIGN Cross-sectional design using a questionnaire survey. SETTING/PARTICIPANTS In total, 116 hospital inpatients admitted with palliative care needs in an urban hospital in New Zealand. Recruitment was from an oncology ward, four general medical wards and a respiratory ward. RESULTS Those living in more deprived areas experienced more benefit being in hospital ( F(4, 109) = 3.15, p = 0.017), while younger people ( F(4, 109) = 4.44, p = 0.00) and those from Asian or Pacific cultures ( F(2, 111) = 7.78, p = 0.000) experienced more burden. Those with a non-cancer diagnosis felt less safe in hospital ( p = 0.04). 'Feeling safe' was a significant ( B = 0.14, p = 0.03) predictor for a preference to return to hospital. CONCLUSION Deprivation, diagnosis, age and ethnicity influenced experiences of benefit and burden in hospital. 'Feeling safe' was a significant predictor for a preference to return to hospital. Further research is needed to understand why certain patient factors influence experiences of hospitalisation and how 'feeling safe' can be replicated in other care environments.
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Affiliation(s)
- Jackie Robinson
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,2 Auckland City Hospital, Auckland, New Zealand
| | - Merryn Gott
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Clare Gardiner
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Christine Ingleton
- 3 The School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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Duggleby W, Tycholiz J, Holtslander L, Hudson P, Nekolaichuk C, Mirhosseini M, Parmar J, Chambers T, Alook A, Swindle J. A metasynthesis study of family caregivers' transition experiences caring for community-dwelling persons with advanced cancer at the end of life. Palliat Med 2017; 31:602-616. [PMID: 28618898 DOI: 10.1177/0269216316673548] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Family caregivers (broadly defined as family and friends) experience multiple concurrent transitions when caring for a person with advanced cancer. AIMS To (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience. DESIGN Sandelowski and Barroso's methodology for synthesizing qualitative research included (a) a comprehensive search of empirical literature, (b) quality appraisal of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. DATA SOURCES Literature was sourced from six electronic data bases. Inclusion criteria were as follows: (a) published qualitative studies (and mixed-method designs) of the caregiving experience of family caregivers of community-living persons with advanced cancer at the end of life, (b) participants (caregivers and care recipients) of 18 years of age and above, (c) studies published in English in any country, and (d) studies published between 2004 and 2014. RESULTS A total of 72 studies were included in the metasynthesis. Family caregivers experience a "life transition" whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient. CONCLUSION The findings provide a framework to guide the development of supportive programs and future research.
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Affiliation(s)
- Wendy Duggleby
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jamie Tycholiz
- 2 Strategic Planning and Policy Development, Alberta Health, Edmonton, AB, Canada
| | - Lorraine Holtslander
- 3 College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,4 University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Hudson
- 5 Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,6 The University of Melbourne, Melbourne, VIC, Australia.,7 Palliative Care, Queen's University Belfast, Belfast, UK
| | - Cheryl Nekolaichuk
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Jasneet Parmar
- 9 Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.,10 Network of Excellence in Seniors' Health and Wellness, Covenant Health, Knoxville, TN, USA
| | - Thane Chambers
- 11 University of Alberta Libraries, Edmonton, AB, Canada
| | - Angele Alook
- 12 Alberta Union of Provincial Employees, Edmonton, AB, Canada
| | - Jennifer Swindle
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Skorstengaard MH, Neergaard MA, Andreassen P, Brogaard T, Bendstrup E, Løkke A, Aagaard S, Wiggers H, Bech P, Jensen AB. Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients. J Palliat Med 2017; 20:1217-1224. [PMID: 28574737 DOI: 10.1089/jpm.2017.0082] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The dual aim of this study is, first, to describe preferred place of care (PPOC) and preferred place of death (PPOD) in terminally ill patients with lung and heart diseases compared with cancer patients and second, to describe differences in level of anxiety among patients with these diagnoses. BACKGROUND Previous research on end-of-life preferences focuses on cancer patients, most of whom identify home as their PPOC and PPOD. These preferences may, however, not mirror those of patients suffering from nonmalignant fatal diseases. DESIGN The study was designed as a cross-sectional study. SETTING Eligible patients from the recruiting departments filled in questionnaires regarding sociodemographics, PPOC and PPOD, and level of anxiety. RESULTS Of the 354 eligible patients, 167 patients agreed to participate in the study. Regardless of their diagnosis, most patients wished to be cared for and to die at home. Patients with cancer and heart diseases chose hospice as their second most common preference for both PPOC and PPOD, whereas patients with lung diseases chose nursing home and hospice equally frequent as their second most common preference. Regardless of their diagnosis, all patients had a higher level of anxiety than the average Danish population; patients with heart diseases had a much higher level of anxiety than patients with lung diseases and cancer. CONCLUSION Patient preferences for PPOC and PPOD vary according to their diagnoses; tailoring palliative needs to patients' preferences is important regardless of their diagnosis.
