Palliative Care at the End of Life

Families' Experiences of End-of-Life Care at Home for Iranian Older Adults: A Qualitative Study

Aim:

While the care of dying elderly patients at home is very complex and ambiguous, it has not been studied in Iran so far. Hence, this study aimed to explore the experience of a representative sample of the Iranian family caregivers from the end-of-life (EOL) care for their elderly relatives.

Methods:

The present study was conducted using a qualitative content analysis method. Twelve family caregivers caring for the chronically ill dying elderly were selected using purposeful sampling. The purposive sampling method was applied with an extreme variation in sampling, and data gathering was pursued until data saturation was achieved. Semi-structured interviews were utilized for data collection. Interviews were recorded and instantly transcribed verbatim. Inductive content analysis was used to analyze the data.

Results:

Four core themes and 13 subthemes emerged from the experiences of family's caregiver as fallow: (1) Committed to care: This is related to encounter with the end of stage disease of the relative, accepting the care role and priority of care, (2) challenges of Care: Caregivers, despite their efforts, provided ineffective care, so they sought to empower themselves and at the same time provide compassionate care, (3) the crisis of care including the complexity of care, fear, and wandering, helplessness, devastating tension, and vacuum of supporting, and (4) conditions after death that family members involved with a sense of loss and Tension control.

Conclusion:

When families had to take care of their elderly patients at home, although their wish to give the best care, they are completely powerless to provide care, and in an atmosphere of the vacuum of supporting, they encounter severe challenges and crisis. It is vital that palliative care centers in the society are arranged to care for EOL elderly with comprehensive insurance services.

Does Time for (in)Direct Nursing Care Activities at the End of Life for Patients With or Without Specialized Palliative Care in a University Hospital Differ? A Retrospective Analysis

BACKGROUND

Nurses' end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients.

AIMS

(1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC.

METHODS

Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses.

RESULTS

Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC (P < .001), whereas indirect care time increased only on the day of SPC.

CONCLUSIONS

This study gives insight into nurses' time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses' care activities may be helpful for benchmarking or reimbursement analysis.

Palliative Care: A Systematic Review of Evidence-Based Interventions

The authors conducted an integrative review to determine evidence-based and most efficient strategies for improving the palliative care of patients at the end-of-life stage. Thirteen articles that met the overall inclusion criteria were evaluated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart approach was used for the screening process. The Critical Appraisal Skill Program and the Mixed-Methods Appraisal Tool were also used for the critical appraisal of the data. Full reports of relevant articles were retrieved, and data were extracted by 2 reviewers independently. The quality of studies was appraised in reference to Consolidated Criteria for Reporting Qualitative Research guidelines. Key aspects included communication and coordination among the team members-patient-centered approach. The major theme was the application of a holistic approach to palliative care consisting of providing comfort to the dying patient. It was identified that relationships, which were identified as spiritual needs, are also crucial to the improvement of palliative care. Improving nursing education in this area, undertaking appropriate curriculum development, and providing coordination among training programs will help knowledgeable health care providers deliver compassionate, affordable, sustainable, and high-quality care to a growing population of aging patients facing the end of their lives.

End-of-Life Care for Patients with Glioma

OBJECTIVE

To describe best practices and guidelines in symptom management at the end of life for adults with malignant glioma.

DATA SOURCES

Journal articles, evidence-based reviews, textbooks, and clinical guidelines.

CONCLUSION

Symptom management is an essential element of end-of-life care that aims to preserve dignity and quality of life for patients with glioma and their family caregivers.

IMPLICATIONS FOR NURSING PRACTICE

Advance care planning using a holistic approach to the patient's symptoms experience and goals of care are necessary to develop, implement, and evaluate outcomes of an evidence-based plan of care tailored for each patient and family.