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Affiliation(s)
| | - Mette A Neergaard
- 1 Department of Oncology, Aarhus University Hospital , Aarhus, Denmark .,2 The Palliative Care Team, Aarhus University Hospital , Aarhus, Denmark
| | | | - Trine Brogaard
- 4 The Research Unit for General Practice, Aarhus University , Aarhus, Denmark
| | - Elisabeth Bendstrup
- 5 Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus, Denmark
| | - Anders Løkke
- 5 Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus, Denmark
| | - Susanne Aagaard
- 6 Department of Cardiology, Aarhus University Hospital , Aarhus, Denmark
| | - Henrik Wiggers
- 6 Department of Cardiology, Aarhus University Hospital , Aarhus, Denmark
| | - Per Bech
- 7 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital , Copenhagen, Denmark
| | - Anders B Jensen
- 1 Department of Oncology, Aarhus University Hospital , Aarhus, Denmark
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Santatzoglou S, Lillie AK, Wrigley A, Ashby S, Read S, Moore A. Law, ethics and end-of-life care: the policy and practice interface in England. Int J Palliat Nurs 2017; 23:213-218. [DOI: 10.12968/ijpn.2017.23.5.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alison Kate Lillie
- Lecturer, School of Nursing and Midwifery, at Keele University, Staffordshire, UK
| | - Anthony Wrigley
- Senior Lecturer in Ethics, PEAK, School of Law, at Keele University, Staffordshire, UK
| | - Sue Ashby
- Lecturer, School of Nursing and Midwifery, at Keele University, Staffordshire, UK
| | - Sue Read
- Professor of Learning Disability Nursing, School of Nursing and Midwifery, at Keele University, Staffordshire, UK
| | - Andrew Moore
- Research Fellow in Qualitative Research, School of Clinical Sciences, University of Bristol
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Dhall SS, Yue JK, Winkler EA, Mummaneni PV, Manley GT, Tarapore PE. Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians. Neurosurgery 2017; 80:854-862. [DOI: 10.1093/neuros/nyw168] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open
Abstract
Abstract
BACKGROUND: Management of axis fractures in the elderly remains controversial. As the US population increasingly lives past 80 years, published C2 fracture morbidity/mortality profiles in younger cohorts (55+) have become less applicable to octogenarians.
OBJECTIVE: To report associations between surgery and mortality, hospital length of stay and discharge disposition in octogenarians with traumatic C2 fractures.
METHODS: Retrospective cohort study of 3847 patients age ≥ 80 years representing 17 702 incidents nationwide, divided into surgery/nonsurgery cohorts, using the National Sample Program of the National Trauma Data Bank from 2003 to 2012. Inpatient complications, mortality, length of stay, and discharge disposition are characterized; multivariable regression was utilized to determine associations between surgery and outcomes.
Institutional Review Board (IRB): The National Sample Program dataset from the National Trauma Data Bank is fully deidentified and does not contain Health Insurance Portability and Accountability Act identifiers; therefore, this study is exempt from IRB review at the University of California, San Francisco.
RESULTS: Incidence of surgery was 10.3%. Surgery was associated with increased pneumonia, acute respiratory distress syndrome, and decubitus ulcer risks (P < .001). Inpatient mortality was 12.8% (nonsurgery—13.0%; surgery—10.3%; P = .120). Length of stay was 8.31 ± 9.32 days (nonsurgery 7.78 ± 9.21; surgery 12.86 ± 9.07; P < .001) and showed an adjusted mean increase of 5.68 days with surgery (95% confidence interval [4.74-6.61]). Of patients surviving to discharge, 26% returned home (nonsurgery—26.8%; surgery—18.8%; P = .001); surgery patients were less likely to return home (odds ratio 0.59 [0.44-0.78]).
CONCLUSION: The present study confirms that surgery of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer increased medical complications during their stay. Given the retrospective nature of this study, it is unclear whether these conclusions reflect differences in injury severity between surgery cohorts. This question may be considered in a future prospective study.
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Affiliation(s)
- Sanjay S. Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Ethan A. Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Phiroz E. Tarapore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
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Otsuka M. Factors Associated with Length of Stay at Home in the Final Month of Life among Advanced Cancer Patients: A Retrospective Chart Review. J Palliat Med 2017; 20:884-889. [PMID: 28437210 DOI: 10.1089/jpm.2016.0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Living at home is an important factor for maintaining high quality of life among patients. Many studies have discussed parameters associated with place of death, but no studies have yet clarified which factors influence the length of stay at home during the end of life. OBJECTIVE The aim of this study was to identify factors influencing the amount of time spent at home during the final month of life among patients with advanced cancer. METHODS A retrospective chart review was conducted for 415 patients with advanced cancer. Multivariate multiple linear regression analysis was used to examine relationships between the length of stay at home during the final month of life and variables measuring patient's background (four indicators), family structure (three indicators) cancer type (four types), chief complaint at initial palliative care referral (seven indicators), and medical interventions (three factors). RESULTS The multiple linear regression predicting time spent at home in the last month of life yielded partial regression coefficients of 4.2 for past outpatient palliative care services (OPCS) (p < 0.001) and 3.3 for in-home nurse visits (p = 0.003). DISCUSSION The most influential factor for length of stay at home in the final month of life was a history of OPCS. Many patients with advanced cancer who receive chemotherapy without OPCS spend time as inpatients after an initial period at home. Palliative care interventions for outpatients effectively enable patients with advanced cancer to adapt and continue living at home.
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Affiliation(s)
- Masatomo Otsuka
- Department of Palliative Care, Kindai University Sakai Hospital , Osaka, Japan
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Reyniers T, Deliens L, Pasman HR, Vander Stichele R, Sijnave B, Cohen J, Houttekier D. Reasons for End-of-Life Hospital Admissions: Results of a Survey Among Family Physicians. J Pain Symptom Manage 2016; 52:498-506. [PMID: 27401513 DOI: 10.1016/j.jpainsymman.2016.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
Abstract
CONTEXT Although the acute hospital setting is not considered to be an ideal place of death, many people are admitted to hospital at the end of life. OBJECTIVES The present study aims to examine the reasons for hospital admissions that result in an expected death and the factors that play a role in the decision to admit to hospital. METHODS This was a survey among family physicians (FPs) about those of their patients who had died nonsuddenly in an acute university hospital setting in Belgium between January and August 2014. Questions were asked about the patient's health situation, care that the patient received before the admission, the circumstances of the hospital admission, the reasons necessitating the admission, and other factors that had played a role in the decision to admit the patient to hospital. RESULTS We received 245 completed questionnaires (response rate 70%), and 77% of those hospital deaths were considered to be nonsudden. FPs indicated that 55% of end-of-life hospitalizations were for palliative reasons and 26% curative or life-prolonging. Factors such as the patient feeling safer in hospital (35%) or family believing care to be better in hospital (54%) frequently played a role in the end-of-life hospitalization. When patients were admitted with a limited anticipated life expectancy, FPs were more likely to indicate that an inadequate caring capacity of the care setting had played a role in the admission. CONCLUSION To reduce the number of hospital deaths, a combination of structural support for out-of-hospital end-of-life care and a more timely referral to out-of-hospital palliative care services may be needed.
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Affiliation(s)
- Thijs Reyniers
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University, Ghent, Belgium
| | - H Roeline Pasman
- EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bart Sijnave
- IT Department, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Gao W, Verne J, Peacock J, Stiller C, Wells C, Greenough A, Higginson IJ. Place of death in children and young people with cancer and implications for end of life care: a population-based study in England, 1993-2014. BMC Cancer 2016; 16:727. [PMID: 27641492 PMCID: PMC5027635 DOI: 10.1186/s12885-016-2695-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/07/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Efforts to improve end of life care (EoLC) have made tangible impacts on care in adults, including enabling more people to die at their preferred place of death (PoD), usually home or hospices. Little is known how the PoD in children and young people (CYP, ≤24 years) has changed over time, especially in the context of a series of national initiatives for EoLC improvement since the late 1990s. To inform evidence-based policy-making and service development, we evaluated the national trends of PoD and the associated factors in CYP who died with cancer. METHODS Population-based observational study in the National Health Service (NHS) England, 1993-2014. All non-accidental CYP deaths with cancer (N = 12,774) were extracted from the death registration database of the Office for National Statistics (ONS). RESULTS Hospital deaths reduced from >50 to 45 %, hospice deaths were rare but more than doubled from 6 % in 1993-2000 to 13 % in 2005-2014, and home deaths fluctuated at around 40 %. Those aged 0-19 years were more likely to die at home than young adults (adjusted proportion ratio (PRs): 1.23-1.62); haematological cancer patients or those with 2+ comorbid conditions had higher chances of hospital death (PRs for home: 0.18-0.75, hospice: 0.04-0.37); deprivation was associated with a reduced chance of home death (PRs: 0.76-0.84). The residential region affected hospice but not home deaths. The variations of PoD by cause of death, comorbid conditions and deprivation slightly decreased with time. CONCLUSIONS Hospitals and home were the main EoLC settings for CYP with cancer. Home death rates barely changed in the past two decades; deaths in hospitals remained the most common but slightly shifted towards hospices. CYP with haematological malignancy or with comorbid conditions had persistently high hospital deaths; these cases had an even lower chance of deaths in hospices (50 %) than at home. There were deprivation- and area-related inequalities in PoD which may need service- and/or policy-level intervention. The findings highlight a need for CYP specific initiatives to enhance EoLC support and capacities both at home and in hospices.
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Affiliation(s)
- Wei Gao
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
| | - Julia Verne
- Public Health England, Knowledge & Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol, BS8 2RA, UK
| | - Janet Peacock
- King's College London, Division of Health and Social Care Research, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Charles Stiller
- Public Health England, Childhood Cancer, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | - Claudia Wells
- Office for National Statistics, Life Events and Population Sources Division, Cardiff Road, Newport, Wales, NP10 8XG, UK
| | - Anne Greenough
- King's College London, School of Medicine, Division of Asthma, Allergy and Lung Biology, Denmark Hill, London, SE5 9RS, UK
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
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Abstract
BACKGROUND There have been many studies on the actual and preferred place of care and death of palliative patients; however, most have been whole population surveys and/or urban focused. Data and preferences for terminally ill rural patients and their unofficial carers have not been systematically described. AIM To describe the actual place of death and preferred place of care and/or death in rural palliative care settings. METHOD A systematic mixed studies review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCE PubMed, PsychINFO, Scopus and CINAHL databases were searched (September to December 2014); eligible quantitative and qualitative studies included preferred and/or actual place of death/care of rural, regional or remote residents; rural data that are clearly identifiable; death due to palliative condition (malignant and non-malignant) or survey of participants with current or hypothetical life-limiting illness. RESULTS A total of 25 studies described actual place of death; 12 preferred place of care or death (2 studies reported both); most deaths occurred in hospital with home as the preferred place of care/death; however qualitative studies suggest that preferences are not absolute; factors associated with place are not adequately described as rurality was an independent variable; significant heterogeneity (rural setting and participants), however, many areas had a greater chance of home death than in cities; rural data are embedded in population reports rather than from specific rural studies. CONCLUSION Home is the preferred place of rural death; however, more work is needed to explore influencing factors, absolute importance of preferences and experience of providing and receiving palliative care in rural hospitals which often function as substitute hospice.
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Affiliation(s)
- Suzanne Rainsford
- Medical School, The Australian National University, Canberra, ACT, Australia
| | - Roderick D MacLeod
- HammondCare, Sydney, NSW, Australia Palliative Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas J Glasgow
- Medical School, The Australian National University, Canberra, ACT, Australia
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